UNTIL recently sex workers in Australia have been able to access confidential, free, anonymous testing services from sexual health clinics in many major centres and each capital city of Australia. However, the closure of major sexual health clinics in Queensland and the proposed Abbott Government co-payment scheme have sex workers concerned over costs and access to services.
Sex workers are regularly the safer sex educators of our clients, engaging with and negotiating safer sex practices with clients who are not as informed on risks and transmission. The outcome is exceptionally good for sex workers and the broader community as rates of HIV/STIs remain low. However, this success remains susceptible to the impacts of laws, policing practices and policy changes which impact on our ability to be effective educators and have autonomy over our own sexual health.
Removal of barriers to testing for marginalised communities has been key to increasing access. For sex workers the combination of confidential, free and anonymous testing lifts major barriers–proven as sex workers continue to attend while risking pervasive stigma and discriminatory attitudes in openly disclosing to sexual health staff that they are sex workers.
The closure of Biala and other sexual health clinics in Queensland has had a two-fold impact. Biala is where many sex workers, including street based sex workers who are often the most criminalised and marginalised of our community, could access testing and treatment free of charge in the inner city of Brisbane without an appointment. The closure of Biala leaves a major gap in services. It has also resulted in the significant overloading of alternative clinics as sex workers are forced to go to other clinics that are already at capacity.
As part of draconian laws that can be linked back to the 1800s, brothel-based sex workers in Queensland are required to present a certificate in order to work, demonstrating they have attended for a mandated set of tests. Studies have shown that mandatory testing is excessive, a waste of health resources, and ineffective as a public health measure. For sex workers the irony of being legally required to test at an unnecessary frequency whilst testing locations are being cut and health resources are stretched is a harsh sting.
Lulu, a queer sex worker in Queensland, sums up the outcomes:
“Biala is closed and other sex-worker friendly health clinics like Family Planning and PASH (PA) are either so full you can’t get an appointment for weeks or, in the case of the PA, aren’t taking on any new clients! This means that we are forced to get our health certificates from GPs, who aren’t always willing or educated about it. Many of them don’t know what a health certificate is, or don’t think they can issue one because they haven’t done it before.”
This issue is impacted by another popular misconception – that sex workers are making large sums of money. While it may be true for some, for others sex work is a part-time income source for single parents or students, or a job that allows the flexibility necessary for those with significant health, including mental health, conditions.
For some sex workers, particularly street-based, trans/gender diverse and male workers in inner city Brisbane locations, bulk billing is unlikely to be found. But for those that do locate a GP, the proposed $7 co-payment on each visit as well as on each pathology or diagnostic service costs will mean testing is another expense that sometimes will not be able to be met. The co-payment will have significant impact for HIV-positive sex workers accessing treatment and testing services. Some sex workers already describe the need to travel to Ipswich or further to access a GP that will bulk bill for tests. With GPs already publicly raising concerns that they will be worse off under the new budget if they bulk bill, this is a dwindling option. Whilst some sex workers will not find these costs burdensome, there are many for whom these extra expenses could mean that testing is simply unaffordable.
Sex workers are also experiencing the difference between accessing GPs, who handle a diverse case load, and accessing a clinic whose staff have specialised training.
Lulu says: “Sometimes they don’t know how to do a thorough check, or think they can’t give us the health certificate without the blood results, which take a week, which means a week without income because we can’t work without one.”
Being required to present a Medicare card for testing also creates a significant barrier for sex workers. The fear of having their legal name attached to sex work is often too great a risk and for others their visa or migration status means they do not have a Medicare card.
Accessing testing has all of a sudden become very expensive for some sex workers and impossible to access for others. It brings significant risks for even more sex workers. It remains in the interest of public health and HIV prevention that sex workers have access to confidential, free and anonymous testing services. The Queensland government’s decisions and the Federal government’s proposed co-payments puts this fundamental principle of public health at stake.