Background Sex workers are a priority population in the WHO sexually transmitted infection (STI) global strategy. In Australia, condom use for vaginal sex has remained high over the past decade rates in sex workers with corresponding low rates of STIs. In recent years, there have been anecdotal reports of Sydney sex workers increasingly reporting unprotected fellatio with clients which has coincided with an increase in cases of pharyngeal gonorrhoea in these women. The aim of this study was to investigate the extent and predictors of inconsistent condom use for fellatio at work, and rates of pharyngeal gonorrhoea among sex workers attending a large sexual health clinic.
Methods All female sex workers reporting fellatio at work seen at the Sydney Sexual Health Centre from May 2009 to January 2011 were included. Demographic data, risk behaviours and STI diagnoses were extracted from the clinic database. Pharyngeal gonorrhoea cultures were collected routinely. Multivariate logistic regression analysis was used to determine predictors of inconsistent condom use for fellatio at work.
Results There were 1539 sex workers seen during the study period—most (n=1142, 74%) worked in brothels and 24% reported inconsistent condom use for fellatio at work. Significant independent predictors of reporting inconsistent condom use for fellatio at work were being a new client at our clinic (compared to an existing client) (adjusted (AOR) 2.66, 95% CI 2.08 to 3.44), speaking a Mandarin or Cantonese language (AOR 3.01, 95% CI 1.67 to 5.42), inconsistent condom use for vaginal sex at work (AOR 12.54, 95% CI 7.32 to 21.48), and being older than 40 years (AOR 2.85, 95% CI 1.91 to 4.25). Thai language speakers were less likely to report inconsistent condom use for fellatio (AOR 0.44, 95% CI 0.23 to 0.83). No significant association was demonstrated for injection drug use or sexual practice outside of work. During the study period 17 of the 1539 sex workers (1.1%, 95% CI 0.6 to 1.8) were diagnosed with pharyngeal gonorrhoea.
Conclusions These finding suggest interventions to promote condoms for fellatio by sex workers are needed. We could not determine if inconsistent condom use for fellatio at work was directly associated with pharyngeal gonorrhoea due to the low sample size of cases. Further research into the determinants of this behaviour, particularly among different language groups is warranted.