Implications of HIV Self Testing (HIVST) for Sex Workers in Australia 2017 Australasian HIV & AIDS Conference 8th November Scarlet Alliance

Sex workers in Australia Sex workers in Australia experience world renowned low rates of HIV and STIs. This has largely being attributed to highly successful and targeted sex worker-led HIV prevention programs, including: peer education; peer support and outreach services; distribution of comprehensive and free safer sex information and tools; and community developed health promotion and resources. However, sex workers in Australia continue to struggle with criminalisation, stigma and discrimination, and counterproductive public health policies.

Scarlet Alliance HIVST Consultation Scarlet Alliance conducted a preliminary consultation to explore the implications of HIVST on sex workers. Our focus group participants include peer educators and individual sex workers from each state and territory in Australia. A number of peer educators additionally consulted their sex worker steering committee, reference group or colleagues to inform their responses in the Scarlet Alliance HIVST consultation. We aimed to include a diverse cohort of participants who identified as and worked with sex workers of different genders, sexuality, age groups, locations, and sex work experience. In total, we consulted 11 participants.

This consultation aimed to answer the questions: What are the risks and benefits of HIVST for sex workers in the different social, legal and policy environments in Australia? What are the conditions necessary to ensure that HIVST does not inadvertently undermine the human rights of sex workers?

What are the benefits of HIVST What are the benefits of HIVST? “home testing is great, it just needs to be voluntary”. Quote from participant in HIVST consultation. The participants identified a number of benefits: HIVST may provide some sex workers with additional testing options that: is private and confidential; is outside of a clinical setting; and if used in a private and confidential setting, will not necessarily lead to instant criminalisation upon receiving a reactive result. Benefits of HIVST Sex Workers

What are the risks of HIVST for sex workers in the different social, legal and policy environments? The participants also discussed the ways in which the benefits of HIVST for sex workers are compromised by the social and legal environments they are working within: As sex workers in Australia are a low prevalence population, HIVST will produce a higher rate of false reactives. The National Policy on HIV Testing states a HIVST reactive result will be considered evidence of HIV infection unless confirmatory testing proves otherwise. As a result, this policy explicitly create disincentives for sex workers to use HIVST as they must adhere to laws that criminalise or restrict the activities of sex workers living with HIV as if they are confirmed to be living with HIV. Sex Workers Benefits of HIVST

‘reasonable precaution’ laws; and Laws and policies that place restrictions on sex workers living with HIV includes: disclosure laws; ‘reasonable precaution’ laws; and laws that excludes sex workers living with HIV from working in the regulated sex industry. Sex workers may be forced to HIVST in jurisdictions where employers are expected to know the HIV status of their workers and held legally liable for transmission. Employers, clients, health officials, police, and co-workers may pressure sex workers to self-test. A lack of legal and workplace protections for sex workers expose sex workers to greater vulnerability for potential abuse of HIVST. HIVST may shift sex industry sexual health messaging from effective prevention and safer sex to knowing everyone’s status. Sex Workers Benefits of HIVST

HIVST may lead to increased surveillance of and stigma against sex workers’ living with HIV. In most states and territories the safety and support structures of private sex workers are criminalised. HIVST provides little or no opportunities for pre- and post- test counselling.

What are the conditions necessary to ensure that HIVST does not inadvertently undermine the human rights of sex workers? In response to these barriers, the participants identified a number of conditions necessary for sex workers to benefit from HIVST: Sex workers need continued investment in programs that we know works: Community-led and integrated sexual health clinics Voluntary, confidential, free, and patient-initiated sexual health screening Peer outreach and education Sex workers need comprehensive protections against forced or coerced testing. Sex Workers Benefits of HIVST

Laws that unfairly target, criminalises and forces sex workers to undergo testing need to be abolished. This includes: removing criminal laws related to sexual health and BBVs, such as laws that mandate ‘reasonable precautions’ or criminalise transmission and sex workers living with HIV. removing laws and policies that coerces or forces sexual health testing, such as spitting laws and mandatory testing. Sex workers need to have their privacy rights adequately protected.

Sex workers are a low prevalence population and the evidence demonstrates that they should not be targeted for HIVST. However, due to the risks of HIVST being used against workers as a result of the current policy environment, at a minimum, there needs to be comprehensive and translated sex worker specific information on: the risks of false reactives and non-reactives; the need for confirmatory testing; state and territory legal rights and responsibilities upon receiving a reactive result; sex worker-led or friendly referrals; and what to do in the instance of forced or coerced testing.

Further Questions? policy@scarletalliance.org.au