Validation of a computerised logMAR visual acuity measurement system (COMPlog): comparison with ETDRS and the electronic ETDRS testing algorithm in adults and amblyopic children.

BACKGROUND/AIM: The COMPlog clinical visual acuity measuring system is being developed for both routine and research use. This study aimed to validate its performance in amblyopic children and both normal and diseased adults against the gold standard ETDRS chart and the E-ETDRS computerised acuity measurement algorithm. METHOD: Timed test and retest fully interpolated five letters per line logMAR visual acuity measurements were taken for 70 adults and 59 amblyopic children using the ETDRS chart and the COMPlog visual acuity measurement system. 39 of the adults also underwent computerised acuity testing using the E-ETDRS testing algorithm. The tested adults included normals as well as subjects with a range of ocular diseases. The methods of Bland and Altman were employed with test-retest variability (TRV) expressed as 95% confidence limits for agreement. RESULTS: No significant bias was observed between the gold standard ETDRS acuity measurements and those taken with either COMPlog or E-ETDRS. TRVs of +/-0.12 logMAR and +/-0.10 logMAR were respectively found for COMPlog measurements in the amblyopic children and adult groups compared with +/-0.12 logMAR for the ETDRS chart in both groups. The TRV of the E-ETDRS system was slightly greater at +/-0.16 logMAR. Median testing times for COMPlog and ETDRS were 95 and 85 s and 66 and 56 s respectively in the paediatric and adult groups and 120 s for the E-ETDRS measurements on adults. DISCUSSION: COMPlog measurements agree well with and are similarly reliable to the gold standard ETDRS chart with comparable test times. E-ETDRS algorithm measurements took approximately twice as long.

Demographic, migration status, and work-related changes in Asian female sex workers surveyed in Sydney, 1993 and 2003.

OBJECTIVE: To compare demography, sexual health awareness, migration and workplace conditions of Asian female sex workers in Sydney in 1993 and 2003. METHOD: A Chinese interpreter and a Thai-speaking health education officer (HEO) were used to administer a questionnaire survey to Thai- and Chinese-speaking sex workers attending sexual health clinics in 1993. A follow-up survey, which included some women contacted at work as well as clinic attenders, was administered by Thai- and Chinese-speaking HEOs in 2003. RESULTS: Ninety-one female sex workers were surveyed in 1993 and 165 in 2003. Median age increased (26 years vs. 33 years, p=0.000), as did numbers of Chinese- versus Thai-speakers (1993, 25.3% Chinese vs. 2003, 58.2% Chinese, p=0.000). In 2003, the women reported more years of schooling and better English skills. Fewer reported previous sex work (48.4% vs. 17.6%, p=0.000). Numbers currently or ever on a contract decreased sharply (27.5% vs. 9.1%, p=0.000) and the majority were apparently working legally. Condom use at work for vaginal (51.6% vs. 84.8%) and oral sex (39.6% vs. 66.1%) increased significantly (p=0.001). Chinese-speaking sex workers were less informed about HIV transmission and safer sex practices than were Thai sex workers. Drug and alcohol use was low. CONCLUSIONS AND IMPLICATIONS: Positive changes have occurred in the conditions of Asian female sex workers surveyed over 10 years in Sydney. Maintaining current levels of health service delivery will ensure continued improvements in health and workplace conditions and address inequalities between language groups.

The many faces of sex work.

OBJECTIVE: To compile a global typography of commercial sex work. METHODS: A Medline search and review of 681 "prostitution" articles was conducted. In addition, the investigators pooled their 20 years of collected papers and monographs, and their observations in more than 15 countries. Arbitrary categories were developed to compile a workable typology of sex work. RESULTS: At least 25 types of sex work were identified according to worksite, principal mode of soliciting clients, or sexual practices. These types of work are often grouped under the headings of "direct" and "indirect" prostitution, with the latter group less likely to be perceived or to perceive themselves as sex workers. In general, policing sex work can change its typology and location but its prevalence is rarely affected. The public health implications of sex work vary widely. CONCLUSION: Developing comprehensive sexual health promotion programmes requires a complete understanding of the types of sex work in a particular area. This study provides a checklist for developing appropriate and targeted programmes.

