Key messages
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Self-employed sex workers solicit clients independently of a third-party. This study included 76 female and 79 male self-employed sex workers.
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Inconsistent condom use occurred in 35.7% of FSW and, 29.6% of MSW with vaginal sex and, 46.2% of FSW and 35.7% of MSW with receptive anal sex.
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The majority of both FSW (67.1%) and MSW (67.7%) tested for STI in the past year, and 11.6% of FSW and 8.1% of MSW reported having had an STI.
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STI prevention efforts remain important, considering the low compliance to condom use and the large number of sexual contacts that might facilitate STI spread.
Background
Methods
Study design, population and data collection
Variables
Data analysis
Results
Study population
Female sex workers n(%)a | Male sex workers n(%)a | Total n(%)a | p-value | |
---|---|---|---|---|
Demographics | ||||
Country of birth | 0.043 | |||
The Netherlands | 52 (65.8) | 61 (80.2) | 113 (72.9) | |
Other country | 27 (34.2) | 15 (19.7) | 23 (14.8) | |
Educational level | 0.154 | |||
Low educational level | 14 (17.7) | 6 (7.9) | 20 (12.9) | |
Intermediate educational level | 37 (46.8) | 36 (47.4) | 73 (47.1) | |
High educational level | 28 (35.4) | 34 (44.7) | 62 (40.0) | |
Relationship status | 0.021 | |||
Relationship | 36 (45.6) | 21 (27.6) | 57 (36.8) | |
Single | 43 (54.4) | 55 (72.4) | 98 (63.3) | |
Gender sex partners in private life | 0.979 | |||
Same sex | 6 (7.6) | 6 (7.9) | 12 (7.7) | |
Opposite sex | 50 (63.3) | 49 (64.5) | 99 (63.9) | |
Both opposite and same sex | 23 (29.1) | 21 (27.6) | 44 (28.4) | |
Gender work sex partners | 0.085 | |||
Same sex | 2 (2.7) | 9 (12.3) | 11 (7.5) | |
Opposite sex | 48 (65.8) | 45 (61.6) | 93 (63.7) | |
Both opposite and same sex | 23 (31.5) | 19 (26.0) | 42 (28.8) | |
Sex work | ||||
Work years | 0.027 | |||
< 1 year | 11 (16.4) | 21 (36.8) | 32 (25.8) | |
1–5 year | 33 (49.3) | 24 (42.1) | 57 (46.0) | |
> 5 year | 23 (34.3) | 12 (21.1) | 35 (28.2) | |
Work frequency past 6 months | 0.016 | |||
Daily | 29 (36.7) | 22 (17.4) | 46 (29.7) | |
Weekly | 38 (48.1) | 31 (40.8) | 69 (44.5) | |
Monthly or less | 12 (15.2) | 28 (36.8) | 40 (25.8) | |
Reasons for self-employed sex work | ||||
Wanted to be independent | 21 (26.6) | 6 (7.9) | 27 (17.4) | 0.002 |
Bad experience with pimp, partner | 8 (10.1) | 2 (2.6) | 10 (6.5) | 0.058 |
For the money | 48 (60.8) | 31 (40.8) | 79 (51.0) | 0.013 |
Freedom in working hours | 31 (39.2) | 14 (18.4) | 45 (29.0) | 0.004 |
I like sex | 27 (34.2) | 39 (51.3) | 66 (42.6) | 0.031 |
Need money for drugs | 9 (11.4) | 1 (1.3) | 10 (6.5) | 0.011 |
Already had casual partners, made it my job | 13 (16.5) | 7 (9.2) | 20 (12.9) | 0.179 |
Because of a friend | 10 (12.7) | 7 (9.2) | 17 (11.0) | 0.492 |
Other | 7 (8.9) | 4 (5.3) | 11 (7.1) | 0.383 |
