Screening Guam

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Screening Guams 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

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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

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Sex Industry Facilities

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

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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

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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

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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 doctors 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

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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

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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

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Characteristics of MPWs Obtaining Health
Certificate, 2000-2003
2000 N55 2001 N56 2002 N48 2003 N47
Age Groups 18-19 1 (2) 1 (2) 0 1 (2)
Age Groups 20-29 4 (7) 2 (4) 3 (6) 5 (11)
Age Groups 30-39 15 (27) 13 (23) 5 (10) 5 (11)
Age Groups 40-49 30 (55) 31 (55) 30 (63) 27 (57)
Age Groups 50-59 5 (9) 9 (16) 10 (21) 9 (19)
Ethnicities Korean 48 (87) 46 (82) 40 (83) 40 (85)
Ethnicities Caucasian 1 (2) 5 (9) 3 (6) 0
Ethnicities Vietnamese 1 (2) 2 (4) 2 (4) 2 (4)
Ethnicities Other 2 (4) 2 (4) 3 (6) 4 (9)
Ethnicities Missing 3 (5) 1 (2) 0 1 (2)
Number of Screening Visits 1 visit 17 (31) 16 (29) 16 (33) 12 (26)
Number of Screening Visits 2 visits 13 (24) 14 (25) 10 (21) 16 (34)
Number of Screening Visits 3 visits 11 (20) 15 (27) 14 (29) 12 (26)
Number of Screening Visits 4 visits 12 (22) 11 (20) 8 (17) 7 (15)
Number of Screening Visits 5 visits 2 (4) 0 0 0
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Reported Number of Employers by MPWs, 2000-2003
Number of Reported Employers Number of MPWs
1 62
2 9
3 7
4 1
Unknown/Missing 3
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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
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Number of Cases of Reportable STDs Among Women,
Guam, 2000-2003
2000 2001 2002 2003
Syphilis 5 10 8 12
Chlamydia 413 320 523 446
Gonorrhea 23 22 26 38
HIV 0 2 1 1
AIDS 0 0 1 2
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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
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Screening Costs
Who Pays? How Much? For What Services?
DPH 60 per screening visit Labor HIV/STD Prevention Counseling, DIS, Physician, Lab Blood Test (Supplies, Kits, Reagents)
MPW 150 per screening visit Doctors visit Culture Test Chest X-Ray Certificate
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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

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Limitations

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

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Limitations

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

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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

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Recommendations

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

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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

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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