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Try out PMC Labs and tell us what you think. Learn More. To describe the characteristics of sex workers accessing care at a peer based clinic in San Francisco and to evaluate predictors of sexually transmitted infections STI. We conducted an observational study of sex workers at St James Infirmary. Individuals underwent an initial questionnaire, and we offered screening for STI at each clinic visit. We performed univariate, bivariate, and multivariable analyses to assess for predictors of STI in this population. We saw sex workers identifying as female Participants represented a wide range of ethnicities, educational backgrounds, and types of sex work.

The most common substance used was tobacco Over half reported domestic violence, and Those screened had gonorrhoea In contrast, participants who had only ever engaged in collective sex work were less likely to have an STI OR 0. The majority of sex workers have never discussed their work with a medical provider. Domestic violence is extremely prevalent as is work related violence. Working with other sex workers appears to be protective of STIs. Addressing violence in the workplace and encouraging sex workers to work collectively may be effective prevention strategies.

The clinic uses a harm reduction approach, with San Francisco webcam sex emphasis on engaging sex workers in addition to identifying and reducing the individual and community level risks associated with sex work. Additionally, clinic staff distributes safer sex supplies and offers HIV testing to sex workers in the setting of street and venue based outreach. Since Septemberwe have been conducting an ongoing, prospective evaluation of all individuals accessing care at SJI. We limited this analysis to those current or past sex workers who sought care at SJI between September and November We defined sex work as the provision of sexual services or performances in exchange for money or goods of economic value including but not limited to drugs, housing, and food.

The questionnaire ascertained demographics, sex work history, drug use, social support, legal history, and violence. We modified the questionnaire in September to include additional questions about HIV and STI diagnoses, past drug use, and mental health history. At the initial and any subsequent clinic visits, SJI staff offered voluntary screening for STI to all clinic patients. There were no set screening intervals. Predictor variables included demographics, history of HIV and STI diagnosis, and behaviour self reported in the questionnaire.

We analysed each type of sex work as a distinct predictor variable.

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For the purpose of multivariable analysis, we categorised the sex workers into three mutually exclusive groups—those who had engaged in exclusively independent sex work, both independent and collective sex work, and exclusively collective sex work. Some individuals underwent repeat STI screening, so we calculated the percentage of positive STI as the proportion of unduplicated sex workers with any positive test among the total population of individuals testing. We assessed for multicollinearity and normal distribution. We evaluated all models using likelihood ratio and goodness of fit tests and conducted all analyses using Stata SE 8.

We obtained approval to conduct this study by the committee on human research at the University of California San Francisco. Overall, we conducted intake questionnaires on sex workers who identified as female Of these sex workers, underwent the original intake questionnaire and the remaining were administered the modified intake questionnaire.

The mean age of participants was Strippers were less likely to have sex as part of their sex work Overall, individual sex workers Overall, Eighty one per cent of sex workers reported having a support network or community. Almost half of participants had been arrested in the past, with MTF sex workers more likely to be arrested and convicted of sex work related charges.

Those most likely to be arrested included those involved with street based work In addition, MTF sex workers were at ificantly higher risk of work violence, customer violence, and police violence. Also at higher risk of work related violence included those engaged in street based sex work Legal history was also ificantly associated with violence, with Seventy per cent of patients had never disclosed their sex work to a healthcare provider before their initial visit to SJI.

MTF sex workers were ificantly more likely to disclose to providers. The reasons for not disclosing one's sex work history included negative past experiences with disclosure 4. The most common substance reported was tobacco, with Male sex workers were the most likely to be actively using drugs, particularly methamphetamines. San Francisco webcam sex with those who did not test, STI testers were ificantly younger Among testers, the proportion of those with at least one positive test included In bivariate analysis, there was no association found between presence of an STI and educational level, drug use, domestic violence or violence in the setting of sex work.

