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The legalisation and regulation of street sex work in Victoria, Australia, is likely to improve the health of street sex workers and their clients.
In Victoria, street sex work is illegal. In comparison, brothel and escort agency sex work is legal, and these individuals are required by law to have monthly certification of STI screening. Any incident infections are detected early and treated so that the prevalence of STIs is low.1 There is no such requirement for street sex workers, who have infrequent STI screens and high rates of STIs.1
Following an acceptability and feasibility study,1 funding was secured for the Inner South Community Health Service Youth Health Bus to offer STI screening using self administered samples to street sex workers. Female workers provided a tampon sample and male and transsexual workers a first passed urine sample. These samples were then tested by polymerase chain reaction (PCR) for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis.2 The Youth Health Bus provides support and condoms to street sex workers several evenings a week in St Kilda, Melbourne’s street sex worker precinct. They have been offering self collected samples for testing since mid-1999.
Over a 2 year period 102 samples were collected yielding 15 positive results (14.7%, 95% CI: 7.8% to 21.6%). This group included 81 females, 20 males, and one transsexual individual, with a mean age of 24 years (range 16–43). C trachomatis was identified in seven sex workers, T vaginalis in seven, and N gonorrhoeae in one. These high prevalences of STIs are compared with the low prevalences in brothel sex workers attending Melbourne Sexual Health Centre in the corresponding time (table 1 above). These street sex workers were also not having regular STI screens, with only eight (7.9%) of the 102 individuals reporting an STI screen in the preceding month, and 12 (11.8%) who had never had one.
The legalisation of street sex work would allow it to be regulated and hence make regular STI screening a legal requirement. Recently, a 2 year trial of designated areas for street sex work in Melbourne has been recommended.3 These recommendations would protect the health of street sex workers and their clients, in addition to the targeted intervention described here. Further research is needed into the best health promotion model for street sex workers.
AM and CF, design, analysis, and writing of paper; ST and SG, laboratory analysis and interpretation; PL and PR, design and collection of specimens.
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