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Introduction: Since the emergence of the HIV pandemic in the s, high rates of condom use for penetrative sex have been reported among sex workers in Australia. The sex industry in Australia and elsewhere has changed over the previous decade with increasing proportions of sex workers working privately and lower proportions of sex workers working in brothels.
There has also been some evidence of reductions in condom use, particularly during penetrative oral sex. We therefore decided to investigate sex workers' use of condoms during penetrative sex with clients.
Methods: This was a cross-sectional mixed methods study of sex workers in Western Australia. The study involved an environmental scan of the sex industry in Western Australia, visits to brothels and other sexual services premises, a survey of sex workers and in-depth interviews.
Results: We surveyed male, female, and transgender sex workers in Western Australia. We found unexpectedly low rates of reported condom use with clients for all forms of penetrative sex. Increasing client demand, fear of losing clients and the ability to charge more for condomless sex were reported reasons for providing this service. Conclusions: There has been an apparent increase in sex workers reporting condomless penetrative sex with clients in Western Australia compared to a previous cross-sectional study.
An increase in private sex work and client demand for condomless sex together with an economic downturn leading to increased competition for clients may be important contributing factors. In response to the emerging human immunodeficiency virus HIV pandemic in Australia in the s, Australian sex workers instituted high rates of condom use with clients and regular sexual health checks that resulted in rates of HIV and sexually transmissible infections STI among sex workers that were equivalent to or even lower than in the general population 1.