HIV/AIDS

New WHO guidelines to better prevent HIV in sex workers

Feature story
12 December 2012

New guidance from the World Health Organization (WHO) aims to better protect sex workers from HIV and other sexually transmitted infections (STIs).

The WHO, in partnership with UNFPA, UNAIDS, and the Global Network of Sex Work Projects, developed new guidelines following consultations with a wide range of stakeholders, including national programme managers, researchers, sex workers’ representatives, international organizations and development partners.

“The risk of a sex worker becoming infected with HIV and STIs is far higher than for other people,” said Dr Gottfried Hirnschall, Director of the WHO Department of HIV/AIDS.

According to global data reported between 2007 and 2011, HIV infections among sex workers were highest in sub-Saharan Africa, where more than a third (36.9%) of female sex workers were HIV-positive, followed by Eastern Europe where the figure was one in ten (10.9%), and around half that number in Latin America and the Caribbean (6.1%) and Asia (5.2%). The lowest rate, 1.7%, was reported in the Middle East and North Africa.

Sex workers often find it difficult to access HIV and STI prevention and treatment services, even though many countries have effective programmes in place. Many sex workers fear the stigma, discrimination and, in some cases, violence they may encounter.

Some national AIDS programmes specifically support implementation of HIV prevention programmes for sex workers. Many do not. The WHO guidelines are intended to be tailored and implemented according to local situations and needs. The aim is to help countries establish national programmes that work.

The new WHO guidelines recommend that countries work towards decriminalization of sex work and urge countries to improve sex workers’ access health services. They also outline a set of interventions to empower sex workers and emphasize that correct and consistent condom use can reduce transmission between female, male and transgender sex workers and their clients.

Evidence indicates that where sex workers are able to negotiate safer sex, HIV risk and vulnerability can be sharply reduced. The guidelines call for voluntary periodic screening and treatment of STIs for sex workers to both improve their health and control the spread of HIV and STIs.

“There are some excellent examples of community-run HIV prevention schemes among sex workers. More national programmes need to support this kind of approach,” says Dr Hirnschall.

WHO’s evidence-based guidelines are designed for use by national public health officials, managers of HIV and STI programmes, civil society and health workers in low- and middle-income countries.

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