Talking about sex and STIs

Is your client a sex worker? Then you talk about:

• How and when do you use a condom?
• What else can you do to prevent getting an STI? PrEP and Hepatitis B, for example
• How often do you get tested each year?
• How do you keep your vagina or penis healthy?
• How do you avoid getting pregnant?

Remember that a sex worker can’t always work safely:

• Limiting the number of sex partners is not feasible when sex is your job
• Not every sex worker is in a good negotiation position with the client. This can be related to the social or economic status, where someone works or the number of clients someone has

Try to engage your client openly and don’t be judgmental. Make sure they know everything is confidential. 

Testing on a regular basis

Advise your client to get tested:

• At least twice a year for all STIs. And get tested all over your body: your vagina or penis, anus and throat
• If you have symptoms
• If a condom broke or slipped off
• If your client has been informed by a sex partner that they have an STI

Advise male sex workers and sex workers with a neo-vagina to get tested for STIs two to four times a year. Men who have sex with men and people with a neo-vagina are at a greater risk of getting an STI or becoming HIV positive. For example because anal sex involves more risks or because a neo-vagina does not get as moist and it’s easier to damage** them.

Using a condom and condom failures

Talk to your client about using condoms. Sex workers often use a condom at work, but not always in their personal lives and with regular clients. Sex workers can sometimes earn more money by having sex without using a condom. You can bring this up naturally without being judgmental.

Some sex workers use creams after a condom has broken or come off to prevent getting an STI. The creams don’t work and may involve additional risks. Advise your clients to not use them.
In the case of sex with a condom that broke or slid off, advise your client to pee, drink lots of water and rinse their vagina with lukewarm water. Tell them to not use a vaginal douche. They are then at more risk of getting an STI.

Discuss possible reasons for the condom failures and how important it is for a condom to fit properly. Recommend using water or silicon based lube for vaginal and anal sex. Does your client have a neo-vagina? If they do, they should not use water-based lube. The skin can weaken and the walls can stick to each other. Recommend using an oil-based lube and a condom that is resistant to that, like polyurethane or a latex-free condom. 

Also talk about other ways to protect yourself against STIs: PrEP against HIV or a Hepatitis B vaccine. There are various ways to avoid getting pregnant

Working if you have an STI

It’s important for sex workers to be able to get back to work sooner after they have tested positive for an STI. To them, no sex means no income. Talk about when it’s safe to go back to work. It’s important to tell them that

• there is no longer a risk of passing it on
• the body has had enough time to recover

Talk to your client about whether there are other services that a sex worker can offer until them. Maybe web cam sex, sexting or a strip tease show.

Talk about the different things involved in working if the client has an STI

Working when you have your period

It’s easier to get and pass on HIV or an STI when you’re on your period. However, not working during your period means a loss of income for a sex worker. 

You can recommend that they use a vaginal sponge during their period. Such a sponge should be used only once and not for longer than eight hours. Tell your client not to take a bath while wearing the sponge. And tell them they still need to use a condom.

A healthy vagina or penis

Keeping your vagina or penis clean reduces the risk of STIs. You can include the following aspects in your advice:

• Many sex workers use vaginal douches. This can damage the mucous membrane and actually increases the person’s risk of getting an STI
• “Dry sex” is common in some cultures. Dry sex is vaginal sex without lube and without the inside of the woman’s vagina being moist. This increases the risks of small wounds and an STI
• Some sex workers put herbs in their vagina or use vaginal steam baths. This can damage the vaginal mucous membrane and actually increase the person’s risk of getting an STI

Advise both people with a penis and those with a vagina: wash using lukewarm water and do not use soap or soap products.

Advise people with a vagina to not use vaginal douches, herbs or steam baths.

More about a healthy vagina
More about a healthy penis

Alcohol and drugs

Some sex workers use drugs during sex. They do so either voluntarily or are forced to. You can include the following aspects in your advice:

• When clients use drugs, the sex is sometimes rougher or lasts longer, or the vagina is drier. This can more easily lead to small wounds in the vagina and it’s easier to get an STI.
• Drugs sometimes make it more difficult to say no**. This can lead to someone more readily having unsafe sex or taking more risks during sex (several people, other acts)
• Drugs may make a client more aggressive. This increases the risk of violence

Talk to your client about whether they use drugs and what their experiences have been. Advise your client about how they can work as safely as possible.

Also talk about the possibilities for help if your client wants to stop taking drugs or if they want to have more control of their drug use.

Professional risks 

Sex work may entail risks for your client’s health. And not just when it comes to STIs. Irregular working hours, working at night, poor working condition, debts and work relationships can cause stress.

Also talk about these health risks. If necessary, refer your client to a social worker.

Contraception

Not all sex workers use contraception. Paying their insurance deductible or not having health insurance may be an impediment to using contraception. In addition, because of an irregular lifestyle, it is sometimes difficult for a sex worker to always take the pill on time. 

• Talk to your client about how they can best protect themselves against unwanted pregnancy:
• Tell them that a condom does not offer enough protection for this
• Discuss the various contraceptives 
• Does your client not always use contraception? Discuss the morning-after pill