Consistent condom use among Western Australian sex workers has declined over the past decade. However, compared to the Australian general population, there are still high testing rates, higher rates of condom use and comparable rates of sexually transmissible infections among sex workers. The drivers for this decline are varied, with criminalisation of sex work being a primary factor, finds new research published in Frontiers in Public Health.
The study of 354 sex workers found unexpectedly low rates of reported condom use for all forms of penetrative sex -- but particularly oral sex, where only 33% of respondents reported consistent condom use with clients. This compares to 84% and 96% reporting consistent condom use during oral sex with clients in two studies of female sex workers in 2007. The study also found that female sex workers working exclusively in brothels reported higher rates of condom use compared to those working privately.
"Participants in our study told of the increased requests by clients for "natural" or condomless sex. This, coupled with the economic downturn (resulting in decreased demand for sexual services) and the criminalisation of sex work in Western Australia, brings further challenges for sex workers to hold the line on condom use," says Julie Bates AO, one of the study authors. Bates is Head of Urban Realists Planning & Health Consultants and was a key player in increasing condom use among sex workers in Australia following the onset of the HIV pandemic in the 1980s.
"We don't know whether this change has also occurred in other Australian states and territories -- but our findings in Western Australia point to the need for increased sexual health education in the wider community and increased peer support opportunities among sex workers, particularly those new to the industry."
The authors highlight criminalisation of the sex industry and how this inhibits health promotion and the ready availability of condoms as a significant impediment to safe practices.
"In order to facilitate peer-based education and support services for sex workers, as well as accessible health services, we recommend decriminalisation of sex work in Western Australia and other Australian jurisdictions where sex work is currently either criminalised or licensed," says Bates. "Increased funding is also needed for peer-based education and support -- particularly for private sex workers, as the law in Western Australia currently prohibits two workers working together in a private situation thus impeding the benefits of long established informal peer support opportunities."
"Sex workers have held the line so to speak in safe practices for over 30 years, it's now time for the rest of the community to catch up," says Julie Bates. The authors also recommend broad-based education on sexual health and condom use in the general community, highlighting the importance of condom use during sex with casual partners and testing for sexually transmissible infections.
The research was prompted by observed changes to the sex industry in Australia over the past decade, with an increasing proportion of private sex workers working outside of brothels.
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