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Methods: This was a cross-sectional mixed methods study of sex workers in Western Australia. The primary reason for the visits to the sexual services premises was to recruit sex workers to participate in the study.

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For the purposes of this study we defined a sex worker as someone who provides sexual services sexual intercourse with, or masturbation of another person, using any part of the body or an object in exchange for financial gain. Survey participants were recruited via social media Facebook and Twitter ; advertisements in print media; notifications to e-lists and sex worker organizations; visits to sexual services premises; text messages to private sex workers identified via perusal of online and newspaper advertisements; promotional materials left at businesses likely to engage or have contact with sex workers; and via personal networks of peer researchers.

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A lower proportion of sex workers who reported getting safe sex information from clients reported condom use with all clients in an average week during all forms of penetrative sex compared to respondents who reported getting safe sex information from other sources Table 5. Brothels are also illegal 7. For interviews, participants ticked a box on a paper survey indicating consent that was countered by the investigator.

Sex worker survey respondents were invited to indicate an interest in participating in an in-depth interview and other participants were recruited through word of mouth by peers, peer researchers and peer organizations.

Table 4. To increase the of premises with predominantly Asian sex workers visited, attempts were made to also visit a of massage shop front premises that were identified by peer researchers. Peer-based sex worker organizations exist in most Australian jurisdictions, and these are members of a national sex worker organization, Scarlet Alliance 6.

Declining condom use among sex workers in western australia

We visited 22 sexual service premises. The sex worker survey instrument was based on a survey that was used ly 2. The use of condoms with clients in an average week by respondents reporting this type of sex with clients. We compiled two separate lists: those with predominantly English-speaking sex workers and those with predominantly Asian sex workers. The Google search engine was used to search the following search terms—escort, massage, brothel, sex, parlor, sensual, sexual, services, and classified. The survey included demographic information; questions about access to information and health services; condom usage; drug and alcohol use; interactions with police; and experiences of violence, stigma, and mental health.

The study involved an environmental scan of the sex industry in Western Australia, visits to brothels and other sexual services premises, a survey of sex workers and in-depth interviews. Of these, 18 were brothels and four predominantly provided massage services.

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Proportion of respondents reporting that clients requested sex without condoms in an average week. There are three different legislative approaches to sex work in Australia: decriminalization, regulation, and criminalization 7. All participants provided informed consent to participate according to the Declaration of Helsinki.

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This audit tool included the presence of age stating a requirement to use condoms during penetrative sex, as well as other infrastructure and resources aimed at improving occupational health and safety of sex workers, such as a lunch room, duress alarms and security cameras. Descriptive codes or labels were ased to items of interest and related codes were then grouped into to develop overarching themes that addressed the research questions We perused advertisements for sexual services.

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The objectives of the aspects of the study reported here were to assess the proportion of sex workers reporting that clients requested and participated in condomless sex, and to investigate the factors associated with condomless sex with clients. We developed a list of sexual services premises and their locations after scanning the advertisements.

However, those respondents who reported drinking six or more standard drinks on any one occasion at least weekly were less likely than other respondents to report condom use always during oral, vaginal and anal sex with clients Table 4.

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Introduction: Since the emergence of the HIV pandemic in the s, high rates of condom use for penetrative sex have been reported among sex workers in Australia. : We surveyed male, female, and transgender sex workers in Western Australia. Proportion of respondents reporting that all clients used condoms in an average week according to reported use of illicit drugs in the past 6 months and consuming six or more standard drinks on any one occasion at least weekly. In contrast there was one prosecution for this offense in the years — 7.

Quantitative: Frequency analyses were undertaken of the survey responses and when comparisons were made between groups of respondents, Mantel Haenszel Chi squared analysis was undertaken or where appropriate Fischer's Exact Test to estimate p values. The condom researchers undertook visits to sexual services premises including brothels, and were involved in recruitment of study participants. Decriminalization on the other hand, may result in better health outcomes for sex workers 29.

Eighty one percent of respondents were women. However, street-based sex work is illegal and it is illegal to live off the earnings of another's sex work. We found unexpectedly low rates of reported condom use with clients for all forms of penetrative sex. The semi-structured interview sex were analyzed thematically to identify common themes in the data and any emerging themes that warranted further exploration in subsequent interviews as described elsewhere 7.

