Despite the occupational risks, the incidence of STIs in sex workers in Australia is among the lowest in the world. This has largely been through the establishment of safe-sex as a norm, the availability of safe sex equipment and community-driven health promotion and peer-based interventions. Sustaining this achievement will require continuing support of prevention initiatives to minimise transmission of STIs and BBVs.
Sex workers are a priority population because of their significantly higher number of sexual encounters and the higher potential for transmission of STIs. The risk increases for street-based sex workers (and people engaging in sex for favours) who have less opportunity to control the occupation health and safety conditions of their work and who are therefore at increased risk of BBV and STI transmission.
Priority actions for testing and treating sexually transmissible infections
- Build the capacity of primary healthcare services, the ACCHS, National Aboriginal Community Controlled Health Organisation (NACCHO) and general practitioners to initiate testing, diagnosing, treating and engaging in culturally appropriate partner notification strategies, particularly among those aged 15 to 30 years.
- Investigate models that normalise health-seeking behaviour and specifically reach those aged 15 to 19 years, particularly in high prevalence communities. Models could include:
- specific youth health programs within primary healthcare services
- active outreach models
- uptake of the Adult Health Check and other such initiatives.
- Integrate provider-initiated STI testing and treatment into routine health checks provided in primary care.
- Improve systematic, integrated surveillance systems using existing patient information management systems that can report on the proportions of people aged 15 to 30 years who are offered regular STI testing and treatment.
- Respond to high rates of syphilis in Aboriginal and Torres Strait Islander communities through greater emphasis on comprehensive sexual health programs in the primary care setting (that may include syphilis testing, treatment, contact tracing and follow up), as well as healthcare provider and community education.
- Improve partner notification initiatives in communities that encompass cultural and social considerations.
- Encourage the development of testing, treatment and care guidelines for specific target groups:
- those aged 15 to 30 years
- those in custodial settings
- sex workers
- gay men, other men who have sex with men, sistergirls and transgender people.
- Conduct a systematic review of the evidence base around trichomonas vaginalis infection to develop actions to deal with it.
This is seen as an important initiative to ensure that regular STI testing is best practice in STI control.