Screening Guams Massage Parlor Workers How Often Should

Screening Guam’s Massage Parlor Workers: How Often Should They Be Screened? Bernadette P. Schumann, M. P. A. Guam Department Health and Social Services 2004 National STD Conference Philadelphia, PA March 8 -11, 2004

Background • Guam Massage Parlors began appearing in 1984 • Rules and Regulations: – Sanitary Operation of Massage Parlors, February 13, 1984 – Health Certificates, December 26, 1989 – Issuance of Health Certificates, March 21, 2001

Sex Industry Facilities • Massage Parlors • New Shiatsu/Foot Reflexology Clinics • Therapeutic Massages • Karaoke Lounges

Current Screening Requirements • STD Screening required every 3 months: – – Syphilis Chlamydia Gonorrhea HIV – Trichomoniasis • PPD Skin test for TB required every 2 years: – If positive, chest x-ray is performed

Obtaining Health Certificates for Massage Parlor Workers (MPWs) • Step 1: MPW goes to health department (HD) – Gets blood test for HIV and syphilis and obtains referral to private doctor • Step 2: MPW goes to private doctor – Tested for gonorrhea, chlamydia and trichomoniasis • Step 3: MPW returns to private doctor – Picks up test results

Obtaining Health Certificates for Massage Parlor Workers (MPWs) • Step 4: MPW returns to HD 2 weeks after tests – Provides gonorrhea, chlamydia and trichomoniasis results to HD – All results placed in chart for doctor’s review – HD doctor signs clearance form – Referred to TB Program for clearance • Step 5: MPW reports to TB program for • clearance Step 6: MPW reports to Division of Environmental Health (DEH) for health certificate

Objectives • Describe characteristics of MPWs • • • receiving health certificate Determine prevalence of STDs among MPWs Determine level of compliance with screening requirements Analyze cost of screening MPWs

Methods • Reviewed Department of Public Health (DPH) records for MPWs receiving a certificate during 2000 -2003 • Reviewed data related to cost of processing health certificates for MPWs

Characteristics of MPWs Obtaining Health Certificate, 2000 -2003 Age Groups 2000 N=55 2001 N=56 2002 N=48 2003 N=47 18 -19 1 (2%) 0 1 (2%) 20 -29 4 (7%) 2 (4%) 3 (6%) 5 (11%) 30 -39 15 (27%) 13 (23%) 5 (10%) 5 (11%) 40 -49 30 (55%) 31 (55%) 30 (63%) 27 (57%) 50 -59 5 (9%) 9 (16%) 10 (21%) 9 (19%) 48 (87%) 46 (82%) 40 (83%) 40 (85%) Caucasian 1 (2%) 5 (9%) 3 (6%) 0 Vietnamese 1 (2%) 2 (4%) Other 2 (4%) 3 (6%) 4 (9%) Missing 3 (5%) 1 (2%) 0 1 (2%) 1 visit 17 (31%) 16 (29%) 16 (33%) 12 (26%) 2 visits 13 (24%) 14 (25%) 10 (21%) 16 (34%) 3 visits 11 (20%) 15 (27%) 14 (29%) 12 (26%) 4 visits 12 (22%) 11 (20%) 8 (17%) 7 (15%) 5 visits 2 (4%) 0 0 0 Korean Ethnicities Number of Screening Visits

Reported Number of Employers by MPWs, 2000 -2003 Number of Reported Employers 1 Number of MPWs 62 2 9 3 7 4 1 Unknown/Missing 3

*Compliance With 3 -month Screening Requirement, 2000 -2003 • Among the 68 women with at least 2 screening visits: – 28% were never compliant* – 54% were compliant at least 50% of the time – 26% were compliant at least 75% of the time – 12% were compliant 100% of the time *Compliancy is defined as 2. 5 to 3. 5 months between screening visits

Number of Cases of Reportable STDs Among Women, Guam, 2000 -2003 Syphilis Chlamydia Gonorrhea HIV AIDS 2000 2001 2002 2003 5 413 23 10 320 22 8 523 26 12 446 38 0 0 2 0 1 1 1 2

Time Period Between Screening Visits Among MPW Clients With an STD, 2000 -2003 - 1 -2. 5 months - 2. 5 -3. 5 months - 3. 5 -6 months - 7 -12 months - Over 1 year

Screening Costs Who Pays? DPH How Much? For What Services? $60 per screening visit • Labor: HIV/STD MPW $150 per screening visit • Doctor’s visit • Culture Test & Chest X- Prevention Counseling, DIS, Physician, Lab • Blood Test (Supplies, Kits, Reagents) Ray • Certificate

Summary • Majority of MPWs over the age of 35 • Low STD infection rate among MPWs who • • are screened MPW screening visits are not consistent with regulations Costly screening

Limitations • Lack of standard documentation of • • • screening visits Limited staff dedicated to certificate issuance Certificates issued by DPH but enforcement by DEH does not enforce regulation on parlors that are non-compliant

Limitations • Inconsistent screening practices for MPWs by clinicians • Not all MPWs in establishment are screened • Not all sex industry workers are screened

Recommendations • Modify screening requirements – Revise rules and regulations for determining the establishments whose employees are required to have health certificates – Reassess and adjust screening intervals • Standardize screening practices among all providers

Recommendations • Provide listing of providers to MPWs • Standardize documentation for screening process • Enforce regulations

Acknowledgements Guam Department of Public Health & Social Services Robert Haddock, D. V. M. , M. P. H. Tom Nadau Rosanne Rabago Centers for Disease Control and Prevention Roxanne Barrow, M. D. , M. P. H. Thom Cylar Dianna Frick, M. P. H. John Glover

Acknowledgements Guam Community College Medical Assistant Students Julie Cruz Celeste Leon Guerrero George Prudente Maria Urbino Portland State University Trina M. P. Pacheco, Graduate Student