https://www.infirmiere-canadienne.com/blogs/ic-contenu/2024/07/17/soutenir-consomment-substances-commerce-sexe
How you can be sensitive to your client’s needs and ask the right questions
By Morgan Peeters
July 17, 2024
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It is important for nurses to be aware of their own biases, both toward sex and sex work. Recognize that engaging in these conversations can be uncomfortable, and it will take practice.
This article is part of the Canadian Nurse series, Harm Reduction Saves Lives.
Both sex workers and people who use drugs are exposed to many harms on a daily basis, including blood-borne diseases, overdoses, violence, discrimination, stigma and possibly death. Many of these harms are exacerbated by a lack of stable or safe housing. It is not always obvious when a client is engaging in drug use or sex work, so nurses need to approach these situations with sensitivity and ask assessment questions that focus on clients’ needs.
Asking questions in a straightforward manner while maintaining a non-judgmental approach is the most beneficial approach. For example, ask a client directly if they engage in intravenous drug use rather than waiting for the client to volunteer this information themselves. By using this strategy, you are acknowledging the stigma surrounding this behaviour and recognizing why a client may not want to be forthcoming with this information. Some other example questions to ask include the following:
- Is the client engaging in sexual acts in exchange for money or drugs?
- Where are they obtaining their supplies for ingesting substances (i.e., are they borrowing needles or purchasing their own from a pharmacy)?
- Are they using condoms? Are they experiencing pressure not to use condoms?
- Are they experiencing any violence, or do they have any safety concerns?
Below are four strategies that nurses can use to foster harm reduction in daily practice when they work with clients who may use drugs or engage in sex work.
1) Be aware of your own biases
It is important for nurses to be aware of their own biases, both toward sex and sex work. Recognize that engaging in these conversations can be uncomfortable, and it will take practice. Much the same as public speaking, the first time discussing sex with a client may be awkward or filled with tension. But once you find a rhythm and presentation style that works for you, that unease will fall away. Nurses can ask questions in a straightforward manner.
Nurses can also avoid making assumptions about the care clients are seeking. Do not assume that a client wants to stop their substance use or cease engaging in sex work. For substance use specifically, clients may be seeking abstinence for a short period of time to reduce their tolerance, or they may want to maintain abstinence from one specific substance while continuing to engage in the use of others. It is important to involve a client in their own care. Engaging clients empowers all individuals while acknowledging that clients who have been victims of trauma often were robbed of control in that situation.
2) Create a safe space where clients can talk
An important way health care can support people who use drugs and engage in sex work is by creating a safe space where clients feel comfortable discussing their substance use and sexual history. By creating a non-judgmental and open environment, nurses can help decrease the amount of shame or fear a client may be grappling with prior to these disclosures.
Sex work and substance use are difficult topics to discuss, both for the person making the disclosure and the person receiving the information. Using a trauma-informed approach and employing unconditional positive regard is crucial to building and sustaining relationships with people in this population. Nurses can use a trauma-informed approach by being aware of their own body language and tone of voice.
Many of the people in this population have learned to read body language to maintain their physical and psychological safety. Using a relaxed posture and speaking in a calm, quiet manner can help put clients at ease and increase rapport. Nurses can be aware of the environment they are in with a client. If possible, dim the lights to make them less harsh or minimize background noise. Move a client to a quieter and more private area to further the conversation. These approaches minimize distractions for both you and the client.
It may help to be aware of common lingo that clients may use. For example, a client may refer to heroin as “smack.” There are many resources, such as this harm reduction toolkit from the Community AIDS Treatment Information Exchange (CATIE), available to help clarify terminology. It would be appropriate to ask about the term to clarify it; however, the nurse should avoid continued use of a client’s language.
3) Offer safe sex or safe substance use kits
Safe use kits can include sterile needles/pipes, sterile water, alcohol swabs and other items used during substance use. These kits are often disposable and help decrease the transmission of STIs or other harms, such as cuts sustained from supplies or items becoming brittle due to repeated use. Other kits, such as safe sex kits, are also available and provide items such as male and female condoms. Safe sex and safe use kits can be handed out together or individually depending on a client’s specific needs.
By offering both in a “take what you need” type of way, nurses limit the pressure placed on a client to disclose specifics of their daily life in order to obtain these harm reduction tools. Nurses can create a more accepting and non-judgmental environment when offering safer supplies that invites clients to discuss their daily lives with nurses when they choose to do so. Staff will often recognize clients who are repeatedly coming back for supplies. Learning their names and engaging them in general conversation can create a welcoming and comfortable environment, fostering continued interaction with staff. When clients trust nurses, they are more likely to seek health care when they need it, and these trusting relationships can form the foundation of getting referrals to other services, such as detoxification services, mental health, and housing supports.
4) Provide education on sexually transmitted infections
Education on STIs is also important for clients, including medication that can be used to treat or prevent STIs. Nurses can use education to help decrease the stigma around these diagnoses and encourage routine testing. Furthermore, it’s important for nurses to include discussions about pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) when there is a risk of HIV transmission. PrEP is designed to be taken daily for individuals who are frequently at risk of contracting HIV, such as sex workers or individuals who engage in intravenous drug use. PEP, in contrast, is designed for post-exposure and can be used after an unprotected sexual exposure, such as a condom tearing during intercourse or a sexual assault.
Be knowledgeable about current best practices for STI screening and treatment. For example, when offering STI testing, a rectal swab should be routinely offered. Clients who are infected with gonorrhea or chlamydia rectally require a different type of antibiotic than other sites of infection, and female clients are highly likely to reinfect themselves vaginally.
Nurses can empower clients with this education so that clients can make informed decisions to promote their health.
All of these efforts can ensure that nurses provide safe care to clients who use drugs and engage in sex work. The relationships that nurses build with clients can support clients to make informed decisions about their health care and maintain their safety.
Morgan Peeters, RPN, works in the addiction recovery centre of Alberta Hospital Edmonton.
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#addictions
#harm-reduction
#nurse-patient-relationship
#nursing-education
#stigma
#substance-use