Are condoms the only way sex workers can protect themselves from STDs?

Q: How can sex workers protect themselves from sexually transmitted diseases?

A. The World Health Organisation and The Joint United Nations Programme on HIV/Aids (UNAIDS) have made several recommendations as to how those involved in the sex work industry can protect themselves against sexually transmitted diseases. 

Sex work includes a broad range of sexual contact and/or sexual activities. These include the services offered by massage parlours; using content produced by the adult film industry; engaging with exotic dancers, and having penetrative sex with clients.

The health dangers that sex workers face are the result of multiple high-risk sex partners and of engaging in sexual acts and interactions such as anal sex, fisting and the use of sex toys.

Sex workers also face a higher risk of violence associated with unsafe working spaces and increased exposure to sexually transmitted infection due to lack of access to internal and external condoms.

Furthermore, sex workers sometimes expect to receive more money for sex without a condom and so agree to take a chance and not insist on one.

Some sex workers may use condoms less often with regular clients than with one-time clients and even less frequently with intimate partners.

For sex workers who are HIV-negative, prevention options like pre-exposure prophylaxis (PrEP) can be used to decrease the risk of HIV transmission if a condom was not used.

For those who are living with HIV, taking medicines to treat the disease - anti-retroviral (ARV) medication - is the right way to keep healthy and is effective in reducing the chance of transmitting HIV to others.

Many people face stigma, poverty and lack of access to health care and other social services, all of which pose challenges to HIV prevention efforts.

Part of responsible sex work includes understanding sexual behaviours related to health and pleasure.

• Dr Tlaleng Mofokeng (MBChB), sexual and reproductive health practice, Disa Clinic, safersex.co.za. Mofokeng has recently been named SA's Commissioner of Gender Equality by President Cyril Ramaphosa.

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