Managing the risk of sexually transmitted infections and blood-borne viruses in the sex industry

What is an STI?

STI means sexually transmitted infection. BBV means blood-borne virus. STIs are infections spread through sexual contact. Sexual contact includes vaginal, anal or oral sex. Some STIs are only transmitted by contact with bodily fluids. Others can also be transmitted by skin-to-skin contact.

Examples of STIs include:

• bacterial infections such as chlamydia, gonorrhoea and syphilis
• viral infections such as genital herpes and genital warts
• parasitic infections such as trichomoniasis

Control the risk of STIs and BBVs

Sex workers work in many different settings and offer many different services. Many sex workers will engage in different types of sex work. The risk of transmitting an STI may vary between different activities or services. Minimising the exchange of bodily fluids such as semen, vaginal fluids or blood can greatly reduce the risk of contracting an STI or BBV.

If you are an employer, you have a duty under the Occupational Health and Safety Act (OHS Act) to control health and safety risks in your workplace. The OHS Act says risks to workplace health and safety must be eliminated, so far as reasonably practicable. In other words, do everything that is reasonable to remove risks from the working environment.

If it is not reasonably practicable to eliminate a risk, you must reduce the risk so far as is reasonably practicable.

Reducing the risk may involve a single control measure. Or it may involve a combination of different controls that work together. Your controls have to provide the highest level of reasonably practicable protection.

Condom and barrier use

External and internal condoms and other barriers such as dental dams or gloves are control measures that can reduce the risk of STIs and BBVs. When using condoms and other barriers as part of your risk controls, you should provide enough of these items in different sizes for employees to use during their shift.

Condoms and other barriers are most effective when they are:

• fitted or inserted correctly. For example, external condoms should be the right size and not too loose or too tight. They should also be rolled to the base of the penis or sex toy
• not damaged or broken
• used with a compatible lubricant such as water-based lubricant to prevent breakage
• within the expiry date
• not re-used
• stored in a cool dry place away from heat and moisture

Condoms and other barriers are less effective at reducing the risk of STIs that can be spread by skin-to-skin contact. This includes viruses such as herpes, and bacterial infections such as syphilis.

Other risk controls

Condoms and other barriers should be used with other risk controls to provide protection from STIs and BBVs. Other risk controls include:

• visibly assessing clients for symptoms or signs of infection. This means looking at a client’s penis, anus, vagina, mouth and surrounding areas under good lighting for sores, blisters, rashes, bleeding or discharge. If an employee suspects a client has an STI you should support them to refuse or change the service. Other services may include mutual masturbation or erotic massage that avoid the site of the infection. You should also support your employee in suggesting the client is tested before returning.
• providing information on accessing voluntary sexual health testing based on individual needs and advice from a doctor. Employees may also talk to their doctor about vaccinations for hepatitis A, hepatitis B, human papillomavirus (HPV) and mpox (monkeypox). They may also talk about the suitability of pre-exposure prophylaxis (PrEP). PrEP is an oral medication that prevents HIV in people at risk of infection.
• providing information to clients on the businesses safe sex practices. This may include pamphlets and posters promoting condom and barrier use.
• Practising good hygiene and cleaning procedures such as:
  • changing linen and towels in-between clients
  • disinfecting items used or touched during sessions
  • wearing gloves when cleaning bodily fluids or blood and having a biohazard spill kit available
  • regularly washing hands with warm water and soap
  • safely disposing of used condoms and other barriers

The Department of Health has more information about the prevention of STIs and BBVs, including sexual health testing, vaccinations and PrEP.

WorkSafe has guidance about risk management in sex work. WorkSafe's Facilities for Sex Work guidance also includes information about cleaning up bodily fluids.

The Environment Protection Authority (EPA) Victoria provides guidance on the safe disposal of clinical and related waste. The guidance includes information for brothels.

Consult with your employees

The OHS Act requires employers to consult with their employees and any health and safety representatives (HSRs) about certain matters that affect them or are likely to affect them. If you are an employer, you must fulfil this duty so far as is reasonably practicable. Under the OHS Act, for the purposes of consultation, ‘employees’ includes the following in relation to matters over which you have control:

• independent contractors you have engaged
• employees of the independent contractors

There are also consultation obligations between employers and labour hire providers who share occupational health and safety duties to labour hire workers.

When managing the risk of STIs and BBVs, input from employees in identifying and addressing the risk factors is important. Give employees and any HSRs the opportunity to have their say about their protection needs and which barriers they prefer to use. Encourage them to ask questions, raise concerns, suggest options and make recommendations.

Information, instruction, training and supervision

The OHS Act requires employers to provide employees with:

• information
• instruction
• training
• supervision

For this purpose, 'employees' includes independent contractors and employees of independent contractors.

As an employer, you have to meet a certain standard when fulfilling this duty. You must provide what is 'necessary' for employees to work safely and without risks to health. The degree of information, instruction, training and supervision that is necessary can vary. It will depend on the types of hazards in the workplace. It will also depend on how much employees already know about the risks and how to control them.

You should provide information, instruction, training and supervision about managing the risks of STIs and BBVs to your employees. This includes, for example:

• information on services in which condom or other barrier use is recommended
• information about STIs and BBVs
• information on health testing and treatment for STIs and BBVs
• how to check clients for visible signs of an STI and how to recognise symptoms
• procedures for seeking a second opinion after assessing a client for STI symptoms
• how to use condoms and other barriers safely
• how to store condoms and other barriers
• how to dispose of used condoms and other barriers safely
• cleaning, disinfecting and good hygiene practices
• how to negotiate condom and barrier use with clients, and how to deal with a client who refuses to wear a condom or other barriers
• what to do if a client intentionally removes or tampers with a condom or intentionally does not use a condom. This may be considered lack of consent under the Crimes Act
• what to do if a condom or barrier breaks or slips

You might engage employees to provide information, instruction, training and supervision. In this case, ensure those people have necessary skills and experience. Also ensure they are familiar with the business’s policies and procedures.

The Department of Health has more information about the prevention of STIs and BBVs.

Keeping records of your risk controls

Keeping basic written records on your risk management approach and safe systems of work can have many benefits for your workplace. Documenting how your workplace controls the risk of STIs and BBVs can:

• assist in induction and training for new employees
• show others, such as clients, how your workplace manages risk
• show how decisions about what is reasonably practicable were made following the consultation process

Written records may also include:

• logbooks on premises' cleaning and disinfecting practices, including laundering of linen and towels
• logbooks on quantities, expiry dates and replacement dates of condoms and other barriers