An outreach programme for sexually transmitted infection screening in street sex workers using self-administered samples

Melbourne Sexual Health Centre, Carlton, Australia.
International Journal of STD & AIDS (Impact Factor: 1.04). 12/1999; 10(11):741-3. DOI: 10.1258/0956462991913286
Source: PubMed

ABSTRACT Street sex workers represent an at-risk group of individuals who find it difficult to access mainstream health services. This was a cross-sectional study of street sex workers in Melbourne, Australia using a self-administered method to detect chlamydial, gonorrhoea and trichomonas infections. Of the 81 individuals approached, 63 (78%) (95% CI: 67-86%) agreed to participate. Overall, 87% of the participants obtained their results. Of the 63 participants, 53 (84%) had a past history of injecting drug use (95% CI: 73-92%), and 21 (33%) had a history of a sexually transmitted infection (STI) (95% CI: 22.0-46.3%). Neisseria gonorrhoeae was identified in 7 (11%) participants, Trichomonas vaginalis in 7 (11%), Chlamydia trachomatis in 1 (1.6%). None of the 19 (30%) participants who had been screened for an STI in the preceding 3 months were infected. Our results demonstrated that this method of testing for STIs was acceptable to the street sex workers, and demonstrated a disturbingly high proportion with infections.

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    • "Notably a comparable number of sex workers solicit on the streets of Melbourne (Morton 1999) where street sex work is illegal and the potential client base is smaller. This suggests that the law has little effect on the presence of street prostitution. "
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    ABSTRACT: To determine the health and welfare status of female and transgender street sex workers and their work-related experiences. Also to estimate population numbers, determine work locations, and identify the most appropriate education, health and welfare services for this group. Forty-eight street sex workers completed a questionnaire, mainly at their place of work. Demographic and sexual health profiles of sex workers attending the Sydney Sexual Health Centre and the Kirketon Road Centre in 1997 were compared with the street sample. Up to 120 female and transgender sex workers worked on the streets in Sydney, Newcastle, Wollongong and surrounding areas in any one night: more than 80% of these were female. Of those sampled, fewer street workers than brothel sex workers (6% vs. 41%; p<0.001) were from non-English speaking backgrounds, and more (77% vs. 7%; p<0.0001) were currently injecting drugs. The street workers reported lower rates of condom use at work than local brothel workers (91.7% vs. 98.8%; p<0.016) and high rates of hepatitis B and C infection. Seventy-five per cent had experienced violence at work. Child care, lack of supportive relationships, community intolerance and low self-esteem were important problems for the street workers. While the police were frequently required by the community to move the street workers on, there were no reports of corrupt behaviour by police. Health services need to specifically target this group with particular attention to the prevention of blood-borne virus infections, contraception, drug dependency and transgender issues. Consideration should be given to developing a network of safe houses to reduce community pressure and violence.
    Australian and New Zealand Journal of Public Health 02/2001; 25(1):84-9. DOI:10.1111/j.1467-842X.2001.tb00556.x · 1.90 Impact Factor
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    ABSTRACT: Background: Prostitution has been documented in most societies, although the context in which it occurs may vary greatly. In Queensland, Australia, sex workers can operate from legal brothels or privately but all other sectors of the sex industry are prohibited. It is assumed that regulation of the sex industry through legalization leads to better health and social outcomes for sex workers and their clients. However, this assumption has rarely been subjected to empirical scrutiny. Aims: This research examined the occupational health and safety of female sex workers in Queensland and explored the relationship between legislative change, workplace violence, mental health and job satisfaction. Sex workers interviewed in 2003 (after legalisation) were compared to a prior study of this population conducted in 1991 (before official regulation of the sex industry). Further, in-depth analysis of the 2003 cohort compared sex workers employed in legal and illegal sectors, to assess violence, health status and job satisfaction. Methods: Cross-sectional, convenience sampling was used to collect data from female sex workers in 2003. This data was compared with data collected earlier (in 1991) and explored differences in the two samples using bivariate analysis. Similar recruitment strategies on both occasions were used to recruit women from all known sectors of the Queensland sex industry. The 1991 comparison sample (Boyle et al. 1997) included 200 women (aged between 16 and 46 years), and in 2003, 247 women (aged 18 to 57) participated. The 2003 sample included workers from legal brothels (n=102), private sole-operators (n=103) and