A look at the contributions sex work to public health.
Societal Views on Sex Work and Health
A pervasive and entrenched view of society is the assumption that sex workers are somehow “unclean”, “dirty” or vectors of disease. This view is inconsistent with many studies and probes into the subject. Sex workers in Australia rank one of the lowest demographics in reported positive STI infection and conversely, are the highest group in testing rates.
It is particularly the case with sex workers operating in NSW, where sex work is decriminalised and sexual health services and outreach groups are readily available and easily accessed.
What does this mean? It means that sex workers are more likely to be tested and less likely to test positive than the general population. This especially rings true when you consider the Kirby Institute, Faculty of Medicine study that found condom use in Sydney brothel settings to approach almost 100% in all sexual encounters.
This is in contrast to 2018 UNSW study on the sexual health-related knowledge, attitudes and practices of young people in Australia which found 75% of responders had condom-less sex in the preceding 12 months. 58% of participants had never been tested for STI/BBV.
Our objective in showing these stats is not to demonise any demographic or make sweeping statements of social behaviours, but to show the effectiveness of health initiatives and education amongst the sex worker community and advocacy groups.
Sex Industry Response to Sexual Health
As previously mentioned, condom use and sexual health awareness ranks highest amongst the sex worker community in Australia. This is due to tireless efforts by individuals and advocates within the community, along with sex worker outreach groups and sexual health clinics and health professionals. These health initiatives, spearheaded by the sex worker community, really took shape in the face of global health crises and helped shaped policies and the way we look at sexual health today.
The general community globally has not always been as proactive in regards to sexual health. Since their inception, condoms were known as a preventative measure for transmissible illnesses and pregnancy. Unfortunately, due to a variety of reasons (accessibility, cost and/or moral objections) condom use was not a universally used form of STD prevention/contraception.
Condom use fell even more out of favour in the 1960’s following the development of the combined oral contraceptive pill. This may suggest that condoms were primarily used to prevent unwanted pregnancy rather than for the prevention of communicable illnesses.
This all changed in the early 1980’s, where the world witnessed the start of the HIV/AIDS epidemic.
Sex Industry Response to the HIV/AIDS Epidemic
The early 1980’s saw the emergence of a new and deadly virus and the start of a worldwide health crisis. The start of the HIV/AIDS epidemic.
Australian’s initially were not too concerned of this new virus, the thought that the average person could catch or transmit HIV was a foreign one.
Watch virtually any media relating to HIV/AIDS, particularly from the early 1980’s, and you will see a common trait – HIV was not seen as a heterosexual issue. Comedians joked about the “gay virus”, films depicted IV drug users as carriers of the virus, sex workers were considered infected and famous people with the virus were forced to hide their condition from the public eye, lest they be lumped into one of the categories.
Misinformation spread widely, which unfortunately also contributed to the spread of HIV. The view that HIV/AIDS was the disease of “gays, junkies and whores” was a common but false concept, one that was difficult to shake. This led to an unlikely alliance of sex worker, drug user and LGBT groups along with health professionals to tackle these misconceptions and develop programs to prevent the spread of HIV.
1982 saw the first case of HIV in Australia. Government response to the outbreak was mixed.
Funding for many initiatives to tackle the health crisis was met with resistance. The ongoing conservative view is that the promotion of abstinence is preferred over harm minimisation tactics – these views still exist today in the opposition of clean needle exchanges and free condoms provided to students in sexual health classes. While abstinence as a policy works in theory, the reality is that the vast majority of people will still continue in behaviours as they see fit, including partaking at risky sex, etc. These risky behaviours, without harm reduction strategies, put the greater community at risk.
Sex worker advocates began lobbying for safe sex practices (i.e. mandatory condom-use) to be implemented in every brothel, better sexual education and sexual health services to be available and easily accessed by the community.
Clean needle exchanges were also heavily pushed by sex worker advocates, outreach groups and health professionals as a harm minimisation tactic. This initiative was blocked by government on many levels, viewing the funding of such a program to be unpalatable to voters – the funding of a “junkie program”. In fact, the first clean needle exchange programs in NSW operated illegally, with doctors viewing first-hand the effects and spread of HIV in the community and taking action in the absence of government response.