Other job besides sex work | 0.000 | |||
Yes | 27 (40.3) | 41 (71.9) | 68 (54.8) | |
No | 40 (59.7) | 16 (28.1) | 56 (45.2) | |
Main job | 0.084 | |||
Sex work | 7 (25.9) | 4 (10.0) | 11 (16.4) | |
Other job | 20 (74.1) | 36 (90.0) | 56 (83.6) | |
Work location | ||||
Window | 7 (8.9) | 0 (0.0) | 7 (4.5) | 0.008 |
Private club | 16 (20.3) | 5 (6.6) | 21 (13.5) | 0.013 |
At home | 28 (35.4) | 28 (35.4) | 56 (36.1) | 0.856 |
Club | 10 (12.7) | 2 (2.6) | 12 (7.7) | 0.020 |
At client's home | 24 (30.4) | 35 (46.1) | 59 (38.1) | 0.045 |
Hotel room | 27 (34.2) | 30 (39.5) | 57 (36.8) | 0.494 |
Home of third party | 11 (13.9) | 12 (15.8) | 23 (14.8) | 0.744 |
Care institution | 2 (2.5) | 6 (7.9) | 8 (5.2) | 0.131 |
Swingers club | 8 (10.1) | 7 (9.2) | 15 (9.7) | 0.847 |
Massage parlour | 7 (8.9) | 2 (2.6) | 9 (5.8) | 0.097 |
Streets | 7 (8.9) | 1 (1.2) | 8 (5.2) | 0.034 |
Other | 6 (7.6) | 8 (10.5) | 14 (9.0) | 0.524 |
STI risk behaviour | ||||
Types of sex during work | ||||
Oral sex | 65 (82.3) | 68 (89.5) | 133 (85.8) | 0.199 |
Vaginal sex | 68 (86.1) | 60 (78.9) | 128 (82.6) | 0.242 |
Receptive anal sex | 33 (41.8) | 27 (35.5) | 60 (38.7) | 0.425 |
Insertive anal sex | n.a | 43 (56.6) | n.a | n.a |
BDSM or fetish | 27 (34.2) | 15 (19.7) | 42 (27.1) | 0.043 |
Use sex toys | 41 (51.9) | 42 (55.3) | 83 (53.5) | 0.675 |
Erotic massage with manual climax | 52 (65.8) | 44 (57.9) | 96 (61.9) | 0.310 |
Erotic massage with oral climax | 44 (55.7) | 48 (63.2) | 92 (59.4) | 0.344 |
Inconsistent condom use during work | ||||
When giving oral sex | 44 (62.0) | 27 (62.8) | 71 (62.3) | 0.930 |
When receiving oral sex (only men) | n.a | 56 (80.0) | n.a | n.a |
With vaginal sex | 35 (35.7) | 21 (29.6) | 46 (32.6) | 0.437 |
With receptive anal sex | 18 (46.2) | 15 (35.7) | 44 (40.7) | 0.339 |
With insertive anal sex (only men) | n.a | 14 (25.9) | n.a | n.a |
Unprotected sex at clients’ demand | 0.861 | |||
Yes | 24 (32.9) | 25 (34.2) | 49 (33.6) | |
No | 49 (67.1) | 48 (65.8) | 97 (66.4) | |
Ask more money for unprotected sex | 0.023 | |||
Yes | 21 (87.5) | 14 (58.3) | 35 (72.9) | |
No | 3 (12.5) | 10 (41.7) | 13 (27.1) | |
Ask more money for special requests | 0.007 | |||
Yes | 42 (59.2) | 26 (36.6) | 68 (47.9) | |
No | 29 (40.8) | 45 (63.4) | 74 (52.1) | |
Alcohol use during work | 0.300 | |||
Yes | 20 (25.3) | 14 (18.7) | 34 (21.9) | |
No | 59 (74.7) | 62 (81.6) | 121 (78.1) | |
Drug use during work | 0.103 | |||
Yes | 27 (34.2) | 17 (22.4) | 44 (28.4) | |
No | 52 (65.8) | 59 (77.6) | 111 (71.6) | |
More often unprotected sex with alcohol or drugs | 0.708 | |||
Yes | 13 (43.3) | 8 (38.1) | 21 (41.2) | |
No | 17 (56.7) | 13 (61.9) | 30 (58.8) | |
Group sex during work | 0.739 | |||
Yes | 33 (45.2) | 31 (42.5) | 64 (43.8) | |
No | 40 (54.8) | 42 (57.5) | 82 (56.2) | |
STI testing | ||||
STI testing past year (self-reported) | 0.946 | |||
Yes | 47 (67.1) | 44 (67.7) | 91 (67.4) | |
No | 23 (32.9) | 21 (32.3) | 44 (32.6) | |
STI test location(s) of STI test(s) in past yearb | ||||
