The authors say the unexpectedly low rate of consistent condom use during sex with clients points to the need to decriminalise the sex industry, increase sexual health education in the broader community and increase peer support opportunities among sex workers.
Consistent condom use among sex workers in Western Australia has declined over the past decade. However, sex workers continue to have high rates of testing, higher condom use and fairly high rates of sexually transmitted infections compared to the general Australian population. The latest study found that the drivers of this decline are diverse, with the criminalisation of sex work being a major factor.
The research of 354 sex workers found that condom use was surprisingly low across all forms of penetrative sex, but particularly oral sex, with only 33% of respondents reporting consistent condom use with their clients. By comparison, in two studies of female sex workers in 2007, 84% and 96%, respectively, consistently used condoms during oral sex with clients. The study also found that female sex workers working exclusively in brothels reported higher condom use than female sex workers working privately.
"In our study, participants recounted an increase in client demand for "natural" or condom-free intercourse. This, coupled with the recession (which has led to a reduction in demand for sexual services) and the criminalisation of sex work in Western Australia, creates further challenges for sex workers to limit their condom use," said Julie Bates AO, one of the study's authors. Bates, who heads Urban Realists planning and health consultancy, was a key figure in increasing condom use among Australian sex workers in the wake of the HIV pandemic in the 1980s.
"We don't know if this change is also happening in other Australian states and territories - but our findings in Western Australia suggest the need for increased sexual health education in the broader community and increased peer support opportunities among sex workers, especially those new to the industry."
The authors highlight the criminalisation of the sex industry and how this has inhibited health promotion and the ready availability of condoms, which is a significant barrier to safe practice.
"To promote peer education and support services for sex workers and accessible health services," says Bates, "we recommend the decriminalisation of sex work in Western Australia and other Australian jurisdictions where it is currently criminalized or licensed. More funding is also needed for peer-based education and support - particularly for private sex workers, as Western Australian law currently prohibits two workers from working together in a private situation, thus hindering the benefits of long-established informal peer support opportunities.
"For more than 30 years sex workers have had the upper hand in safe practices and it is 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, emphasizing the importance of condom use when having sex with casual partners, and testing for sexually transmitted infections.
The study was prompted by changes in the Australian sex industry over the past decade, with an increasing number of private sex workers working outside of brothels.