The view that easy access to sexual health services, to prophylactics, to clean needle exchange programs encourages IV drug use or promiscuity has shown time and time again to be a false assumption. The benefits of minimising the amount of cases within the community however, has massive positive effects on the community – you don’t need to be gay, a sex worker or IV drug user to catch and spread HIV.
It wasn’t until 1987, with the release of the infamous grim reaper television commercial, that public opinion on HIV and government policy changed dramatically. This education campaign was extremely effective. HIV/AIDS was now recognised as a real threat to public health and that it was no longer a virus exclusively affecting homosexual men, sex workers or IV drug users.
By 1988, clean needle exchange programs were available around the country, sexual health programs and clinics were created and community outreach and education programs were in place.
Order of Australia recipient: Julie Bates
This article would not be complete without mentioning the tireless efforts of Julie Bates, 2018 Order of Australia recipient.
Julie Bates has been a sex worker, sex worker rights activist and harm minimisation advocate for well over 35 years. She was at the forefront of the HIV/AIDS epidemic and helped draft multiple government policies on public health and harm minimisation.
She is a founding member of many sex-worker rights groups along with many still-running HIV outreach groups today.
Without the efforts of Julie Bates and other advocates, access to many essential public health services would not be available today. These actions are why the rate of STI and HIV infection are among the lowest in the world in the Australian sex worker community.
Sex Industry Response to the COVID Epidemic
There has been an ongoing argument that the sex industry is neither capable or willing to operate in a way that is conducive to a safe and in the interests of public health.
The counter argument is that the sex industry is more prepared than most industries to handle a global health crisis – Why? Because we’ve done it before.
Public health initiatives to tackle previous health crises (in particular the HIV/AIDS epidemic) were implemented by the industry well before community action. In fact, the sex industry moved to make changes in the interest of public health well before the industry was even decriminalised in NSW.
The sex industry was quick to implement any changes as advised by governing health bodies (i.e. NSW Health) to tackle the COVID epidemic. Compliance in COVID Safe plans are higher in sex worker premises than in most other commercial settings.
A major motivation in being proactive in any public health efforts is the fact that the sex industry is still heavily discriminated against. Despite having no known transmission events or cases at any brothels in Australia, it is still demonised within this context. (More info on sex worker discrimination is available on our SEX WORK IS WORK blog post).
Despite being decriminalised in NSW, sex workers and brothels are still targeted by press, police and policy makers. Logically, there are no benefits for a brothel or sex worker to not be compliant with COVID-safe plans. The ramifications for being the source of even a single case of COVID is huge as media coverage and public opinion is always disproportional when it concerns the industry.
Discreet Gentlemen Club’s Role in Public Health
As with all legitimate brothels in NSW, no natural services are offered at Discreet Gentlemen’s Club. Safe sex practices are promoted through education of staff, service providers and clients (through different avenues, including but not limited to, this blog). All rooms have signage in a multitude of languages reinforcing the mandatory use of condoms in all services.
Service providers are directed and encouraged to utilise additional resources available to them – ladies are acquainted with advocacy and support groups along with government agencies and public health initiatives.
Prophylactics (condoms, dental dams, etc) are provided by Discreet for every service. Condoms offered are available in 7 sizes – making service as safe as possible for both ladies and clients and nullifying excuses of condoms “not fitting”. Water-based lubricants are also provided.
New service providers undergo an induction process which thoroughly explains health and safety aspects. Advice is given on the safe use of prophylactics and are all shown how to conduct proper health checks prior to bookings commencing. The Scarlet Alliance “Red Book” (STI & BBV resource) is made readily available in booklet form to all providers inhouse for referral and are directed to the online version for referral on outcalls.
All service providers are required to have regular testing, this regardless of a complete absence of symptoms or exposure potential.
Discreet Gentlemen Club’s COVID Response:
Discreet has been working closely with NSW Health to implement COVID Safe plans to mitigate exposure risks and to safeguard the wider community.
Newcastle / Hunter Resources for Sex Workers and Clients
- Pacific Health – Sexual health clinic.
- ACON – Non-profit sexual health promotion organisation.
- Family Planning NSW – Offering a range of reproductive and sexual health services.
Plus national outreach programs for Sex Workers including, among others: