World Sexual Health: Change, Healthy Clients and Escorts

Keeping sexually in good health and safe is a common theme in blogs and articles about sex work. It's especially a concern for female escorts. However, it should also be on the radar of anyone involved in escorting – no matter what their sex and sexual orientation are. In the 1980s public health warnings were predominantly about HIV and AIDS, but now there is pre-exposure prophylaxis (PrEP) medicine to prevent HIV, and the Centers for Disease Control and Prevention in the US says reduces the risk of getting the virus, and AIDS – the disease that it causes - from sex by about 99%.

In more recent times, escorts have had to contend with COVID, and this has let to drop in sexually transmitted infections (STIs) and sexually transmitted diseases (STDs). Public Health England (PHE) wrote a press release on 7^th September 2021 that 'STI rates remain a concern despite fall in 2020' as STIs reduced by 32% in 2020 compared to 2019. The pandemic, worryingly, saw health screening rates fall by 25%. They involve tests for chlamydia, gonorrhoea, syphilis, or HIV.

Due to social distancing and Covid restrictions, clinical in-person assessments for genital warts and herpes saw a greater drop in diagnoses – from 46% to 40% when compared to STIs that could be self-tested using self-sampling kits following an internet consultation for STIs such as chlamydia and gonorrhoea, which respectively saw a 29% and 20% fall.

Dr Katy Sinka, Head of Sexually Transmitted Infections section at PHE is quoted as saying in the PHE press release: “No one wants to swap social distancing for an STI, and as we enjoy the fact that national COVID-19 restrictions have lifted, it's important that we continue to look after our sexual health and wellbeing. If you are having sex with new or casual partners, use a condom and get tested – STIs can pose serious consequences to your own health and that of your current or future sexual partners.”

The PHE warned that STI can often be passed on unwittingly, making it easier for the clients of escorts and escorts themselves to pass them on to others. The government organisation therefore promotes the use of condoms and advises people generally – not just those involved in the escort industry – to get regularly tested regardless of whether they are symptomatic or not.

US State of Sex Survey

In support of the World Health Organisation's annual World Sexual Health Day, which is held of 4^th September, the 'Everlywell State of Sex Survey' was recently published (in 2022). Everlywell offers health and wellness solutions including laboratory testing for wellness monitoring. It surveyed “1,000 Americans from ages 18-35 to learn how their sex lives have changed since the beginning of the pandemic with regard to dating, testing, prevention, and overall sexual health.”

This what the survey found:

·      STI testing is down: One out of five sexually active respondents reported not getting tested at all, citing issues such as cost, lack of access, lack of time, and discomfort visiting a testing site as key barriers.

·      Squashing the stigma: Some good news? One out of three respondents reported asking more questions designed to reduce sexual health risk since March 2020, such as questions about STIs and STI testing status. Communication is key.

·      Telehealth and at-home testing have changed the game: Of respondents who reported getting tested more frequently in the last two years, almost one in four (24 percent) said that at-home tests or telehealth made it more convenient to get tested. In fact, 11 percent of respondents said they had taken an at-home STD test within the last three months - proving a need for more education on alternative methods of testing.

·      Testing frequency: One in four reported getting STI tested after a sexual encounter and one in four reported getting STI tested before a sexual encounter.

·      Impact for women: Eight out of ten women had not been tested for HPV and more than half had not been tested for chlamydia and gonorrhoea, leaving them at risk for infertility and certain cancers.

·      When testing is part of getting ready to go out: One in four reported getting STI tested after a sexual encounter and one in four reported getting STI tested before a sexual encounter.

“It is crucially important to normalize getting tested for STIs regularly,” says sex and relationship researcher, educator, and clinician, Dr. Kristen Mark, PhD, MPH in Everlywell's article on STI testing, 'World Sexual Health Day: we surveyed how the pandemic changed our sex lives, even two years later.” He adds: “The best protection against spread is regular testing and correct and consistent barrier protection during sexual activity. Since so often STIs don't have symptoms, regular testing needs to be integrated into one's engagement in healthy behaviours.”

Positive and respectful approach

The World Health Organization (WHO) defines sexual health and emphasises that there needs to be “a positive and respectful approach to sexuality and sexual relationships, one that cannot be separated from sexual well-being.” The United Nations organisations recognises that sexual health is a state of physical, emotional, mental and social well-being related to sexuality. “It is not merely the absence of disease, dysfunction or infirmity,” it says before commenting:

“Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled.” This includes protection from coercion or violence, which is often cited as another risk from which escorts have to protect themselves.

Talk about pleasure and health

To protect themselves and their clients, most escorts heed sexual health advice, requiring their clients to take STI tests before they meet, which is especially important if both or all parties are get involved with unprotected sex. Escorts will often get themselves regularly tested too because hygiene and sexual health is vital. The Mail Online reveals that author Adele Parks interviewed one sex worker called who said she sponge-bathed her sweaty and nervous, predominantly male clients to ensure they are hygienic before a session, and there are reports of escorts offering it as a service afterwards.

The World Association for Sexual Health wants everyone to talk about pleasure, sexual health and safety. So, on World Sexual Health Day 2022, it set out a goal to promote sexual pleasure in law and in policy “as a fundamental part of sexual health and well-being, grounded in the principles of sexual rights as human rights, including self-determination, non-discrimination, privacy, bodily integrity, and equality.” It also challenges legal and cultural norms in a call to overcome feelings of guilt, stigma, and shame to open up discussions to facilitate change, and this could include how escorting is perceived.