Mandatory Testing for HIV and Sexually Transmissible Infections among Sex Workers in Australia: A Barrier to HIV and STI Prevention

Elena Jeffreys, Janelle Fawkes, Zahra Stardust

Scarlet Alliance, Australian Sex Workers Association, Redfern, Australia.

DOI: 10.4236/wja.2012.23026                

Abstract

Australia is an apt landscape upon which to measure the success of mandatory testing of HIV and sexually transmissible infections (STIs) among sex workers. Mandatory testing is implemented in some Australian jurisdictions and not others, allowing for a comprehensive comparison of the outcomes. It is apparent that mandatory testing of HIV and STIs among sex workers in Australia has proven to be a barrier to otherwise successful HIV and STI peer education, prevention and free and anonymous testing and treatment. The outcomes of mandatory testing are counterproductive to reducing HIV and STI rates, do not reach the intended target group, are costly and inefficient, and mandatory testing has proven to be a very difficult policy to repeal once in place. Scarlet Alliance, the Australian Sex Workers Association, as well as numerous academics and policy leaders in Australia recommend against mandatory testing of HIV and STIs among sex workers.

Keywords

Sex Work; Mandatory Testing; STI and HIV Prevention; Health Promotion; Public Health Objectives; Criminalization; Law Reform; Scarlet Alliance