STI clinic | 25 (53.2) | 19 (43.2) | 44 (48.4) | 0.359 |
General practitioner | 18 (38.3) | 21 (47.7) | 39 (42.9) | 0.487 |
Hospital | 5 (10.6) | 3 (6.8) | 8 (8.8) | 0.503 |
Home-test | 2 (4.3) | 6 (13.6) | 8 (8.8) | 0.131 |
Other | 6 (12.8) | 1 (2.2) | 7 (7.7) | 0.060 |
Main reasons for last STI testing | ||||
Routine screening | 33 (50.8) | 34 (68.0) | 67 (58.3) | 0.710 |
Partner notification | 5 (7.7) | 3 (6.0) | 8 (7.0) | 0.777 |
Unprotected sex | 13 (20.0) | 6 (12.0) | 19 (16.5) | 0.104 |
STI related symptoms | 3 (4.6) | 1 (2.0) | 4 (3.5) | 0.330 |
Condom failure | 7 (10.8) | 4 (8.0) | 11 (9.6) | 0.383 |
Other | 4 (6.2) | 2 (4.0) | 6 (5.2) | 0.433 |
Had an STI in the past year (self-reported) | 0.500 | |||
Yes | 8 (11.6) | 5 (8.1) | 13 (9.9) | |
No | 61 (88.4) | 57 (91.9) | 118 (90.1) |
STI risk behaviour and STI testing
Reported STI testing in the past year
STI testing past year n (%)a | No STI testing past year n (%)a | p-value | |
---|---|---|---|
Demographics | |||
Gender | 0.946 | ||
Female | 47 (67.1) | 23 (32.9) | |
Male | 44 (67.7) | 21 (32.3) | |
Country of birth | 0.747 | ||
The Netherlands | 68 (66.7) | 34 (33.3) | |
Other country | 23 (69.7) | 10 (30.3) | |
Educational level | 0.542 | ||
Low educational level | 12 (66.7) | 6 (33.3) | |
Intermediate educational level | 46 (71.9) | 18 (28.1) | |
High educational level | 33 (62.3) | 20 (37.7) | |
Relationship status | 0.439 | ||
Relationship | 33 (63.5) | 19 (36.5) | |
Single | 58 (69.9) | 25 (30.1) | |
Gender private sex partners | 0.335 | ||
Same sex | 7 (70.0) | 3 (30.0) | |
Opposite sex | 62 (71.3) | 25 (28.7) | |
Both opposite and same sex | 22 (57.9) | 16 (42.1) | |
Gender work sex partners | 0.538 | ||
Same sex | 9 (81.8) | 2 (18.2) | |
Opposite sex | 57 (67.1) | 28 (32.9) | |
Both opposite and same sex | 25 (64.1) | 14 (35.9) | |
Sex work | |||
Work years | 0.021 | ||
< 1 year | 20 (62.5) | 12 (37.5) | |
1–5 year | 46 (80.7) | 11 (19.3) | |
> 5 year | 19 (54.3) | 16 (45.7) | |
Work frequency past 6 months | 0.640 | ||
Daily | 30 (73.2) | 11 (26.8) | |
Weekly | 39 (65.0) | 21 (35.0) | |
Monthly or less | 22 (64.7) | 12 (35.3) | |
STI risk behaviour | |||
Inconsistent condom use during work | |||
When giving oral sex | 0.942 | ||
Yes | 45 (68.2) | 21 (31.8) | |
No | 27 (67.5) | 13 (32.5) | |
When receiving oral sex (only men) | 0.172 | ||
Yes | 36 (73.5) | 13 (26.5) | |
No | 7 (53.8) | 6 (46.2) | |
With vaginal sex | 0.168 | ||
Yes | 26 (60.5) | 17 (39.5) | |
No | 63 (72.4) | 24 (27.6) | |
With receptive anal sex | 0.284 | ||
Yes | 19 (61.3) | 12 (38.7) | |
No | 30 (73.2) | 11 (26.8) | |
With insertive anal sex (only men) | 0.581 | ||
Yes | 9 (81.8) | 2 (18.2) | |
No | 28 (73.7) | 10 (26.3) | |
Alcohol use during work | 0.417 | ||
Yes | 21 (61.8) | 13 (38.2) | |
No | 70 (69.3) | 31 (30.7) | |
Drug use during work | 0.516 | ||
Yes | 28 (63.6) | 16 (36.4) | |
No | 63 (69.2) | 28 (30.8) | |
Group sex during work | 0.680 | ||
Yes | 40 (65.6) | 21 (34.4) | |
No | 51 (68.9) | 23 (31.1) |