Category 3: Implementation
Key issues in providing treatment, care and support for HIV-positive sex workers
Projects can consider setting up counselling and peer support systems so that sex workers can be helped to accept their HIV status, develop a positive attitude and take action to prevent infecting others. Some projects have established self-help groups of sex workers living with HIV/AIDS and have provided training in home care skills for sex workers living with HIV/AIDS.
Where possible, facilitate access to treatment, care, support, home care and ARV therapy. Extra training for staff in mainstream services may be required in order to ensure a high quality, non-judgemental service.
Key issues in HIV testing and counselling
Provide HIV testing and counselling staff with training to enable them to provide a sensitive, non-judgmental service that is tailored to the needs of sex workers and clients. Strict confidentiality is crucial in performing HIV testing and in releasing and storing the results.
It is important that HIV testing and counselling services include pre-test and post-test counselling and that informed consent be obtained before testing is performed. Pre-test and post-test counselling should include individual risk assessment, risk reduction planning, and helping to prepare individuals to cope with their test results.
Where possible, refer HIV positive sex workers and clients to psychological support and clinical care services. It may be necessary to work together with these services to ensure that they are sensitive to the needs and situation of sex workers.
Key issues in STI treatment
STI management approaches vary from place to place, according to local epidemiology and available resources. Many national HIV/STI programmes have developed case management protocols which can be adapted to the sex work context. It may be useful to seek technical advice on setting up this aspect of a programme. At a minimum, interventions should provide:
- management of symptomatic STIs
plus either:
- screening for asymptomatic STIs, or
- presumptive treatment of STIs when accurate screening is not feasible.
Communication activities can be used to raise awareness about STIs and to promote use of services. Peer educators can reinforce correct use of medications and encourage patients to attend follow-up clinics.
STI services should be available and easily accessible for clients as well as sex workers. Where feasible, the partner treatment can be arranged for regular partners to reduce the chances of reinfection and further transmission.
Key issues in harm reduction services for sex workers
Where sex work is linked to injecting drug use it is important to offer access to harm reduction services including information and links to services. Harm reduction services should include support for the following choices.
- Not to use drugs.
- If using drugs, not to inject them.
- If injecting, not to share needles.
Depending on the legal and policy environment, interventions can take steps to provide access to needle exchange programmes, substitution medicine therapy and drug-dependence treatment. Where appropriate, provide specific counselling, support and communication materials for sex workers who inject or are dependent on drugs.