San Francisco Health Care Clinic Makes Sex Workers At Home

By Carol Stuart

The St.James Infirmary is one of the first of its kind — an occupational health clinic for sex industry workers.

What makes the St. James Infirmary different is that it is entirely peer based. When we began the St. James Infirmary ten years ago, we had no idea if our social experiment would work. Drawing from a model developed by Priscilla Alexander while she worked in Nairobi with the World Health Organization, I worked with Margo St. James, founder of Call Off Your Old Tired Ethics (COYOTE) and Johanna Bryer, co-founder Exotic Dancers Alliance (EDA), to build a place where community could flourish. Our priority was not only to improve the health outcomes of our participants, but also to dispel certain myths about sex industry workers. We focused on providing services and developing harm reduction models for the same population that constructed the programs themselves.

Our experiment has worked: we have provided free, nonjudgmental general medical care to over 16,000 sex industry workers and their families in the San Francisco Bay Area. This has included primary care for adults and adolescents, health maintenance screening, evaluation and treatment of acute and chronic asthma, respiratory infections, abdominal pain, high blood pressure, high cholesterol and anemia.

We provide gynecological and urological care such as: confidential testing for HIV, sexually transmitted diseases (STIs), tuberculosis and hepatitis; STI treatments; pap smears; breast exams; referrals for ultrasound and mammograms; colonoscopies; testicular and prostate exams; contraceptive counseling; prescriptions for all genders; free birth control and hepatitis A & B immunizations. patients can also acquire condoms and lube, food and clothing, legal and social service referrals and occupational injury and illness screening.

And, what have we learned? That before coming to St. James, 70 percent of our participants had never disclosed their sex work status to their medical provider for fear of discrimination or diminished services. We found that sex workers who work collectively have lower rates of HIV and sexually transmitted infections, and that sex workers who have a history of arrest of more likely to test positive for HIV and STIs.

These conditions make it crystal clear that the same medical expertise that influences both health care and public policy is, in fact, woefully misinformed about the true health status of sex industry workers. Only by insisting on a seat at the table can we demystify the long held views that sex workers are the source of disease. The politics of division, born of fear, keeps any population of “other” discriminated against and dispossessed.

Carol Stuart is a member of the board of the St. James Infirmary in San Francisco and worked in the offices of California legislators Senator Milton Marks and then Assemblymember John Burton at the dawn of the AIDS epidemic.

Also See: Divide, Conquer and Sell by Merle Hoffman in this edition of On The Issues Magazine.

Also See: On The Frontline of Sex Wars by Carol Leigh in this Edition of On The Issues Magazine.


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