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Australian Government Department of Health and Ageing, “Sixth National HIV Strategy 2010-2013,” Commonwealth of Australia, Canberra, 2010, p. 16. http://www.health.gov.au/internet/main/publishing.nsf/ Content/ohp-national-strategies-2010-hiv/$File/hiv.pdf
[2]	Australian Government Department of Health and Ageing, “Second National STI Strategy 2010-2013,” Commonwealth of Australia, Canberra, 2010, p. 16. http://www.health.gov.au/internet/main/publishing.nsf/ Content/ohp-national-strategies-2010-sti/$File/sti.pdf
[3]	NSW Department of Health, “STI Strategy Environmental Scan,” Sydney, 2006, p. 20. http://www.health.nsw.gov.au/pubs/2006/pdf/ sti_strat_enviroscan.pdf
[4]	R. Perkins and F. Lovejoy, “Call Girls,” University of Western Australia Press, Sydney, 2007.
[5]	B. Donovan, C. Harcourt, S. Egger, L. W. Smith, K. Schneider, J. M. Kaldor, M. Y. Chen, C. K. Fairley and S. Tabrizi, “The Sex Industry in New South Wales: A Report to the NSW Government,” Kirby Institute, University of New South Wales, Sydney, 2011, p. 7.
[6]	B. Donovan, “Preliminary Findings,” Proceedings of the Sex Workers Outreach Project Policy Meeting, Australian Society for HIV Medicine, 9 September 2011.
[7]	B. Donovan, C. Harcourt, S. Egger and C. K. Fairley, “Improving the Health of Sex Workers in NSW: Maintaining Success,” Public Health Bulletin, Vol. 21, No. 3-4, 2006, p. 74.
[8]	B. Donovan, C. Harcourt, S. Egger, K. Schneider, J. O’Connor, L. Marshall, M. Y. Chen and C. K. Fairley, “The Sex Industry in Western Australia: A Report to the Western Australian Government,” National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, 2010, p. 7.
[9]	National Centre in HIV Epidemiology and Clinical Research, “HIV/AIDS, Viral Hepatitis and Sexually Transmissible Infections in Australia, Annual Surveillance Report 2010,” National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Sydney, 2010.
[10]	C. J. Sturrock, M. J. Currie, H. Vallay, E. J. O’Keefe, R. Primrose, P. Habel, K. Shamburg and F. Bowden, “Community-Based Sexual Health Care Works: A Review of the ACT Outreach Program,” Sexual Health, Vol. 4, 2007, pp. 201-204. doi:10.1071/SH07003
[11]	F. J. Bowden, M. J. Currie, H. Toyne, C. McGuiness, L. L. Lim, J. R. Butler and N. J. Glasgow, “Screening for Chlamydia Trachomatis at the Time of Routine Pap Smear in General Practice: A Cluster Randomised Controlled Trial,” MJA, Vol. 188, No. 2, 2008, pp. 76-80.
[12]	M. J. Currie and F. J. Bowden, “An Epidemic of Infection, Not Just Testing: Chlamydia Prevalence Estimates in the Australian Capital Territory 1998-2004,” Australian and New Zealand Journal of Public Health, Vol. 30, No. 3, 2006, p. 286. doi:10.1111/j.1467-842X.2006.tb00873.x
[13]	D. Wilson, K. Heymer, J. Anderson, J. O’Connor, C. Harcourt and D. Donovan, “Sex Workers can be Screened too Often: A Cost-Effective Analysis in Victoria, Australia,” Sexually Transmitted Infections, October 2009.
[14]	T. Clark-Florey, “Porn’s Last Taboo: Protected Sex,” Salon.com, 2009. http://www.salon.com/life/broadsheet/ feature/2009/08/25/safe_porn
[15]	M. Young, “Free Choice on Condoms,” Opposing Views: Issues, Experts, Answers, 4 November 2010. http://www.opposingviews.com/i/ porn-director-madison-young-free-choice-on-condoms
[16]	Australian Government, Department of Health and Aging, “Sixth National HIV Strategy 2010-2013,” Commonwealth of Australia, 2010, p. 28.
[17]	A. Samaranayake, M. Chen, J. Hocking, C. Bradshaw, R. Cumming and C. Fairley, “Second National Sexually Transmissible Infections Strategy 2010-2013,” Commonwealth of Australia, 2010, p. 26.
[18]	D. Wilson, K. Heymer, J. Anderson, J. O’Connor, C. Harcourt and D. Donovan, “Sex Workers Can Be Screened Too Often: A Cost-Effective Analysis in Victoria, Australia,” Sexually Transmitted Infections, October 2009.
[19]	C. Healy, “Decriminalization in New Zealand, New Zealand Prostitutes’ Collective,” Proceedings of the Australasian Society for HIV Medicine Conference, Sydney, 2010. doi:10.1016/S0968-8080(10)35496-6
[20]	E. Jeffreys, K. Matthews and A. Thomas, “HIV Criminalisation and Sex Work in Australia,” Reproductive Health Matters, Vol. 18, No. 35, 2010, pp. 129-136.
[21]	A. Daniel, “The Sexual Health of Sex Workers: No Bad Whores, Just Bad Laws,” Social Research Briefs, NSW Health, No. 19, 2010, p. 1. http://nchsr.arts.unsw.edu.au/ media/File/SRB19_Sex_workers.pdf
[22]	M. Holt and J. Ellard, “HIV Risk Reduction Strategies among Gay Men,” Discussion Paper, Australian Federation of AIDS Organizations, Sydney, 2011, p. 1.
[23]	J. Fawkes, “Pos Worker Won’t Get Fair Trial,” In: E. Jeffreys, K. Matthews and A. Thomas, Eds., Scarlet Alliance Media Release, 2008.
[24]	B. Donovan and C. Harcourt, “Sex Workers,” In: C. K. Fairley, D. Russell and D. Bradford, Eds., Sexual Health Medicine, IP Communications, Melbourne, 2005.
[25]	NGO Delegate (Asia and the Pacific), “Sex Workers Fight Back,” Proceedings of the 2011 UN AIDS Program Coordinating Board, 18 April 2011. http://unaidspcbngo.org/?p=13011challenges %20facing%20current%20sex%20worker %20advocacy%20and%20rights
[26]	Canadian HIV/AIDS Legal Network, “A Human Rights-Based Commentary on UNAIDS Guidance Note: HIV and Sex Work,” 2007, pp. 13-14. http://asia-pacific.undp.org/practices/ hivaids/documents/aprd/IssuesBrief_Criminalization.pdf
[27]	P. Saunders, “Eight Working Papers/Case Studies, Examining the Intersections of Sex Work Law, Policy, Rights and Health,” Open Society Institute, 2006, p. 2. http://www.soros.org/initiatives/health/ focus/sharp/articles_publications/publications/ casestudies_20060601/casestudies_20061012.pdf
