I found STD concerns across the county, there appeared to be a higher concentration in the downtown Charleston area as well as North Charleston, both which had large pockets of lower socioeconomic groups. While anyone can be affected, those that were often had lower levels of education, were either unemployed or underemployed and usually lacked health insurance as well as a permanent health care home. There was also an underlying theme of substance abuse in some patients, admitting to either using alcohol, drugs or both when engaging in sexual behaviors. The majority of patients I saw affected would either present to the free clinics or the emergency rooms as there was no immediate payment required and treatment could be rendered quickly. 4
Community Health and Population-Focused Nursing Field Experience Currently in the STD arena, Charleston is fortunate to have the Charleston Health Center (operated by Planned Parenthood) which provides HIV testing, as well as STD testing, treatment and vaccinations on a walk in basis. The Lowcountry AIDS Services will provide HIV testing and STD testing with the exception of hepatitis and herpes. Lowcountry AIDS also offers counseling as well as HIV education, safe sex education, and will supply speakers upon request. Both facilities provide services at either low cost or no cost depending on ability to pay. Also, the Northwoods Public Health Clinic also provides STD clinics, with specialized clinics for women, men and teens on a sliding scale basis. 6 Charleston County also is home to 5 hospitals and 3 additional free standing emergency rooms that provide care to the uninsured and underinsured, as most feel the ED is a substitute for their primary care/healthcare home. Unfortunately, given our current healthcare system, many people do not qualify for Medicaid, and the costs for the Affordable Care health plans, are in a word, unaffordable to the lower socioeconomic class. One young woman that I spoke with who worked in an adult entertainment venue told me she left a position at a local hospital due to ‘the cost of working’. While she was in a clerical position and the wage was decent, the cost of ‘benefits’ dropped her take home pay to the point she was unable to cover the essentials and she turned to adult entertainment. Now her take home pay averages about $7000 a month, and she chooses to utilize the free clinic downtown when she has medical issues. As I spoke to multiple people who presented for STD care, there was several consistent themes that ran true. Most were very uneducated in disease transmission including sexually transmitted diseases and HIV transmission. Also, to some, contracting STDs was described as ‘it comes with the job’ when I spoke with several women who worked in the adult entertainment arena as well as several who admitted to working as prostitutes. When I asked them about using personal protection, their answers were very similar, in that the people they were involved with ‘did not pay for protection’. One gentleman I spoke with regarding STD transmission was very colorful
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- Winter '16