Those ever engaging in escort work were more likely to be diagnosed with any STI Another predictor of positive STI included a history of chlamydia Lastly, those with a history of arrest were more likely to have an STI On the other hand, those with a history of only engaging in collective sex work were ificantly less likely to test positive for an STI OR 0. By characterising sex workers seeking care at a peer based specialty clinic, we have gained a window into the diverse sex industry in San Francisco.

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As has been seen in other studies, sex workers commonly reported illicit drug use. While nearly all participants had ly tested for HIV, the vast majority had never discussed their sex work history in the healthcare setting. In our study, both self reported history of STI and documented STI prevalence was, overall, lower than has been seen in other studies of urban sex workers. Furthermore, risk of STI differed ificantly by type of sex work. Interestingly, those working collectively with other sex workers were less likely to have an STI.

While this study depicts the landscape of the sex industry in San Francisco, there certainly are limitations. In particular, we had limited information on specific sexual practices with different types of sexual partners and, thus, could not fully explore the complex set of factors that constitute STI risk. While we attempted to ascertain detailed sexual histories, many of the sex workers expressed difficulty in accurately quantifying the of partners and sex acts. Another limitation of this study was the use of a convenience sample of sex workers accessing health care at a sex work specific clinic.

This self selected population may not represent the larger population of female, male, and transgender sex workers in San Francisco and, therefore, estimates of STI prevalence may be biased. Furthermore, STI screening was offered to but not performed on all patients. Furthermore, repeat testing and the interval of such testing were, ultimately, decided by each individual patient.

Despite these limitations, there is value in assessing the local sex work environment and using this as the basis for public health interventions. Indeed, additional work must also be done to maximise the uptake of voluntary STI screening, particularly among HIV infected sex workers.

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Our finding of decreased risk of STI among those individuals who have worked collectively with other sex workers is intriguing and warrants further study. The St James Infirmary represents a novel collaborative effort between public health officials and the sex worker community. Through this unique model, sex workers have helped define public health priorities for their own community and public health officials have gained access to this hidden and stigmatised population.

National Center for Biotechnology InformationU. Journal List Sex Transm Infect v. Sex Transm Infect. Published online Jul Author information Article notes Copyright and information Disclaimer. Accepted Jun This article has been cited by other articles in PMC. Abstract Objectives To describe the characteristics of sex workers accessing care at a peer based clinic in San Francisco and to evaluate predictors of sexually transmitted infections STI.

Methods We conducted an observational study of sex workers at St James Infirmary. Conclusions The majority of sex workers have never discussed their work with a medical provider. Keywords: sex work, sexually San Francisco webcam sex diseases, drug use, transgender health, violence. Methods Since Septemberwe have been conducting an ongoing, prospective evaluation of all individuals accessing care at SJI. Statistical analysis Predictor variables included demographics, history of HIV and STI diagnosis, and behaviour self reported in the questionnaire. Open in a separate window. Social support Overall, Legal history Almost half of participants had been arrested in the past, with MTF sex workers more likely to be arrested and convicted of sex work related charges.

Sex work disclosure Seventy per cent of patients had never disclosed their sex work to a healthcare provider before their initial visit to SJI. Drug use The most common substance reported was tobacco, with Current STI Overall, Discussion By characterising sex workers seeking care at a peer based specialty clinic, we have gained a window into the diverse sex industry in San Francisco. References 1. Lutnick A. The St James Infirmary: a history. Sexuality Culture 10 2 [ Google Scholar ]. Rekart M L. Lancet — Alexander P.

Sex work and health: a question of safety in the workplace. J Am Med Women's Ass 53 77— Logistic regression in the medical literature: standards for use and reporting, with particular attention to one medical domain. J Clin Epidemiol 54 — Harcourt C, Donovan B.

The many faces of sex work. Sex Transm Infect 81 — Day S, Ward H. Violence towards female prostitutes. Violence in sex work extends to more than risks from clients. Am J Epidemiol — Raphael J, Shapiro D L. Violence in indoor and outdoor prostitution venues.

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