Comprehensive Sexual Health Education Guide for Australian Sex Workers: Prioritizing Your Well-being

Sexual Health for Sex Workers in Victoria: Practical, Current Guidance

Sexual health is an important part of staying well in adult-industry work, but it should be based on current evidence rather than old legal requirements or blanket rules.

In Victoria, sex work is decriminalised. The former requirement for sex workers to undergo mandatory STI and blood-borne virus testing every three months ended in 2022. Testing is now voluntary, and how often you test should be decided with a health professional based on your individual circumstances, sexual practices, symptoms, partners and exposure risk.

This guide is general information only. It is not a substitute for personal medical advice from a doctor, nurse or sexual-health clinician.

What changed in Victoria?

Victoria removed sex-work-specific public-health offences as part of decriminalisation. That included the old mandatory quarterly STI and BBV testing requirement and offences linked to working with an STI or BBV.

That does not mean sexual health is unimportant. It means prevention is now based on voluntary testing, safer-sex practices, treatment, education and access to health care rather than compulsory certificates.

Business operators should not rely on STI certificates as a safety control. Current Victorian guidance instead recommends accurate sexual-health information, access to voluntary testing, condoms and compatible lubricant, and workplace policies that support workers to negotiate safer sex and refuse or change services.

STI and BBV testing

Many STIs do not cause obvious symptoms, so testing can still be useful even when you feel well. The right tests and testing frequency depend on the person.

A clinician may consider factors such as:

• the types of sexual activity you have
• whether barriers such as condoms are used
• the number and type of sexual partners
• whether you have symptoms
• whether you have had a recent condom break or other exposure
• your previous STI or BBV history

Testing may involve urine, blood or swab samples. Depending on the sexual practices involved, samples may be taken from more than one site.

In Victoria, Sexual Health Victoria offers confidential STI and BBV testing and also provides screening services for sex workers. Your GP or another sexual-health clinic can also help you work out what testing is appropriate for you.

Condoms, barriers and lubricant

Condoms reduce the risk of many STIs and can also help prevent pregnancy. They do not eliminate every risk because some infections can spread through skin-to-skin contact outside the area covered by a condom.

Good practice includes:

• using a new condom for each sexual act where a condom is part of your safer-sex plan
• checking expiry dates and packaging
• using lubricant that is compatible with the condom material
• changing condoms if you change between different types of sexual activity
• knowing what to do if a condom breaks, slips or is removed without consent

Internal condoms and other barrier methods may also be useful depending on the activity. A sexual-health clinician or peer organisation can help with practical options.

Consent, condom removal and boundaries

Safer-sex decisions are part of consent. In Victoria, non-consensual condom removal, tampering or non-use can amount to a sexual offence.

You should be able to set and change your boundaries at any time. A workplace should support you if you refuse or stop a service because a client ignores a condition you agreed to.

For practical workplace questions, see safety and boundaries in adult-industry work.

Vaccination

Vaccination can reduce the risk of some infections. Depending on your age, health history and previous vaccination status, a clinician may discuss vaccines such as HPV, hepatitis B or mpox.

HPV vaccination is one of the main ways to reduce the risk of HPV infection and HPV-related cancers. Condoms reduce some HPV risk but do not fully prevent skin-to-skin transmission.

If you are unsure what you have already received, ask a clinician to review your vaccination history.

PrEP, PEP and HIV

For some people, HIV prevention may also include PrEP, a medicine taken to reduce the chance of acquiring HIV. PEP is an emergency HIV-prevention treatment that can be considered after a possible exposure and needs to be started promptly.

If you think you may have had a significant HIV exposure, contact a sexual-health service or urgent medical service as soon as possible.

People living with HIV can legally work as sex workers in Victoria. Modern HIV treatment can reduce viral load to an undetectable level, which means HIV is not sexually transmitted while that undetectable viral load is maintained.

Symptoms that should be checked

Get medical advice if you notice symptoms such as unusual discharge, sores, blisters, rash, pain when urinating, pelvic or testicular pain, unexplained bleeding, or persistent genital or anal irritation.

Symptoms are not the only reason to test. Some STIs have no symptoms, so testing decisions should consider exposure as well as how you feel.

Contraception and pregnancy prevention

If pregnancy prevention is relevant to you, condoms can be combined with another contraceptive method such as the pill, an implant or an IUD. The best option depends on your health, preferences and plans.

Emergency contraception is also available after unprotected sex or contraceptive failure. A pharmacist, GP or sexual-health clinic can explain the options and timing.

Privacy and confidentiality in health care

Sexual-health consultations are confidential. You can ask a clinic what information it records, how results are communicated and what costs apply before you book.

You do not need to disclose more personal information than is necessary, but telling a clinician relevant information about your sexual practices can help them recommend the right tests and care.

If privacy is especially important to you, ask:

• how appointment reminders are sent
• whether voicemail or SMS will identify the clinic
• how results are delivered
• who can access your file
• whether Medicare billing will create a record you need to consider

Where to get help in Victoria

• Sexual Health Victoria: confidential STI and BBV testing, contraception, reproductive-health care, PrEP and sex-worker screening.
• Vixen: Victoria’s peer sex worker organisation, offering peer information, outreach and support.
• RhED: support and referrals for sex workers in Victoria.
• Scarlet Alliance Red Book: national peer-developed sexual-health information for sex workers.
• Your GP or local sexual-health clinic: testing, treatment, vaccination and personalised advice.

If you are new to the industry, you may also find the Victoria starting-out checklist useful for broader questions about safety, privacy, pay and worker status.

Mental health and wellbeing

Sexual health is only one part of wellbeing. Privacy concerns, stigma, difficult client interactions, financial pressure and workplace stress can all affect mental health.

Peer support can be especially useful because you can speak with people who understand the industry without having to explain or justify your work. Vixen, RhED and Scarlet Alliance can help connect workers with appropriate support.

If you are in immediate danger or need urgent medical care, use emergency services rather than relying on online information.

Key points

• Victoria no longer requires sex workers to undergo STI testing every three months.
• Testing should be voluntary and based on individual risk, symptoms and clinical advice.
• Condoms and other barriers reduce many risks but do not prevent every STI.
• Vaccination, PrEP, PEP and regular health care may be relevant depending on your circumstances.
• Sexual-health services should be confidential and non-judgmental.
• Current Victorian guidance should be used instead of older pre-decriminalisation rules.

This article provides general information only and does not replace medical advice from a qualified health professional.