Sexual risk and STI testing behaviour among Dutch female and male self-employed sex workers; a cross-sectional study using an Internet based survey.

BACKGROUND: Sex workers are men, women or transgender people who have sex in exchange for money or goods. Self-employed sex workers solicit clients independently from a third-party. Self-employed sex workers are at risk of acquiring sexually transmitted infections (STIs) through their work. We performed a cross-sectional study, using an Internet survey conducted in 2019-2020 aiming to establish sexual risk behaviour and STI testing behaviour among female and male self-employed sex workers. RESULTS: A total of 76 female self-employed sex workers (FSW) and 79 male self-employed sex workers (MSW) completed the survey. Both FSW and MSW more often had sex with partners of the opposite sex during work (65.8% FSW, 61.6% MSW) and in their private life (63.3% FSW; 64.5% MSW). During vaginal sex 35.7% of FSW and 29.6% of MSW did not always use a condom. Inconsistent condom use was observed in 35.7% of FSW and 29.6% of MSW during vaginal sex, 46.2% of FSW and 35.7% of MSW did not always use a condom during receptive anal sex. The majority of both FSW and MSW tested for STIs in the past year (67.1% FSW; 67.7% MSW) and 67.5% were aware of the possibility of low-threshold testing at an STI clinic. In the past year, 11.6% of FSW and 8.1% of MSW had an STI. CONCLUSION: The reported STI positivity rate among self-employed sex workers was not very high. However, STI prevention efforts remain important considering the low compliance with condom use during sex work. Moreover, not testing for STIs in the past year was substantial with one-third of both FSW and MSW and one-third of both FSW and MSW being unaware of the possibility of low-threshold testing at an STI clinic, warranting efforts to increase testing uptake in this population.

Consultation rate and chlamydia positivity among ethnic minority clients at STI clinics in the Netherlands.

OBJECTIVES: Although ethnic minority clients (EMs) from STI endemic countries have a higher risk for STI, little is known about their STI clinic consultation rate proportionality. The aim of this study was to assess consultation and chlamydia positivity rates among different EMs visiting STI clinics in the Netherlands. METHODS: We calculated consultation rates in EM groups by dividing the number of STI consultations by the total number of inhabitants in the region belonging to an EM, then compared the EM rates to native Dutch rates. Factors associated with chlamydia positivity were analysed using multivariate regression analysis. RESULTS: A total of 23,841 clients visiting an eastern Netherlands STI clinic between 2011 and 2013 were included in the analysis, of which 7% were EMs. The consultation rate of native Dutch clients was 22.5 per 1000, compared to 8.5 per 1000 among EMs. Consultation rates in all EMs were lower than in Dutch clients, except for Antillean or Aruban EMs and Latin American EMs. The chlamydia positivity rate among all clients was 15.5%, and Antillean or Aruban ethnicity (27.1%) EMs had the highest rates. Multivariate analysis identified the following factors associated with chlamydia positivity: Eastern or Northern European EM, African EM, Antillean or Aruban EM, STI related symptoms, heterosexual preference, partner in a risk group, receiving a partner notification, and having had three or more partners in the past six months. CONCLUSION: On a population level, most EMs visit STI clinics less often than native Dutch clients, but they have a higher rate of positive chlamydia diagnoses. STI clinics should increase outreach activities for EM clients because they are insufficiently reached by current practices, but contribute substantially to chlamydia incidence rates.

Sexual, addiction and mental health care needs among men who have sex with men practicing chemsex - a cross-sectional study in the Netherlands.

Drug use during sex ('chemsex') has been associated with sexually transmitted infections (STIs) and mental health harms. Little quantitative evidence exists on the health care needs of MSM practicing chemsex from a patient perspective. This study assessed self-perceived benefits and harms and the needs for professional counselling among MSM practicing chemsex. In 2018, 785 MSM were recruited at nine Dutch STI clinics and 511 (65%) completed the online questionnaire. Chemsex was defined as using cocaine, crystal meth, designer drugs, GHB/GBL, ketamine, speed and/or XTC/MDMA during sex <6 months. Chemsex was reported by 41% (209/511), of whom 23% (48/209) reported a need for professional counselling. The most reported topic to discuss was increasing self-control (52%, 25/48). Most MSM preferred to be counselled by sexual health experts (56%, 27/48). The need for professional counselling was higher among MSM who engaged in chemsex ≥2 times per month (30% vs. 17%, p = 0.03), did not have sex without drugs (sober sex) in the past three months (41% vs. 20%, p = 0.04), experienced disadvantages of chemsex (28% vs. 15%, p = 0.03), had a negative change in their lives due to chemsex (53% vs. 21%, p = 0.002), and/or had an intention to change chemsex behaviours (45% vs. 18%, p < 0.001). Our study shows that almost one in four MSM practicing chemsex expressed a need for professional counselling on chemsex-related issues. STI healthcare providers should assess the need for professional counselling in MSM practicing chemsex, especially in MSM with above mentioned characteristics, such as frequent users.