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Health services research
Legislation requiring monthly testing of sex workers with low rates of sexually transmitted infections restricts access to services for higher-risk individuals
  1. A Samaranayake1,2,3,
  2. M Chen1,2,
  3. J Hocking2,4,
  4. C S Bradshaw1,5,5,
  5. R Cumming1,2,
  6. C K Fairley1,2
  1. 1
    Melbourne Sexual Health Centre, Alfred Hospital, Carlton, Australia
  2. 2
    School of Population Health, University of Melbourne, Melbourne, Australia
  3. 3
    Ministry of Healthcare and Nutrition, Colombo, Sri Lanka
  4. 4
    Key Centre for Women’s Health in Society, Melbourne, Australia
  5. 5
    Department of Epidemiology and Preventive Medicine, Monash University, Australia
  1. Correspondence to Professor C K Fairley, Melbourne Sexual Health Centre, 580 Swanston Street, Carlton, Vic 3053, Australia; cfairley{at}unimelb.edu.au

Abstract

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

Methods: Computerised 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 (5722 of 37 670 h) and of these, 2896 h (7.7%) were used for monthly consultations involving testing for gonorrhoea, chlamydia and trichomonas, but no serology (termed swab-only testing). Only 133 (3.2%) of the 4208 cases of STI (defined as gonorrhoea, chlamydia, trichomonas, early syphilis, mycoplasma genitalium or HIV) that were detected at MSHC during the study period were among FSW who underwent swab-only testing. 1726 (41%) STI were detected among men who have sex with men (MSM). The STI detected per 100 h of consultation time was (fourfold) higher for MSM (19) than for FSW (4). If FSW were tested only every 3 months for gonorrhoea, chlamydia, trichomonas, syphilis and HIV the 2896 h 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 has on access to sexual health services for high-risk groups.

https://doi.org/10.1136/sti.2009.037069

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    Footnotes

    • Funding CSB holds a National Medical and Research Council Research Fellowship, grant ID 465164. JSH holds a National Health and Medical Research Council Career Development Awards ID 566576.

    • Competing interests None.

    • Ethics approval Ethics approval was obtained from the Ethics Commitee of Alfred Hospital, Melbourne, Australia.

    • Contributors: CKF conceived the idea for the study. CKF, JSH, MC, RC and CSB designed the study. AS and CKF undertook the analysis. AS prepared the first draft of the manuscript and all authors critically revised the article for intellectual content and approved the final version. CKF has full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    • Provenance and Peer review Not commissioned; externally peer reviewed.

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