There is no mandatory testing for sex workers.  In some municipalities the licence system condition includes the obligation of the brothel owners to stimulate the safe sex policy in their establishments and to give access for the health authorities to the sex workers and their access to prevention and safe sex commodities measures. Moreover there are regulations with regard to hygiene and safety of the working place.  In the majority of the  municipalities, the competences of the local public health agencies is the control and inspection of application of these rules. It means that it is not a national law, but municipal administration regulation.

All citizens in NL have compulsory health insurance (based on the labour situation). All prevention services (child and family care, infectious diseases, basic inoculation etc) are municipal/public services accessible for all citizens.

Uninsured migrant sex workers have access to STI screening and treatment, some child and family care. For the EU citizens their own national health insurance is applicable for temporary health care. In the case that a person becomes a resident in NL and in the situation of self employment (in prostitution) she/he has to buy private health insurance.

Undocumented sex workers have very few possibilities to access public health care: in big cities there are health centres for general care that are run by  voluntary doctors.  STI screening and treatment are free and accessible. The doctors and the hospitals cannot refuse the basic health care in the case of emergency. Also, lack of knowledge how the health care is organised in the NL due to language barriers, social isolation and mobility are important barriers for these persons to access health care.

If an uninsured person needs a medical care she/he has to pay for it from her/his own pocket. In principle the hospital is not allowed to refuse a medical assistance to the person in health emergency, but it is very reluctant to offer it. Most of the hospitals have a special funds from which they finance the medical care offered to uninsured persons. The rest of possible care is based on the few good -will medical initiatives. (specific medical care for undocumented migrants). In the case of serious illness the majority of the sex workers decide to go back to the mother country, and/or to wait to have medical consultation and diagnostic for the moment when they visit their country, which has serious consequences for their health and risk for getting chronic diseases.

Most of the major prostitution areas are covered by the services of local municipal health services (GGD) who either carry out outreach work and invite the sex workers to their STI centres, or hold a consultation hour on the prostitution street. Some of them offer, next to health services, also social services. In some cities social assistance is offered by  independent sex work projects who specialize in offering social services to sex workers.

Access to HIV/AIDS treatment:

Everybody in NL is obliged to have health insurance. In the case of lack of insurance, everybody  is entitled to receive basic health care in the case of emergency, including hospitalisation and treatment.

In some HIV clinics  HIV positive persons (independently of their juridical status) receive free of charge HIV treatment and accompaniment. Although being not an official policy, it is applied in several (academic) hospitals all over the Netherlands. The treatment is confidential, but the person has to give her/his real name and has to have an address. The treatment does not include other medical services such as dental care, neither it offers social assistance - for example help in finding accommodation. The trajectory from the moment of receiving the diagnosis to receiving the treatment in one of these “ migrant friendly HIV clinics” can be long because it happens often that the persons diagnosed HIV positive at one of the medical points do not receive any HIV counselling nor the referral to the HIV clinic. It is due to the fact that there is no adequate reach out/accompaniment to these groups. 

A person can apply for a residence permit that is based on the acute medical situation. It concerns temporary residence for one year, that has to be prolonged every year; after 3 years it can be changed into permanent residence permit. The acute medical situation means: when in the country of origin the person will die within three months or undergo serious physical or mental damage  because of lack to access to treatment. One also can get residence permit if it is anticipated that the medical treatment will last longer than one year. 

Access to harm reduction programmes:

National drug using sex workers have full access to harm reduction programmes, those without insurance will be supported to achieve a health insurance

Migrant drug using sex workers who are legal residents and who have a health insurance, have full access to harm reduction programmes.

Persons, who are not insured, have access to basic harm reduction programmes as drop-ins, needle exchange, condom distribution, STI control, but may face difficulties to obtain medical treatment. Due to the so-called “Koppelingswet” (the personal data base is connected, so once you are registered, your status is known to all social institutions), it is difficult to get insurance without report in residence.  

Due to the “Koppelingswet” , undocumented migrants usually are not able to get insured, however, some individual cases are known, where persons still are insured without registration.

Basic harm reduction services as drop-in centres, street work counselling, needle exchange and condom distribution are principally available for undocumented migrant drug-using sex workers. However, contacts with official instances can led to risks like investigations and in the worst case deportation. Emergency medical help is provided in most cases.