Sexual risk and STI testing behaviour among Dutch female and male self-employed sex workers; a cross-sectional study using an Internet based survey

Abstract

Background Sex workers are men, women or transgender people who have sex in exchange for money or goods. Self-employed sex workers solicit clients independently from a third-party. Self-employed sex workers are at risk of acquiring sexually transmitted infections (STIs) through their work. We performed a cross-sectional study, using an Internet survey conducted in 2019–2020 aiming to establish sexual risk behaviour and STI testing behaviour among female and male self-employed sex workers. Results A total of 76 female self-employed sex workers (FSW) and 79 male self-employed sex workers (MSW) completed the survey. Both FSW and MSW more often had sex with partners of the opposite sex during work (65.8% FSW, 61.6% MSW) and in their private life (63.3% FSW; 64.5% MSW). During vaginal sex 35.7% of FSW and 29.6% of MSW did not always use a condom. Inconsistent condom use was observed in 35.7% of FSW and 29.6% of MSW during vaginal sex, 46.2% of FSW and 35.7% of MSW did not always use a condom during receptive anal sex. The majority of both FSW and MSW tested for STIs in the past year (67.1% FSW; 67.7% MSW) and 67.5% were aware of the possibility of low-threshold testing at an STI clinic. In the past year, 11.6% of FSW and 8.1% of MSW had an STI. Conclusion The reported STI positivity rate among self-employed sex workers was not very high. However, STI prevention efforts remain important considering the low compliance with condom use during sex work. Moreover, not testing for STIs in the past year was substantial with one-third of both FSW and MSW and one-third of both FSW and MSW being unaware of the possibility of low-threshold testing at an STI clinic, warranting efforts to increase testing uptake in this population.

Sexual (Risk) Behavior and Risk-Reduction Strategies of Home-Based Male Sex Workers Who Have Sex with Men (MSW–MSM) in The Netherlands: A Qualitative Study

“…In a quantitative Dutch study among self-employed sex workers, condom use was similarly to our study self-reported to be Fig. 2 Factors influencing hepatitis B vaccination behavior as reported by MSW-MSM relatively high with anal sex and low with oral sex; however, only one-third of their MSW study population (also) had sex with men (Kampman et al, 2022). Previous qualitative research among non-sex worker MSM in the USA identified physical discomfort of condoms, relationship trust, usage based on the type of sexual act, substance use, and knowledge of a partner's STI/HIV status as factors related to condom use (Giano et al, 2020).…”

Factores asociados con el uso del condón en trabajadoras y trabajadores sexuales de origen venezolano en Colombia

“…Se observó que, entre las personas entrevistadas el uso del condón era inconsistente, lo que corresponde con otros estudios realizados con trabajadores y trabajadoras sexuales ( 13 ), ya que este depende de diversos factores, tanto de tipo personal de quien ofrece y de quien demanda el servicio sexual, como de aspectos sociales asociados con el trabajo sexual. En cuanto a los factores personales, estos se relacionan con el individuo con el cual se llevará a cabo la relación sexual; se evidencia que, en el caso de los clientes, el uso del condón es más frecuente con los y las trabajadoras sexuales que con sus parejas afectivo-sexuales.…”

Facilitators and Barriers for Chlamydia and Gonorrhea Testing in Female Sex Workers: A Scoping Review

“…Four articles examined CT- and NG-related knowledge [ 23–26 ]. A cross-sectional survey that recruited 417 FSWs in India found that knowledge of CT and NG influenced testing behaviors among FSWs.…”

“…Additionally, a community randomized trial and a cross-sectional study both conducted in Peru found that FSWs who had received prevention messages in HIV/STI health education or counseling sessions in outreach programs were more likely to seek health health services including CT and NG testing [ 25 , 26 ]. A study in the Netherlands explored the determinants of reluctance to seek CT and NG testing and found that one-third of FSWs were unaware of the possibility of getting a free and anonymous test at local STI clinics [ 23 ].…”

“…Four articles reported the impact of criminalization laws of sex work on access to CT- and NG-related care services among FSWs [ 23 , 25 , 27 , 28 ]. In the Netherlands, the legalization of sex work was accompanied by strict controls imposed on the sex industry and its workers, such as prohibitions on working from home and requirement for registration with the authorities.…”