illegal street-based sex workers (n=42). Using data collected in 2003, this study assessed the relationship between physical and mental health and job satisfaction and two main independent variables, i.e., current work sector and recent workplace violence. Bivariate analysis of physical health and independent variables showed no significant relationships and therefore further analysis was not undertaken. However, analysis of mental health and job satisfaction showed complex interactions between multiple variables and therefore linear modeling was performed to adjust for confounding. Results: Analysis of the 1991 and 2003 samples showed little apparent change over time in self-reported sexually transmitted infections (STIs). There were substantial changes over time in the types of sexual services being provided to clients, with the 2003 sample more likely to provide 'exotic' services. Violence experienced ever in their lifetime differed; in 1991, 29% reported having ever been raped compared with 42% in 2003 (p= &lt0.01). In 2003, 50% of illegal sex workers reported having ever been raped by a client compared with 12% of private sex workers and 3% of brothel-based sex workers (p=&lt0.01). Overall, the sex workers reported roughly equivalent job satisfaction to Australian women. A desire to leave the sex industry was most strongly correlated with reduced job satisfaction (p=&lt0.01). Satisfaction was also relatively low among those whose family was not aware of their sex work (p=&lt0.01). Similarly, the mental and physical health of this sample was comparable to age-matched women from the general population. Wanting to leave the sex industry was most strongly associated with poor mental health (p=&lt0.01), as was recent sexual or physical assault by a client (p=0.06) and the woman's main work sector (p=0.05). Illegal sex workers reported substantially lower mental health scores than their counterparts in legal sex work. Conclusions: Self-reported STI diagnosis was high in these samples but the prevalence appears not to have changed over time. Comparing 2003 to 1991, there were trends towards safer and more diverse sexual practices. It is likely the sex industry has 'professionalized' and now includes more sex workers providing specialist, 'exotic' services. This sample of female sex workers reported high rates of violence, with those working illegally at greatest risk. Analysis suggests a complex interaction between variables contributing to mental health and job satisfaction. In general, it appears that the majority of sex workers enjoyed at least as much job satisfaction as women working in other occupations. It also appears that this sample had equivalent mental health to women from the general population, although the sub-group of illegal workers generally had poorer health. Job satisfaction and the extent of workplace hazards (especially risk of violence) were also strongly associated with different sectors of the sex industry. It is probable that legalisation has benefited some (perhaps most) but there are health and safety concerns for those outside the legal framework. Legislative reform should focus on violence prevention, promoting reporting of violent events to police, and further exploration of the impact of legislation on the health of workers in the sex industry.
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    ABSTRACT: A modified sanitary napkin was compared with endocervical swab and urine specimens for the detection of urogenital Chlamydia trachomatis infection. Endocervical swabs and/or first-catch urine were collected from 510 women at medical or community settings in Quebec City. Participants were also asked to wear a modified sanitary napkin (Ezy-Detek) during 4 consecutive hours and to bring it back to the clinic or mail it to the laboratory. Endocervical and urine specimens were tested using the Cobas Amplicor CT/NG assay (Roche Diagnostic Systems) according to the manufacturer's instructions, as were specimens collected with the napkin after adequate preparation. If the PCR test result was positive on the endocervical sample or on any two samples, a woman was considered to be infected. PCR testing results on paired samples were identical for 493 (96.6%) of 510 women. According to the definition given above, 58 (11.3%; 95% confidence interval [CI], 8.7 to 14.5%) women were infected with C. trachomatis. The sensitivity and specificity of PCR testing on modified sanitary napkin specimens were, respectively, 93.1% (54 of 58; 95% CI, 83.3 to 98.1%) and 98.9% (447 of 452; 95% CI, 97.4 to 99.6%) compared to 81.0% (47 of 58; 95% CI, 68.6 to 90.1%) and 100% (451 of 451; 95% CI, 99.2 to 100%) for urine specimens. The positive and negative predictive values were, respectively, 91.5% (54 of 59) and 99.1% (447 of 451) for the sanitary napkin specimens compared to 100% (47 of 47) and 97.6% (451 of 462) for urine samples. These results suggest that a modified sanitary napkin represents an effective noninvasive device for self-collection of specimens to detect urogenital C. trachomatis infection.
    Journal of Clinical Microbiology 08/2001; 39(7):2508-12. DOI:10.1128/JCM.39.7.2508-2512.2001 · 4.23 Impact Factor
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