Table 5. Additional questions were included in the survey following consultation with key stakeholders including peer-based sex worker organizations. Proportion of escorts reporting that all clients used condoms in an average week according to sources of information about safe sex skills among respondents having this type of sex with clients. Advertisements from without newspapers throughout WA were also perused. Inconsistency in condom use during oral sex has been reported among female sex workers attending a sexual health clinic in Sydney 4.

Following perusal of an information statement, participants ticked a box on the online survey indicating consent. These advertisements were perused to obtain contact details to promote our online survey.

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We interviewed everyone who agreed to be interviewed, and undertook 17 in-depth interviews. Table 3. During these visits peer researchers also undertook a venue audit using a structured audit tool. An increase in private sex work and client demand for condomless sex together with an economic downturn leading to increased competition for clients may be important contributing factors. Additional peers, who were representatives of peer-based sex worker organizations, also contributed to the study de and reviewed our study findings.

Over half of the respondents Table 2.

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This was a broad study that addressed a range of objectives including those relating to condom use with clients. Interviews lasted between 30 and 90 min and all but two who declined condom audio-recorded and transcribed. Some qualitative responses to questions in the survey were coded either manually or by searching for sub-strings within the responses. For example, prior research in New South Sex using a variety of methods estimated the of sex workers in that state to be anywhere between 1, and 10, 3.

Any advertisements that were found to offer condomless or natural sex were noted. Semi-structured in-depth interviews were conducted after the survey, and an interview guide was developed based on themes of interest arising from the survey. The survey was self-administered either online or on paper, unless requested by the respondent when it was completed with the assistance of a peer researcher. Peer researchers undertook all visits to sexual services premises.

In Australia, increased s of sex workers from Asian countries particularly China, Korea and Thailand have also been observed Therefore, we considered it to be timely to investigate the health and safety of sex workers in WA 7. Conclusions: There has been an without escort in sex workers reporting condomless penetrative sex with clients in Western Australia compared to a cross-sectional study. This was done to protect the participants' anonymity. We therefore decided to investigate sex workers' use of condoms during penetrative sex with clients.

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Three did not specify the service. Attempts were made to visit all premises identified as providing full service by predominantly Asian sex workers, as we expected that a of such premises would not be identified. These search terms were identified from the literature and from discussions with peers. Eight current or former sex workers and a brothel receptionist were recruited as peer researchers and were trained by an investigator JBwho is also a peer. There have not been any changes in WA legislation in relation to sex work between when the study was undertaken and the present.

In addition, a of online advertising sites known to advertise sexual services were perused. We removed a of premises from the initial list after being informed by peer researchers that they no longer existed or could not be found. There has also been some evidence of reductions in condom use, particularly during penetrative oral sex.

Increasing client demand, fear of losing clients and the ability to charge more for condomless sex were reported reasons for providing this service.

Introduction

The survey also included a validated question about binge drinking The survey included options for open responses for a of questions. Participants received AUD30 in cash for a completed face-to-face survey or a gift voucher for a completed online survey. JB was involved throughout the study from its development to reviewing study findings and contributing to manuscripts. There is no evidence that criminalization in a reduction in sex work 8. There was no association between reported illicit drug use in the past 6 months and condomless sex with clients.

In WA private sex work is not an offense.

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The sex industry in Australia and elsewhere has changed over the decade with increasing proportions of sex workers working privately and lower proportions of sex workers working in brothels. The use of condoms during sex work has been reinforced and supported over time by outreach, peer education and support by community-based organizations around Australia 5. In response to the emerging human immunodeficiency virus HIV pandemic in Australia in the s, Australian sex workers instituted high rates of condom use with clients and regular sexual health checks that resulted in rates of HIV and sexually transmissible infections STI among sex workers that were equivalent to or even lower than in the general population 1.

For contacting and visits, peer researchers were provided with a random selection of Perth-based brothels with a majority of English-speaking workers offering full service penetrative sex.

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This list was augmented by peers and our peer researchers. Between andthe WA economy boomed, and peaked in Following the peak it declined back to levels Very little is documented about the size and composition of the sex industry in Australia. These languages were the most common native languages of Asian sex workers in Perth. However, many have observed that in the last decade the sex industry in Australia and other countries has changed with an increasing proportion of private sex workers working outside of brothels.

This was a cross-sectional mixed methods study of the sex industry in WA, involving perusal of advertisements, a survey of sex workers, visits to sexual services premises and in-depth interviews with sex workers.