Sex workers can be screened too often : a cost-effectiveness analysis in Victoria, Australia

Objectives Commercial sex is licensed in Victoria, Australia such that sex workers are required to have regular tests for sexually transmitted infections (STIs). However, the incidence and prevalence of STIs in sex workers are very low, especially since there is almost universal condom use at work. We aimed to conduct a cost-effectiveness analysis of the financial cost of the testing policy versus the health benefits of averting the transmission of HIV, syphilis, chlamydia and gonorrhoea to clients. Methods We developed a simple mathematical transmission model, informed by conservative parameter estimates from all available data, linked to a cost-effectiveness analysis. Results We estimated that under current testing rates, it costs over $A90 000 in screening costs for every chlamydia infection averted (and $A600 000 in screening costs for each quality-adjusted life year (QALY) saved) and over $A4 000 000 for every HIV infection averted ($A10 000 000 in screening costs for each QALY saved). At an assumed willingness to pay of $A50 000 per QALY gained, HIV testing should not be conducted less than approximately every 40 weeks and chlamydia testing approximately once per year; in comparison, current requirements are testing every 12 weeks for HIV and every 4 weeks for chlamydia. Conclusions Mandatory screening of female sex workers at current testing frequencies is not cost-effective for the prevention of disease in their male clients. The current testing rate required of sex workers in Victoria is excessive. Screening intervals for sex workers should be based on local STI epidemiology and not locked by legislation.

Effects of beach remourishment on the benthic macrofauna and the fishes of the nearshore zone at Sebastian Inlet State Recreation Area

Approximately 100,000 cubic yards of sand was transported to the ocean beach to renourish the eroded beach front during the period December 1985 through May 1986. The ocean beach at Sebastian Inlet SRA was previously studied in a project examining the benthic macrofauna and the fishes of the nearshore zone during 1981-1982 (Allenbaugh, 1984; Peters, 1984; Nelson, unpublished). In view of the existing data, the US Army Corps of Engineers provided funding to study the effects of the beach renourishment activities at Sebastian Inlet SRA on the benthic macrofauna and the fishes of the nearshore zone. This is the report on the results of this study.

Proceedings of the Royal Society of Victoria.

List of members in each volume (except v. 6, new ser., v. 27)