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Legislation requiring monthly testing of sex workers with low rates of sexually transmitted infections restricts access to services for higher risk individuals
  1. Anil Samaranayake (asamaranayake{at}mshc.org.au)
  1. Melbourne Sexual Health Centre, University of Melbourne, Australia
    1. Marcus Chen (mchen{at}mshc.org.au)
    1. Melbourne Sexual Health Centre, University of Melbourne, Australia
      1. Jane S Hocking (jhocking{at}unimelb.edu.au)
      1. Key Centre for Women's Health in Society, Australia
        1. C Bradshaw (cbradshaw{at}mshc.org.au)
        1. Melbourne Sexual Health Centre, University of Melbourne, Australia
          1. Rosey Cummings (rcummings{at}mshc.org.au)
          1. Melbourne Sexual Health Centre, University of Melbourne, Australia
            1. Christopher K Fairley (cfairley{at}unimelb.edu.au)
            1. Melbourne Sexual Health Centre, University of Melbourne, Australia

              Abstract

              Objectives: In Victoria, Australia, legislation requires sex workers to undergo monthly testing for gonorrhoea (GN), chlamydia (CT) and trichomonas (TV), and 3-monthly for HIV and syphilis, despite extremely low rates of STIs in female sex workers (FSW). Our aim was to quantify the resources and opportunities lost from this screening.

              Methods: Computerized medical records of patients attending the Melbourne Sexual Health Centre, (MSHC) between October 2005 and October 2008 were reviewed.

              Results: Consultations with FSW accounted for 15.1 % of total consultation time (5,722 of 37,670 hours) and of these, 2,896 hours (7.7%) were used for monthly consultations involving testing for GN, CT and TV but no serology (termed swab only testing).

              Only 133 (3.2%) of the 4208 cases of STI (defined as, GN, CT, TV, early syphilis, mycoplasma genitalium or HIV) that were detected at MSHC during the study period were among FSWs who underwent swab only testing. 1,726 (41 %) STIs were detected among MSM.

              The STIs detected per 100 hours of consultation time was (4 fold) higher for MSM (19) than for FSW (4). If FSW were tested only every 3 months for GN, CT, TV, syphilis and HIV the 2,896 hour spent on monthly swab only testing would have been available for higher risk clients.

              Conclusion: The current legislation requiring monthly STI testing is compromising the access for higher risk individuals to sexual health. Other countries contemplating mandatory testing need to consider the influence that the frequency of testing frequency has on access to sexual health services for high risk groups.

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