Category 3: Implementation
What does implementing HIV interventions in sex work settings involve?
HIV prevention work in sex work settings involves both outreach to sex worker communities and implementation of key intervention components to reduce HIV transmission.
Outreach and peer network development are key strategies for reaching sex worker communities. Outreach enables interventions to reach people who are most in need - by taking information and services out to communities, as well as by promoting clinic-based services. Community outreach also includes development and strengthening of peer networks. This may start with selection and training of small numbers of sex workers or clients who represent their peer groups. With adequate support, peer networks can develop into strong advocates for their own interests and ensure that interventions remain relevant to their needs.
Interventions should include basic HIV prevention components that address sex worker empowerment, condom use and STI control. While such components serve to directly reduce HIV transmission, interventions should not limit their activities to these areas. As projects develop, sex workers themselves can identify and prioritize other health and social needs that should be addressed.
Who should be involved?
Peer involvement is an effective way of reaching sex workers and clients. Peers are knowledgeable 'insiders' in sex work settings and their involvement enhances trust and communication. Peer educators are consequently a credible source of advice. They can be powerful role models and can help to change social norms. Peer workers also act as a link between communities and interventions, facilitating local participation. Peer networking and the sharing of information often lead to community mobilization around issues of concern.
While peer workers form the core of HIV prevention interventions in sex work settings, others should be involved as well. A range of community stakeholders - from owners and managers of bars, hotels and brothels to police and social workers - should be regularly informed of project activities and encouraged to provide support as appropriate. Health care workers may be directly involved in providing services or may see sex workers and clients by referral.
Peer workers should be experienced sex workers, preferably dynamic group leaders who are willing and available to carry out extra work. It is important to provide them with regular training, support and supervision in the performance of their tasks. Weekly meetings are useful for maintaining motivation, solving problems and encouraging participation in project activities.
Peer educators may initially face hostility from local people. Working in groups provides support and strength in numbers. In order to be effective, peer educators need to be seen and heard regularly. It is important to recruit enough of them, although the exact ratio will vary according to context and budget.