The health and welfare needs of female and transgender street sex workers in New South Wales.

OBJECTIVES: To determine the health and welfare status of female and transgender street sex workers and their work-related experiences. Also to estimate population numbers, determine work locations, and identify the most appropriate education, health and welfare services for this group. METHODS: Forty-eight street sex workers completed a questionnaire, mainly at their place of work. Demographic and sexual health profiles of sex workers attending the Sydney Sexual Health Centre and the Kirketon Road Centre in 1997 were compared with the street sample. RESULTS: Up to 120 female and transgender sex workers worked on the streets in Sydney, Newcastle, Wollongong and surrounding areas in any one night: more than 80% of these were female. Of those sampled, fewer street workers than brothel sex workers (6% vs. 41%; p<0.001) were from non-English speaking backgrounds, and more (77% vs. 7%; p<0.0001) were currently injecting drugs. The street workers reported lower rates of condom use at work than local brothel workers (91.7% vs. 98.8%; p<0.016) and high rates of hepatitis B and C infection. Seventy-five per cent had experienced violence at work. Child care, lack of supportive relationships, community intolerance and low self-esteem were important problems for the street workers. While the police were frequently required by the community to move the street workers on, there were no reports of corrupt behaviour by police. CONCLUSIONS: Health services need to specifically target this group with particular attention to the prevention of blood-borne virus infections, contraception, drug dependency and transgender issues. Consideration should be given to developing a network of safe houses to reduce community pressure and violence.

Sexually transmitted diseases in Australia: a decade of change. Epidemiology and surveillance.

Survival data in the last decade for sexually transmitted diseases (STDs) other than human immunodeficiency virus (HIV) are uneven across the states/territories. The incidence of gonorrhoea decreased by more than 80%, but at different times in different patient groups, different states, and different anatomical sites. There was a resurgence of rectal gonorrhoea in homosexual men in 1989-1991. Resistance to penicillin steadily increased, and partial resistance to quinolones has emerged. There was a marked decline in syphilis in most states. Lymphogranuloma venereum is rare, and chancroid seen mostly in returning travellers from Southeast Asia; however, hundreds of cases of donovanosis are seen annually among rural Aborigines. The prevalence of genital infections with Chlamydia trachomatis remained stable at 2.5%-14% in STD clinics, and 5% in family planning clinics. The numbers of cases of clinical genital herpes and warts are mostly unavailable. However, specific serology for herpes simplex virus type 2 (HSV-2) indicates that 14% of antenatal clinic patients, and 40%-60% of STD patients have been exposed. Pap smears have detected the presence of human papilloma virus (HPV) in 14%-40% of various clinic populations. Exposure to hepatitis B in the non-Aboriginal population decreased markedly. Hepatitis C infection occurred in a high percentage of injecting drug users; the evidence for sexual transmission is not strong. An epidemic of hepatitis A infection occurred in male homosexuals in 1989-1991. Changes in the Australian sex industry resulted in marked improvements in the sexual health of local (but not international) sex workers. The high levels of STDs in Aboriginal communities continues to cause concern.

A survey of female prostitutes at risk of HIV infection and other sexually transmissible diseases.

