Department of Human Development Nursing Science, College of Nursing University of Illinois at Chicago, Chicago, Illinois, United States of America.
Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, United States of America.
PLoS One. 2021 Jun 29;16(6):e0253749. doi: 10.1371/journal.pone.0253749. eCollection 2021.
Previous studies have established that sex workers experience discrimination and stigma within healthcare settings, limiting their access and receipt of culturally safe care. These barriers impact sex workers' ability and desire to routinely engage with the healthcare system. Community empowerment interventions that are culturally safe offer an effective strategy to improve access to services and health outcomes for sex workers.
This project was designed to inform the development of community empowerment interventions for sex workers by understanding their self-management, health promotion, and harm reduction needs.
In-depth interviews (N = 21) were conducted with sex workers in Chicago. Transcripts of individual interviews were analyzed in Dedoose using rapid content analysis.
Participants had a mean age of 32.7 years; 45% identified as White, 20% as Black, 15% as Latinx, and 20% as multiple races; 80% identified as Queer. A total of 52% of participants identified as cisgender women, 33% as transgender or gender fluid, 10% as cisgender men, and 5% declined to answer. Themes of self-management practices, stigmatizing and culturally unsafe experiences with healthcare providers, and the prohibitive cost of healthcare emerged as consistent barriers to routinely accessing healthcare. Despite identifying patient-centered care as a desired healthcare model, many participants did not report receiving care that was respectful or culturally responsive. Themes also included developing strategies to identify sex worker-safe care providers, creating false self-narratives and health histories in order to safely access care, and creating self-care routines that serve as alternatives to primary care.
Our findings demonstrate how patient-centered care for sex-workers in Chicago might include holistic wellness exercises, accessible pay scales for services, and destigmatizing healthcare praxis. Focus on culturally safe healthcare provision presents needs beyond individualized, or even community-level, interventions. Ongoing provider training and inbuilt, systemic responsivity to patient needs and contexts is crucial to patient-centered care.
先前的研究已经证实，性工作者在医疗保健环境中会遭受歧视和污名化，这限制了他们获得文化安全护理的机会。这些障碍影响了性工作者定期使用医疗保健系统的能力和意愿。文化安全的社区赋权干预措施为改善性工作者获得服务和健康结果提供了一种有效的策略。
本项目旨在通过了解性工作者的自我管理、健康促进和减少伤害的需求，为性工作者的社区赋权干预措施的制定提供信息。
对芝加哥的性工作者进行了深入访谈（N=21）。使用 Dedoose 对个人访谈的转录本进行了快速内容分析。
参与者的平均年龄为 32.7 岁；45%的人自认为是白人，20%的人是黑人，15%的人是拉丁裔，20%的人是多种族裔；80%的人自认为是酷儿。共有 52%的参与者自认为是顺性别女性，33%的人是跨性别或性别流动者，10%的人是顺性别男性，5%的人拒绝回答。自我管理实践、与医疗保健提供者的污名化和文化不安全体验以及医疗保健费用过高的主题是定期获得医疗保健的一致障碍。尽管参与者认为以患者为中心的护理是理想的医疗模式，但许多人报告说没有得到尊重或文化响应的护理。主题还包括确定对性工作者安全的护理提供者的策略、创建虚假的自我叙述和健康史以安全地获得护理，以及创建作为初级保健替代的自我保健常规。
我们的研究结果表明，芝加哥的性工作者以患者为中心的护理可能包括整体健康锻炼、服务的可负担费用以及消除医疗保健实践中的污名化。关注文化安全的医疗保健提供不仅仅需要针对个体，甚至是社区层面的干预措施。持续的提供者培训和内在的、系统的对患者需求和背景的响应能力对于以患者为中心的护理至关重要。