[28]	D. Wilson, K. Heymer, J. Anderson, J. O’Connor, C. Harcourt and B. Donovan, “Sex Workers Can Be Screened Too Often: A Cost-Effective Analysis in Victoria, Australia,” Sexually Transmitted Infections, 2009, p. 117.
[29]	A. Samaranayake, M. Chen, J. Hocking, C. Bradshaw, R. Cumming and C. Fairley, “Legislation Requiring Monthly Testing of Sex Workers with Low Rates of Sexually Transmitted Infections Restricts Access to Services for Higher Risk Individual,” Sexually Transmitted Infections, Vol. 85, No. 7, 2009, pp. 540-542. doi:10.1136/sti.2009.037069
[30]	Investment Framework Study Group, “Towards an Improved Investment Approach for an Effective Response to HIV/AIDS,” The Lancet, Vol. 377, No. 9782, 2011, pp. 2031-2041. doi:10.1016/S0140-6736(11)60702-2
[31]	C. Harcourt, S. Egger and B. Donovan, “Sex Work and the Law,” Sexual Heath, Vol. 2, No. 3, 2005, pp. 121-128. doi:10.1071/SH04042
[32]	Commonwealth Department of Health and Ageing, “National HIV/AIDS Strategy—Revitalising Australia’s response 2005-2008,” Australian Commonwealth Government, Canberra, 2005. http://www.health.gov.au/internet/main/ publishing.nsf/content/3F25543027A178E9CA25 710F0017AD3A/$File/hivaids_strategy.pdf
[33]	B. Donovan and C. Harcourt, “Sex Workers,” In: C. K. Fairley, D. Russell and D. Bradford, Ed., Sexual Health Medicine, IP Communications, Melbourne, 2005.
[34]	S. Metzenrath and L. Banach, “Public Health and Mandatory Testing,” In: S. Metzenrath and L. Banach, Eds., Model Principles for Sex Industry Law Reform, Scarlet Alliance and AFAO, 2000.
[35]	B. Donovan and C. Harcourt, “Sex Workers,” In: C. K. Fairley, D. Russell, and D. Bradford, Eds., Sexual Health Medicine, IP Communications, Melbourne, 2005.
[36]	Commonwealth Department of Health and Ageing, “National Sexually Transmissible Infections Strategy 2005- 2008,” Commonwealth of Australia, 2005, p. 28. http://www.health.gov.au/internet/main/ publishing.nsf/content/0333DF52D0E2F 3EDCA25702A0025132F/$File/sti_strategy.pdf
[37]	Prostitution Licensing Authority, “Key Responsibilities for Brothel Licensees and Approved Managers,” Prostitution Licensing Authority, 2012, p. 12. http://www.pla.qld.gov.au/Resources/ PLA/reportsPublications/documents/KeyResp.pdf
[38]	Queensland Health, “Section 2: Screening Priority Groups,” Queensland Sexual Health Clinical Management Guidelines, Queensland Government, 2010, p. 10. http://www.health.qld.gov.au/sexhealth/ documents/cm_guidelines.asp
[39]	Queensland Health, “Sexual Health Check Certificate of Attendance,” Queensland Government, 2012. http://www.health.qld.gov.au/sexhealth/ documents/cert_of_attend.pdf
[40]	Prostitution Licensing Authority, “Key Responsibilities for Brothel Licensees and Approved Managers,” Prostitution Licensing Authority, 2012, p. 11. http://www.pla.qld.gov.au/Resources/ PLA/reportsPublications/documents/KeyResp.pdf
[41]	Consumer Affairs Victoria, “Sexual Health of Sex Workers,” Victorian Government, 2012. http://www.consumer.vic.gov.au/businesses/ licensed-businesses/sex-work-service-providers/ sexual-health-of-sex-workers
[42]	Business Licensing Authority Victoria, “Small Owner-Operators (Exempt),” 2012. http://www.bla.vic.gov.au/home/sex+work+ service+providers/small+owner-operators/
[43]	Melbourne Sexual Health, “Sex Workers,” Alfred Health, 2012, p. 1. http://www.mshc.org.au/dnn/Portals/ _default/uploads/fact_sheets/sex_workers_a4.pdf
[44]	Communicable Diseases Branch, “Queensland Health Sexual Health Clinical Services and Privacy Policy,” Communicable Diseases Branch, Population Health, Queensland Health, Queensland, 2008, p. 11. http://www.health.qld.gov.au/ qhpolicy/docs/pol/qh-pol-311.pdf
[45]	Un-Named Participants Speaking from the Floor, Proceedings of the Inner South Community Health Service Shining a RhED Light Public Forum, Melbourne, May 2011.
[46]	G. Abel, L. Fitzgerald and J. Brunton, “The Impact of Decriminalization on the Number of Sex Workers in New Zealand,” Journal of Social Policy, Vol. 38, No. 2, 2009, pp. 515-531. doi:10.1017/S0047279409003080
[47]	B. Donovan, et al., “The Law and Sexworker Health (LASH) Project,” Proceedings of the Australasian Society for HIV Medicine Conference, Commonwealth of Australia, 2010, pp. 39-40. http://www.health.gov.au/internet/ main/publishing.nsf/Content/ohp-national-strategies-2010-hiv/$File/hiv.pdf;
[48]	Commonwealth Department of Health and Ageing, “National HIV/AIDS Strategy—Revitalising Australia’s response 2005-2008,” Australian Commonwealth Government, Canberra, 2005. http://www.health.gov.au/internet/main/ publishing.nsf/content/3F25543027A178E9CA25710F0017AD 3A/$File/hivaids_strategy.pdf
[49]	National Centre in HIV Epidemiology and Clinical Research, “HIV/AIDS, Viral Hepatitis and Sexually Transmissible Infections in Australia, Annual Surveillance Report 2006,” National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Sydney, Australian Institute of Health and Welfare, Canberra, 2006. http://www.med.unsw.edu.au/nchecrweb.nsf/ resources/SurvReports_4/$file/06_ansurvrp_rev.pdf
[50]	J. Medew, “Monthly Sex Worker Tests are Ridiculous, Health Experts Say,” The Age, Melbourne, 2011. http://www.interfacejournal.net/wordpress/wp-content/ uploads/2011/12/Interface-3-2-Scarlet-Alliance.pdf
[51]	J. Mann, D. J. M. Tarantola and T. W. Netter, Eds., “AIDS in the World,” Harvard University Press, Cambridge, 1992. http://www.hrw.org/about/projects/ womrep/General-137.htm
[52]	Scarlet Alliance, Australian Sex Workers Association, “Principles for Model Sex Work Legislation,” Redfern, Sydney, 2012, in Press.
[53]	Australian Red Cross, “Eligibility Policy,” 2012. http://www.donateblood.com.au/faq#1.