Culturally Safe Nursing Care for Black Sex Workers in the Greater Chicago Area, 2020‒2021

Complex structural and social factors have created health inequities for Black sex workers. Black people, including those engaged in transactional sex, report leaning on spiritual beliefs to guide health-related decision-making, including whether to get the COVID-19 vaccine. Public health nurses can improve the health of Black sex workers through culturally safe care, which may include a community-stated vision of spiritual support. (Am J Public Health. 2022;112(S3):S288-S291. https://doi.org/10.2105/AJPH.2022.306836).

"Feeling Safe, Feeling Seen, Feeling Free": Combating stigma and creating culturally safe care for sex workers in Chicago

BACKGROUND

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.

OBJECTIVES

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.

METHODS

In-depth interviews (N = 21) were conducted with sex workers in Chicago. Transcripts of individual interviews were analyzed in Dedoose using rapid content analysis.

RESULTS

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.

CONCLUSION

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.

Invited review: Anticholinesterases: dramatic aspects of their use and misuse

While the lore of anticholinesterases (antiChEs), particularly physostigmine and its natural source, the Calabar bean, is a subject of ethnomedicine and predates our scientific era, the pharmacological development of physostigmine analogues and related agents and of the antiChEs of the organophosphorus (OP) type, is a matter of the last two centuries; this development has reached an exponential character in the last fifty years. This explosion relates to certain uses and misuses of these drugs and this aspect of antiChEs is the main focus of this article. Firstly, there is the matter of Senile Dementia of Alzheimer's Type (SDAT); while there are several clinical applications of antiChEs, their employment in the treatment of SDAT is the last and most intense foray in their medical history and this article will focus on the uses and misuses of antiChEs in this area. Secondly, the applied use of antiChEs as insecticides which coincided with the historical development of OP antiChEs was and is, of major significance for the agricultural economy of both advanced and underdeveloped countries, as this employment may mean the difference between life and starvation. However, there are notable dangers with this application of OP drugs, as will be emphasized in this article. Thirdly, there is the significant and tragic development of the OP drugs as warfare agents and tools for terrorists and rogue states and this article will discuss the several types of toxicity of OP agents and their mechanisms, the enigma of the Persian Gulf War Syndrome being particularly stressed. Altogether, the immense range of antiChE topics includes areas of great basic interest and of practical applications that are of significant benefit to mankind as well as of potential danger.