Strategic framework

The diversity of sex work settings requires flexible, locally adapted responses. However, experience shows that HIV prevention in sex work settings should work toward three main outcomes:

  • Increased condom use and safer sex
  • Increased sex worker involvement and control over working and social conditions
  • Reduced STI burden

More broadly (beyond HIV prevention), interventions should of course build on opportunities to improve sex workers' overall health and well-being.

Table 1 illustrates a generic framework of potential objectives, desired outcomes and programme components for HIV prevention interventions in sex work settings.  More detail on programme components is given in Category 3 of the Development of interventions section.

Community mobilization through peer networks is a key strategy for integrating and promoting these programme components. For example, peer networks can help promote use of condoms and health care services. Increased sex worker involvement facilitates setting up services, promotes human rights and empowers sex workers. Likewise, clinical services for STI can reinforce condom promotion and risk reduction and address other health care needs.

At best, each component acts in synergy with others to strengthen impact. However, the framework should not be viewed as a rigid or complete menu of components that must be included in every project. Many interventions start with only one or two components. Where possible, however, efforts should be made to build as comprehensive a response as possible.

A framework for HIV prevention interventions in sex work settings

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