Sex workers in Australia have retained very low rates of HIV and STIs due to the rapid response led by sex workers in partnership with community-based sex worker organisations, governments and other agencies. One of the key successful approaches identified in Australia’s HIV and STI response is voluntary testing. Mandatory testing of HIV and STIs among sex workers in Australia has proven to be a barrier to otherwise successful HIV and STI peer education and prevention, and free and anonymous testing and treatment. However, despite strong evidence against mandatory testing of sex workers, it continues to be enforced in some states in Australia. This section will give you a brief overview of voluntary and mandatory testing.
Voluntary testing allows an individual the unimpeded choice to decide to take a sexual health screening. Voluntary testing requires the medical practitioner to gain informed consent before carrying out the sexual health screening; this involves informing the individual being tested of the testing procedures, why they are being tested, and the implications of the test results.
Benefits of voluntary testing
- Sex workers currently have high rates of sexual health testing in both voluntary and mandatory testing jurisdictions; this reveals mandatory testing to be neither necessary nor effective.
- Central to voluntary testing is informed consent and the pre- and post-test counselling, which has proven to be the most effective strategy in increasing behavioural change to reduce risk of transmission and ensuring positive outcomes for people living with HIV and the wider community.
- Voluntary testing is cost-effective as it reduces excessive and unnecessary testing of sex workers. Consequently, voluntary testing ensures that sex workers in need of sexual health screenings and services are prioritised at sexual health clinics and other medical service providers.
- Mandatory testing perpetuates the misconception that sex workers are ‘vectors of disease’ in need of public health regulation. Voluntary testing provides sex workers with the same basic right as everyone else to choose when they want to test.
- Voluntary testing creates an enabling environment in which the human rights of sex workers are upheld, such the right to bodily integrity, non-discrimination, and high quality health services.
- The Third National Sexually Transmissible Infections Strategy 2014-2017 and Seventh National HIV Strategy 2014 -2017 recognises voluntary testing of HIV and STI to be the optimal approach to achieving public health outcomes. These strategies provide the guidelines for Australia’s HIV and STI response.
- UNAIDS and WHO recognises voluntary testing as central to effective HIV prevention, based on extensive empirical studies.
Mandatory testing refers to the regular and frequent testing of sex workers required by law. In some states and territories where mandatory testing is enforced sex workers must regularly provide proof of sexual health testing, in the form of a ‘sexual health certificate’, to work legally. Mandatory testing is based on the false premise that all sex work entails penetrative sex; however, sex workers provide a range of services with different associated risks of transmission of STIs and HIV or no risk at all. Additionally, for sex workers who work infrequently mandatory testing is invasive and is of little benefit.
Sex workers already engage in safer sex practices, are experts at managing risk, and provide valuable sex education to clients, peers and the wider community.
- Is not evidenced by current epidemiology in Australia.
- Endorses a false sense of security in the form of a ‘certificate’, which due to window periods, cannot actually confirm an individual’s immediate sexual health status.
- Overloads sexual health services which reduces access for sex workers with symptoms or who have experienced a condom breakage and need immediate access to sexual health services;
- Results in reduced quality of sexual health services for sex workers.
- Is in opposition to identified best practice HIV and STI prevention models such as voluntary testing and self-regulation of sexual health amongst sex workers.
- Creates an unnecessary cost burden on public health funds.
- Has the unintentional consequence of perpetuating stigma and the misconception that sex workers are ‘vectors of disease’ even though sex workers in Australia have consistently retained very low rates of STIs and HIV.
Testing laws in Australia
Testing laws for sex workers vary depending on the state or territory you are working in and are liable to change. For this reason we highly recommended you contact your local sex worker organisation for a detailed description of your legal testing requirements.
For additional information, see http://www.scarletalliance.org.au/laws/