OBJECTIVE: To determine risk factors for the transmission of human immunodeficiency virus (HIV), including injecting drug use (IDU), sexual behaviour and other sexually transmissible diseases (STDs), in female prostitutes who attended the Sydney Sexual Health (previously STD) Centre. DESIGN: We surveyed by questionnaire 231 (47%) of 491 female prostitutes who visited the Centre over a 19 month period from 1986 to 1988. All were tested for HIV antibody. MAIN OUTCOME: All the women were seronegative for HIV but a number of major risk factors for infection were identified. RESULTS: Seventeen of 26 (65%) current injecting drug users had shared needles in the previous 6 months. Nineteen per cent of those surveyed had bisexual non-paying partners and 21% had partners who injected drugs. Sixty nine per cent always used condoms for vaginal intercourse with paying clients, but they were rarely used with non-paying partners. Condom use was also rare for anal intercourse with clients and/or partners by those (18%) who practised it. Seventeen per cent used condoms alone for contraception and 48% relied on oral contraceptives. We found a reduction in gonorrhoea, herpes and trichomoniasis when compared with a 1985 study conducted at the same Centre. However, there was an increase in reported abnormal cervical cytology. CONCLUSION: In spite of behaviour change by some, there are still many women working as prostitutes in Sydney who remain seriously at risk of HIV infection. We recommend more widespread use of barrier methods of contraception, intensified efforts to prevent the sharing of intravenous needles, closer monitoring of the health of prostitutes, and scientific study of their paying and non-paying sexual partners.

Drug use by prostitutes in Sydney.

We report a comparative study of drug consumption by 277 female prostitutes and 95 women who had never worked as prostitutes, attending the Sydney STD Centre in 1985 and 1987. Marijuana was the drug most often used by prostitutes and non-prostitutes, followed by sleeping pills, amphetamines, cocaine and heroin. About 12% in both groups used intravenous drugs but prostitutes were significantly more likely to share needles and syringes. Prostitutes were also more likely to smoke cigarettes than non-prostitutes, and young prostitutes smoked significantly more heavily than other women in the study. Although fewer prostitutes than non-prostitutes drank alcohol, those who did drink were more likely to do so at a harmful level. We conclude that where differences in drug consumption exist between prostitutes and non-prostitutes, they are mainly work related.

Human immunodeficiency virus and female prostitutes, Sydney 1985.

One hundred and thirty two female prostitutes and 55 non-prostitutes who were tested for antibodies to human immunodeficiency virus (HIV) were surveyed by questionnaire at this centre. The two groups were well matched for age and were very similar in other except for numbers of their sexual partners. Questions were asked about drug taking, sexual practices, general health, and episodes of sexually transmitted diseases (STDs). None of the women in the survey was found to be seropositive, but both groups were found to be seriously at risk of HIV infection through using intravenous (IV) drugs, having unprotected sexual intercourse with men who used IV drugs, having unprotected sexual intercourse with bisexual men, or exposure to several STDs.

PIP: In 1985, 132 female prostitutes and 55 female nonprostitutes at a sexually transmitted disease (STD) clinic in Sydney, Australia requested to be tested for HIV antibodies and completed a questionnaire covering a wide range of social and medical issues. The 2 groups were matched for age and were similar in other respects, excluding the number of sexual partners. Laboratory personnel tested the serum using the ELISA test and confirmed by the H9 exclusionary ELISA and by immunofluorescence using a T cell line infected with HIV. All the women tested seronegative for HIV antibodies. 19% of the prostitutes and 24% of the nonprostitutes had used IV drugs. A substantial number of women from both groups reported using 1 or more other drugs. 37% of the prostitutes and 45% of nonprostitutes claimed to not have used any of the illegal drugs listed in the questionnaire, during the preceding 6 months. 29% of the prostitutes and 33% of the nonprostitutes recorded partners at risk from IV drug use. The number of sexual partners reported by the 2 groups in the month prior to the survey ranged from 1-250 (median 24.5) for prostitutes and 0-4 (median 1.50) for nonprostitutes. For a 1 year period the corresponding figures included 1-3000 (median 175) for prostitutes and 1-13 (median 3.5) for nonprostitutes. More than 1/3 reported having bisexual partners during the previous 5 years. Prostitutes had significantly more episodes of gonorrhea, chlamydial infection, and pelvic inflammatory disease than the nonprostitute group (p.05). 1/2 of the 8 prostitutes who had hepatitis B were IV drug users. 76% of nonprostitute partners and 49% of prostitute partners did not use condoms. Despite the fact that HIV antibodies were not detected in these women, the researchers concluded that HIV could spread rapidly within the prostitution population and back into the wider community through sexual contacts and IV drug use. Current control measures need to be enhanced and the medical community needs to continue to monitor prostitutes' health.