- Sex workers don’t always go the the doctor or the municipal health service (GGD) for an STI test or a vaccination
- Because of their work, they are at more risk of getting an STI or other health complaints
- It is important for sex workers to have access to STI care
- You yourself can offer health care at a sex club or in an area with window sex work
- Try to visit a location four times a year
Why offer STI care on site?
Not every sex worker goes to the municipal health service (GGD) or a doctor for an STI test or vaccination. There may be all sorts of reasons for this. For example:
- Someone does not have a regular doctor or doesn’t know that they can get tested free of charge
- They may be embarrassed or afraid to go to the doctor
- They don’t speak Dutch
Sex workers should have easy access to STI care. Because of their work, they are more at risk of getting an STI. They can also pass on an STI to more people. And an STI not only has physical consequences for them, it also impacts their finances.
Which locations
The best way to reach sex workers who don’t go to a doctor or municipal health service (GGD) is by testing and vaccinating them at their workplace. They often consider that to be a safe location where they can talk about sex work more easily. That will give you a better idea of what tests are necessary and what your client’s needs are.
Locations where you can offer STI tests and vaccinations:
- Sex clubs
- Areas with window sex work
- Massage parlours
- Private homes
- Sauna clubs or bathhouses
- Streetwalkers’ district
Some sex workers work from home or travel to the client. You can often reach them through the Internet. Especially on websites where they advertise.
Entering a sex work location
Do you want to offer STI tests and vaccinations on site? The manager or landlord of the location is required to enter the premises. That means you don’t have to tell them you’re going to visit. However, things are often easier if you do. That way, sex workers also know in advance that you are going to visit.
It’s best to contact the owner or landlord of the place you’re going to by email or telephone.
During your conversation or in your email, explain:
- Who you are and what you will be doing
- That you need a private area for testing or vaccinating. And good lighting if possible
- State that your conversations with your client are confidential and that the owner never gets the results of a test
- State that sex workers themselves decided whether to get tested or not
- Tell them the advantage of your visit: free tests and vaccinations. That results in healthy workers or tenants
Remember that sex workers don’t always know you will be visiting.
Steady contacts are best
It often helps if the same individuals offer STI care on site. That helps you to connect with your clients, but also with the owner. It is then often easier for you to do your work. Or a client or club owner may be more willing to contact you if necessary. For example if a sex worker has complaints or is pregnant or if there has been an STI outbreak at a location.
What do you take with you?
You need quite a lot of materials to test on site. A bag on wheels can be useful. Take these items with you when you visit:
- The materials you need to perform the STI tests on the penis, vagina, anus and throat. You also need additional items such as a needle container, label printer, small lab kit and gloves
- Stickers for the blood vials
- A cool bag for the hepatitis B vaccines
- Pregnancy tests, morning-after pill and condoms
- Information materials about STIs in various language, such as a flyer or brochure. Many sex workers speak English or Spanish
- Paper or an iPad or laptop on which you can make notes for your next visit. You won’t always have Wi-Fi, so be sure to make a hotspot using your mobile phone.
- Cards with your name, telephone number and email address
Contact with clients
STI care on site is different than during your STI consultation. You come into contact with people who don’t voluntarily come to the walk-in clinic. Keep this in mind in your contact with your client.
- Keep enough space free in your schedule for that day. Sometimes, more people show up than you are expecting. That way, you can see everyone who needs STI care
- Are you seeing a client for the first time? Schedule additional time for that. An initial meeting can sometimes take an hour because your client has so many things going on
- Start the chat with an open mind: be friendly, interested and respectful. Show your interest when listening. Don’t be surprised about things you client tells you and don’t be judgmental
- Have a good understanding of non-verbal communication
- Humor can sometimes help during a chat. Laughing together creates a connection
- Be flexible and remember that you sometimes have to improvise. Sometimes, you’ll be sitting on a mattress on the floor, sometimes in a warm attic room or on a stool. Every situation is different
- Give your client a card with your details so they can contact you. It’s good if there is a steady person your client can contact if they have questions
- If necessary, schedule a follow-up appointment. It’s nice to see a familiar face when your client comes to the municipal health service (GGD)
Misha’s story: “People say it’s only sex work, but to me, it’s my job.”
Misha had a troubled childhood and ran into the police at an early age. That was not what she wanted. She worked from a private home and as an escort. In this video you can see how the police put an end to her sex work. And how this led her to stand up for the rights of sex workers.
Counseling
An important part of the STI consultation is discussing sexually risky behavior and offering support when making healthy choices. Talk about this with your client after the STI test. You talk about:
- Regular testing: in the case of sex workers, the advice is to get tested for all STIs at least twice a year. And test all over the body: vagina, penis and anus and throath
- Also tell your client that they should always get tested if they have symptoms. Or if a condom broke or slipped off or the sex worker did not use a condom
- Hepatitis B vaccination. If possible, offer the vaccination immediately
- Or discuss whether PrEP is necessary for protection against HIV. This applies in particular to men and transgenders who have sex with men
- What someone can do if a condom broke or slipped off during sex
- Vaginal or penile hygiene: this can sometimes help to prevent an STI better
- Contraception: which one is best for your client?
On site you can also offer group counseling if clients also want that. That is often a good thing because sex workers react to each other and share experiences.
Would you like to know what advice to give about this? Read more about STI counseling for sex workers
Discussing test results
Do the tests show that your client has an STI? In that case, you send a message asking them to come to the municipal health service (GGD) for treatment. During the appointment, you discuss:
- The results of the STI test
- Who your client should warn. Offer them help and use the Partner Management guide (Dutch only)
- Whether your client can still work. Or when they can go back to work
Warning partners
Does your client have an STI? In that case, it is important to warn as many sex partners in the past few months as possible. It is often easier to warn your own partner. Warning clients is sometimes more difficult.
Tell your client that they never have to share the results with a landlord of the place of work or the proprietor
Tell them that they can also do this anonymously via partnerwaarschuwing.nl (in Dutch and English) and that you can help them do this.
How do you warn sex partners for your client (Dutch only)
Take action to promote sexual health
Would you like to know how to set up an activity for sex workers about sexual health? The e-learning, which includes practical tips from the SWIT guide, can get you started in two hours.