WORKING WITH SEX WORKERS

1. WORKING WITH SEX WORKERS Jeannie Nicholson Sexual Health Nurse

2. Different Types Of Work • Sexual services • Massage • Dominatrix • Porn. movies • Peep shows • Table top, lap & pole dancing • Stripping • Escorts

3. Reasons for commencing S/W • Need the money • Single income • To subsidise income • While studying • Particular goal in mind • For survival • Talked into it Groves 2007

4. Payment For Services • Money • Food • Shelter • Clothing • Drugs

5. Sex Industry laws – Vic. Victorian Legislation governed by: • Prostitution Control Act 1994 • Prostitution Control Regulations 2004 • Health (Infectious Diseases) Regulations 2001

6. Brothels A brothel is defined as any premises made available for the sole purpose of prostitution services. Licensed (Commercial) Brothels: Licence required from the Business Licensing Authority (BLA) Regulated by local council Planning permit required Prostitution Control Act (PCA) number is required Workers require monthly Med. Certs.

7. Small Owner – OperatedBrothels • Can only have one other person working • No licence required from (BLA) • Must have planning permit from Council to operate • PCA number required • Medical certificates required

8. Escort Agencies • Can be licensed the same way as licensed Commercial brothels • Whether licensed or exempt, must be registered with the BLA & issued with a PCA number • Not allowed to provide sexual services on the premises • Medical Certificates required

9. Private Escorts • Small owner operator escort service • Can “only” have one other person working • Exempt from needing a licence from the BLA, but must register as an Exempt Escort • PCA number is required • Medical certificates required

10. Street Work • Illegal • Much riskier • Greater chance of unprotected sex occurring • Workers often working to meet their drug needs

11. Initial Screening: Full Asymptomatic Screen (♀ S/W’s) A full screen includes: • Relevant history taking • Offering all available tests for the detection of STI’s.

12. Initial ASX ♀ S/W Screen • Blood Tests: Syphilis HIV Hepatitis A a/b (when appropriate) Hepatitis B core & surface a/bs Rubella a/bs (when appropriate)

13. Initial ASX ♀Screen • Speculum examination • Vulval examination • Genital Swabs: Chlamydia, endocervical (DNA) Gonococcal, endocervical (culture & sensitivities) Trichomoniasis, high vaginal & into posterior fornix (culture & sensitivities)

14. Initial ASX ♀ S/W Screen • Pharyngeal swab is optional • Pap test when required • Vaccinations Hepatitis B Hepatitis A Rubella Gardasil (should be advised when appropriate)

15. Positive Results • The worker is informed of the of the result and given relevant information regarding work and Rx. • Document, the above into client’s Hx.

16. Routine Screening (Asx. ♀ S/W) Monthly testing: • Relevant history taking • Speculum examination – not generally required. If Symptomatic – YES • Vulval Exam – IMPORTANT

17. Routine Screening(ASX ♀ S/W’s) • Blind vaginal swabs for: Chlamydia Gonorrhoea Trichomoniasis

18. Routine Screening(ASX ♀ SW’s) Three Monthly Testing: In addition to monthly testing – • Serological testing is carried out every 3 months: Syphilis HIV

19. Routine ASX Screening (♀ S/W’s) Six Monthly Testing: • Speculum Examination • Endocervical Chlamydia & Gonococcal swabs • Vaginal swab & into posterior fornix for Trichomoniasis.

20. Routine Screening(Asx. ♀ S/W) Two Yearly: • Pap smear test, unless otherwise indicated.

21. Screening Male Sex Workers Very similar to testing Female S/W’s If S/W’s clients are only female - • Monthly: Genital Exam. Chlamydia, urine (DNA) • 3 Monthly: All of the above Serology for Syphilis & HIV

22. Screening Asx. ♂ S/W’s If S/W has male &/or Transgender clients – • Monthly: Genital Exam. Chlamydia, FPU & rectal swab (DNA) Gonorrhoea, pharyngeal & rectal swabs (culture & sensitivities)

23. Screening Asx. ♂ S/W’s • 3 Monthly: All of the above Serology for Syphilis & HIV

24. Certificate This is to certify that: Kitty Has attended our Medical Centre on:October 11th , 2008 Practitioner’s Comments: She had swabs and bloods taken for STI testing I declare that the above information is true and correct. Practitioner’s signature: J. Nicholson Date:, 11/10/08 This certificate is issued for the above person and is not valid a photocopy

25. Certificate This is to certify that : Lily Has attended our Medical Centre on:October 11th , 2008 Practitioner’s Comments: She had swabs taken for STI testing I declare that the above information is true and correct. Practitioner’s signature: J. Nicholson Date: 11/10/ 08 This certificate is issued for the above person and is not valid as a photocopy

26. MSHC S/W Care in 2007 • Main Clinic: 27,457 consults., 1,251 STI’s 3,983 S/W consults., 110 STI’s

27. MSHC S/W Care in 2007 • RhEd: Resoursing Health & Education in S/W “OutReach” clinic started 1997 Currently, at RhEd Frid.s,1830 - 2130 97 consults. 4 STI’s

28. MSHC S/W Care in 2007 • TSWC (Thai S/W Clinic): Started 1998 Thai interpreter 1 session per week At MSHC, Tues, 1330 – 1630 300 consults. 15 STI’s

29. MSHC S/W Care in 2007 • KSWC (Korean S/W Clinic): Started July, 2005 1 session a month Korean interpreter Thursday, 1330 – 1430 25 Consults. 0 STI’s ! ! !

30. MSHC S/W Care in 2007 • CSWC (Chinese S/W Clinic): Started July 2005 1 session a month Chinese interpreter 25 consults. 2 STI’s

31. Useful Websites • Policies & Procedures related to screening Sex Workers: www.mshc.org.au • Australasian Legal Information Institute: www.austlii.edu • Resourcing Health & Education in the Sex Industry (RhED): www.sexworker.org.au • Australiasian Sex Workers Association Scarlet Alliance: www.scarletalliance.org.au