7. Comprehensive optimization of health services aimed at sex workers in authorities

The study shows that the Public Health Departments plays an important role in promoting the health of sex workers – primarily through the services offered by the health authorities in accordance with Section 19 of the Infection Protection Act. So that sex workers everywhere in Germany have access to needs-based services, the content of these services must be optimized and a nationwide implementation is necessary. Since the mandatory health counseling for the registration as a prostitute is also implemented by the Public Health Department (§ 10 ProstSchG), it is all the more important to further sensitize the Public Health Department to the needs of sex workers and to establish it accordingly. To optimize the services in accordance with §19 Infection Protection Act and § 10 ProstSchG, the following recommendations can be derived from the study:

  • The participatory development or revision of guidelines to which these services must be oriented. This work should involve sex workers from various communities as well as specialist advice centers and the German Aids Organisation (Aidshilfe).
  • Training and further education on the needs and realities of sex workers for all Public Health Department professionals who work in accordance with the above-mentioned paragraphs.
  • Counseling on PrEP and PEP in the services offered in accordance with the Infection Protection Act and ProstSchG must be systematically anchored.
  • Expansion of services in accordance with the Infection Protection Act to include the following services for sex workers without health insurance:
    • PrEP and PEP (as described in Recommendation 8)
    • HIV therapy (as described in recommendation 9)
    • Treatment of STIs
    • Vaccinations
    • Medical (especially gynecological) consultation hours
  • Expansion of social work and counseling to improve access to sex workers with vulnerability factors (as described in Recommendation 5 and Recommendation 6)
  • It must be clear to sex workers that there is no data transfer between services under the Infection Protection Act and Prostitutes Protection Act and that they do not have to fear any disadvantages if they make use of the former.

In order to implement these optimizations, there needs to be stronger nationwide coordination of the services for sex workers by the Public Health Department. The recommendation is to create a federal coordination office “Sex workers in the Public Health Department”, which would be responsible for the quality assurance of services, the coordination of the development of counselling guidelines and the transfer of knowledge between the health authorities and the federal states.  Because they can be used anonymously and are intended to be provided on an outreach basis, services in accordance with §19 Infection Protection Act have the potential to reach many more sex workers with vulnerability factors (especially undocumented migrants and people without health insurance) than the services in accordance with §10 Prostitutes Protection Act.