Among female sex workers attending a Melbourne sexual health clinic, condomless sex with non-work casual male partners increased significantly from 2011 to 2020 and was associated with higher odds of STI detection, while overall STI positivity remained low.
The majority of female sex workers reported having non-work sexual partners in the past 12 months.
The proportion of FSWs with non-work casual male sexual partners increased significantly from 2011 to 2020.
Condomless sex with non-work casual male sexual partners increased significantly over the study period.
STI positivity among FSWs increased significantly from 2011 to 2020, though overall levels remained low.
Condomless sex with non-work casual male sexual partners was independently associated with higher odds of STI detection.
The study used a repeated cross-sectional design drawing on a decade of clinic data from a Melbourne sexual health clinic.
This research examined how female sex workers' (FSWs) sexual behaviors outside of their work changed over a decade (2011–2020) in Melbourne, Australia, and how those behaviors related to sexually transmitted infection (STI) diagnoses. The study found that most FSWs had sexual partners outside of work, and over the study period, there was a clear increase in both the number of casual non-work male partners and in how often sex occurred without condoms with those partners. Rates of STI detection also rose over the same period, though they remained relatively low overall. This research suggests that condomless sex with casual non-work male partners is associated with a meaningfully higher chance of testing positive for an STI among FSWs — about 41% higher odds compared to those who consistently used condoms with those partners. Importantly, this risk came from outside of sex work itself, suggesting that the personal (non-work) sexual lives of FSWs are a significant factor in STI transmission dynamics for this group. The broader implication is that STI prevention programs targeting FSWs should consider sexual behaviors in all contexts, not only within commercial sex work. The trends seen here — more casual partnerships and less condom use — mirror what has been observed in the general population over the same period, indicating that FSWs are not isolated from wider shifts in sexual norms. Understanding these patterns could help public health services design more relevant and comprehensive support for this population.
Aung E, Yodkitudomying C, Fairley C, Phillips T, Vodstrcil L, Bradshaw C, et al.. (2025). Sexually transmitted infections and sexual practices with non-work partners, among female sex workers attending a sexual health clinic in Melbourne, 2011-2020.. Sexually transmitted infections. https://doi.org/10.1136/sextrans-2024-056390