Occupational health, stigma, and healthcare access in the lives of San Francisco sex workers

BACKGROUND. Much of what we know about the health of Female Sex Workers comes from HIV research, but in countries where background HIV prevalence is low, an HIV focus may obscure more important occupational health needs for this population.
METHODS. I conducted a secondary analysis of data from the SWEAT study (Sex Worker Environmental Assessment Team), a respondent-driven sampling cross-sectional study of 247 female sex workers conducted 2006-7 in San Francisco. I assessed univariate statistics to describe experiences of occupational stigma, occupational injury, and healthcare access.
RESULTS. Perceived stigma from at least one source was reported by 73.0%, while 38.7% felt bad or very bad about doing sex work and 27.2% reported sex work made them feel cut off from society. 77% reported ≥1 work-related injury or condition. The most frequent occupational injuries were Depression (55.1%), Anxiety (42.5%), back pain (31%), and jaw pain (26%). 54% obtained medical care for work-related conditions; 25.6% did not disclose sex work was the cause of injury. Most common reasons for nondisclosure were “none of [provider’s] business” (29.1%), provider not asking (21%), and confidentiality concerns (13%). 95.5% had accessed healthcare in the past year, primarily through community health centers or hospital clinics (51.1% and 46.4%) despite the availability of local sex-worker-specific health services.
CONCLUSION. Sex workers’ occupational health needs go beyond HIV/STI prevention, detection and treatment. By understanding the occupational health experienced and access to care trajectories of sex workers, providers can better meet those needs by asking about sex work while emphasizing confidentiality.