Risk Assessment

  • Do you have any tattoos?' - If yes, you want to know if they were professionally done in this country or if they were done outside of a regulated facility, as there is an increased risk of blood-borne infections if they were done in a non-regulated facility.
  • Do you have any body piercing?' If yes, you want to know if it was professionally done in this country or if it was done outside of a regulated facility, as there is an increased risk of blood-borne infections if it was done in a non-regulated facility.
  • Have you ever injected drugs for any reason?' If yes, you want to know if they have ever shared, and when was the last time that they used/shared. Which drugs did/do they use? Be aware that you may not get this information if they do not trust you and/or the use that may be made of this information in the future.

Regular use of drugs may increase the risk for HIV and hepatitis and the ability to practise/negotiate safer sex. You may ask about willingness to be referred for support.

  • Do you use any recreational drugs?' Which drugs did/do they use? Be aware that you may not get this information if they do not trust you and or the use that may be made of this information in the future. Regular use of drugs may increase the risk for HIV and hepatitis and the ability to practise/negotiate safer sex: for example, snorting coke can cause nose bleeding and lead to blood-to-blood transmission of hepatitis (Fieldhouse, 2005).
  • Have you ever been given blood in a transfusion?' Record when and where, if it hasn't been given in the response to any of the major health problems above. This gives you information about the potential for blood-borne infections, as all donations have been tested since 1985. It will also help you establish the three-month window period.
  • Have you ever had sexual contact with another man/woman?' Record the response as part of your risk assessment if it hasn't been disclosed in the sexual history.
  • Have you ever had viral hepatitis?' Record yes/no. If yes - which, A, B, C, etc. Any follow-up checks, treatment, etc.
  • Have you been vaccinated for hepatitis?' Record yes/no. If yes - which, A, B, C, etc., and when completed. Any follow-up titre checks, etc.?

The questions in the following section are not currently routinely asked in the UK; however, asking them is common practice in the Australian and New Zealand sexual health services.

'Have you ever "worked"?' - If the person, usually female, has been a sex worker they will know what you are referring to - if they say, 'Yes, at Boots', you know that they are not likely to have been a sex-worker. Many people do not realise or forget that men too work in the sex industry. You don't need to pursue this point.

If yes, is the work current or previous. If current, continue with the following:

  • How many shifts a week?' Record what you are told.
  • Any split or broken condoms (how many?) with customers?' Record what is described. You should always re-establish that contraception is adequate. Sex workers often use condoms with customers but not with partners.

It is important to ensure that the worker is aware of the need for hepatitis vaccination, against both A and B, if they are continuing to work in the sex industry. Check if they are aware of the support workers in the community. You would need to know who the key workers are and how to contact them to make a referral.

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