New online toolkit on prevention of HIV/AIDS for sex workers

GTZ, WHO and sex work networks share information and lessons learned

In Krakow, Poland, an outreach worker distributes condoms to sex workers on the street as part of the International Harm Reduction Development prevention programme. Photo: IHRD

Berlin/Geneva - The German technical cooperation (GTZ) and the World Health Organization (WHO), in collaboration with sex work networks around the world, are launching the first ever online tool kit aimed at helping sex workers to protect themselves and their clients from infection with HIV and other sexually transmitted infections. The tool kit is intended for use by people working with female, male and transgender sex workers including programme managers, field workers and peer educators. This is the first time this expertise has been formally documented and made widely accessible.

"Thanks to this innovative project, people working on HIV/AIDS prevention for sex workers can now learn what does and doesn’t work from Poland to Papua New Guinea. Targeted HIV/AIDS prevention and care programmes are urgently needed for sex workers, injecting drug users and other vulnerable groups and we welcome GTZ's leadership and support in this often under funded area," said Dr Jim Yong Kim, WHO's Director of HIV/AIDS.

Included in the online sex work tool kit are practical "how to do it" documents like 'Hustling for Health' and 'Making Sex Work Safe', written by experienced sex worker groups to support programme managers in setting up and maintaining projects. "Of Veshyas, vamps, whores and women" for example, is based on experiences from an Indian NGO and gives practical advice on how to build up a network of peer educators in brothels and deal with the brothel owners, how to set up condom distribution networks and how to structure payment incentives for peer educators.

Despite proof that prevention programmes work in sex work settings, currently only 16% of sex workers have access to these services. Around the world, poor services generally mean higher HIV prevalence.

"Sex workers know better than anyone else about the problems they face, the kind of language and programs that work. Only by involving them can both male and female sex workers and clients be motivated to make use of condoms and health clinics," said Friederike Strack from Hydra - one of the sex worker organizations collaborating on the tool kit.

The tool kit also includes valuable data and analysis which can be shared across regions and used to design better HIV/AIDS prevention programmes for sex workers, for example "Police and Sex Workers in Papua New Guinea". A report on "Meeting the sexual health needs of men who have sex with men in Senegal" gives valuable insight into dealing with the cultural sensitivity surrounding men who have sex with men in West Africa, how their lives are characterized by violence and rejection and that many find it easier to get help and treatment than from clinics than traditional healers.

WHO and GTZ worked closely with sex work networks and organizations to produce an online collection of more than 130 easily-accessible documents, manuals, reports, and research studies. The aim of the tool kit is to make vital information about sex work interventions more accessible to a wider audience and to share lessons learnt to contribute to global efforts to develop and increase effective HIV prevention and care interventions among and with sex workers.

"Targeted programs make a difference - in Germany we have shown over the last 15 years that these kinds of interventions can really work. It's important to share knowledge across borders and within communities to help save lives within one of the oldest professions in the world. We are pleased to support this initiative," said Thomas Kirsch-Woik, Senior Consultant HIV/AIDS, GTZ.

In many countries, sex workers are frequently exposed to HIV and other sexually transmitted infections (STIs). Where sex workers have poor access to HIV prevention services, HIV prevalence can be as high as 60-90%. Evidence shows that targeted prevention interventions in sex work settings can turn the epidemic around.

In Thailand and Cambodia for example, condom use rose to over 80% and HIV and STI`s declined dramatically thanks to large scale programs targeting sex workers and clients. In Nairobi, Kenya, strengthened interventions with sex workers - including peer support, condom promotion and STI services - led to falls in HIV incidence, from 25-50% to 4% in Nairobi sex workers.

"To really have an impact on the epidemic, it's important for services and policies to be made more user-friendly and to be adapted to the reality of the sex work as well as to regional differences. Injecting drug use and sex work are closely linked in Eastern Europe and it is essential to integrate the services," said Monica Ciupagea from the Open Society Institute Hungary which also collaborated on the tool kit development.

The HIV/AIDS Sex work tool kit brings together over a decade's worth of research and practical experience on what does and does not work to change behaviour and protect sex work and clients from HIV AIDS. Now online, it will also be available as CD-ROM and hard copy in early 2005. The kit is a living document and will continue to be updated as new resources are released.

The Sex Work tool kit is one of a series of online tool kits produced by WHO and GTZ and can be found at www.who.int/hiv/toolkit/sw. The Antiretroviral (ARV) Toolkit: A public health approach for scaling up ARV treatment http://www.who.int/hiv/toolkit/arvand the Toolkit for scaling up HIV Testing and Counselling services www.who.int/hiv/toolkit/tc are also available online.


The Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ) GmbH (German technical cooperation) is an international cooperation enterprise for sustainable development with worldwide operations. It offers viable forward-looking solutions for political, economic, ecological and social development in a globalised world. GTZ promotes complex reforms and change processes, even under difficult conditions. GTZ’s aim is to improve people's living conditions on a sustainable basis. The German Federal Ministry for Economic Cooperation and Development (BMZ) is its major client

The World Health Organization aims to help people attain the highest possible level of health by providing leadership on normative issues and technical assistance to its 192 Member States. Health is defined as a state of complete physical, mental and social well being and not merely the absence of disease or infirmity. In 2003, WHO joined UNAIDS in declaring the lack of HIV/AIDS treatment to be a global public health emergency and jointly launched the "3 by 5" initiative to get 3 million people on treatment by 2005. The goal is universal access. To help countries achieve this goal, WHO provides normative guidance and direct technical support in country.

For more information on the tool kit, its dissemination in CD ROM copies, please contact Manuela Moeller, Technical officer, WHO, Geneva; Tel: +41 22 791 2589. email: moellerm@who.int;

For press inquiries, please contact Samantha Bolton, Communications Officer, WHO, Geneva; Tel.:+41 22 791 1970, Mobile: +41 79 239 2366. email: Boltons@who.int. All fact sheet, press releases and other WHO information can be found at http://www.who.int

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