Lost in Interpretation: The Sex Worker

Something amusing happened recently to me when I was attempting to complete my Continuing Professional Development (CPD) assessment on Contraception on the CPPE website. I thought I'll share it...

One of the questions related to the case of a female sex worker who doesn't want to be pregnant and want to minimise the risk of sexually transmitted infections. There were five (5) options for the most appropriate contraception combination to recommend. This appears straight forward enough to everyone else. To me it wasn't that straight forward. You see, we call people who work with individuals addicted to class A drugs: their key workers. We also call people who look after individuals with social needs: their social workers. By deduction therefore, a sex worker might refer to someone who works with individuals working in the sex industry. However, that is not who a sex worker is! According to that bastion of knowledge: Wikipedia, 'a sex worker may be employed as prostitute, strippers, go-go dancers...Other sex workers are paid engage in live sexual performance...' So there you have it: a sex worker isn't someone who supports prostitutes, strippers etc. A sex worker is a prostitute.

Why is this a problem?

This is a problem because it affected the way I attempted to answer the question. If I was thinking of a sex worker as a prostitute, then the contraceptive option is clear. We are arguably discussing consensual sex. In which case a Male condom and a suitable combined oral contraceptive pill will suffice for the lady in question. However, if a sex worker was someone who supports prostitutes etc, then the issue here might be risks associated with that kind of work. We may be discussing non-consensual and even violent sex. If that is the case, then the sex worker cannot rely on the attacker to wear adequate contraception. I know my imagination is running away with me here but there are two important points to glean from this otherwise amusing case.

What are those points?

The demographic of pharmacists in the UK suggests that a significant minority does not have English as their first language. This is not unique. It is merely a reflection of the society we live in. The same applies to other healthcare professional groups. In attempting to assess the professional competencies of the pharmacists, we must pose question in a manner which is not subject to misinterpretation. The question assumes that everyone should knows who a sex worker should be. Maybe we should know but the logic described above is valid. A better way to pose such a question would be to qualify the term 'sex worker'. You may put 'prostitute' in parenthesis with the proviso that the term 'sex worker' is a better term to use when dealing with a patient. This is but a minor point which anyone responsible for setting questions must bear in mind.

The second and most important point is directed at the pharmacist. It relates to our interactions with our patients and customers especially when conduction a medicines use review. If a patients tells you they have thrush and they want something for it, you have to use appropriate questioning to elicit the patient's symptoms. What might be thrush to the patient might be cystitis to you! We need to establish that we are describing the same condition before we can begin to offer a treatment options. So when a customer presents in your pharmacy and describe him or herself as a sex worker, please clarify what they mean.