29 Jul 2016

Gonorrhoea spike linked with policing of sex workers

by Anne Crawford

A study has linked an epidemic of gonorrhoea in South Australia with increased policing of female sex workers when carrying condoms was used as evidence for convictions.

The study was overseen by Professor Kit Fairley of the Central Clinical School and head of the Melbourne Sexual Health Centre, and researched by doctoral student Bin Li, supported by Dr Eric Chow and others.

The gonorrhoea epidemic occurred between 2006 and 2010 in heterosexual men, women and female sex workers (FSW) in South Australia, where prostitution is illegal.

The researchers observed the substantial rise in cases in a retrospective analysis of records made at the Adelaide Sexual Health Clinic between 1990 and 2012, became interested in what was causing it and discovered that increased policing of sex workers was occurring around the time.

Convictions against sex workers in Adelaide peaked during the epidemic with 78 prostitution offences in the 2007/8 financial year compared to 450 over the past 12 years.

The researchers then compared the gonococcal diagnoses with those recorded at the Sydney Sexual Health Centre and Melbourne Sexual Health Centre. No corresponding trend was recorded in Melbourne where prostitution is regulated or in Sydney, where it is legal.

Compared to other years, Adelaide Sexual Health Clinic diagnoses were higher between 2006 and 2010 among heterosexual men (5.34% vs 0.84%), non sex worker women (0.64% vs 0.28%) and female sex workers (FSW) (1.75% vs 0.24%). Yet at the Melbourne clinic similar or significantly lower proportions of all three groups with gonorrhoea were recorded between 2006 and 2010; (0.60% vs 0.75%;  0.27% vs 0.18%; 0.63% vs 0.96%) respectively. In Sydney the proportion with gonorrhoea was lower for heterosexual men (1.80% vs 1.85) and non sex worker women (0.17% vs 0.21%), with the proportion of FSW with gonorrhoea significantly lower (0.75% vs 1.06%) during the epidemic years.

Newspaper articles at the time reported that police were using the carrying of condoms as evidence for convictions, while reports from the Office of Crime Statistics and Research and South Australia Police described increased police activity towards FSW.

“Convictions against sex workers rose and it makes sense that this translated into sex workers not carrying condoms and having more unprotected sex,” Professor Fairley said.

The report concluded that policing of sex work may have resulted in adverse public health outcomes and said removing barriers to condom use was vital to the prevention of HIV and sexually transmitted infections (STI). It points out that New York City stopped using the possession of condoms as evidence of sex work in 2013 and suggests that governments in Australia consider similar legislative revisions.

The authors say the study has limitations –  the centres included represent only a sample of the population in each state, for example, and some evidence was circumstantial.

This study was in part funded by an NHMRC program grant and comes out in August 2016 in the journal Sexually Transmitted Infections.

Li B, Bi P, Waddell R, Chow EP, Donovan B, McNulty A, Fehler G, Loff B, Shahkhan H, Fairley CK. Was an epidemic of gonorrhoea among heterosexuals attending an Adelaide sexual health services associated with variations in sex work policing policy? Sex Transm Infect. 2016 Aug;92(5):377-9. doi: 10.1136/sextrans-2014-051918. Epub 2015 Nov 13.

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