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Implementing Comprehensive HIV/STI Programmes with Sex Workers Pra Ctical Approaches from Collaborative Interventions

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Implementing Comprehensive HIV/STI Programmes with Sex Workers Pra Ctical Approaches from Collaborative Interventions Implementing Comprehensive HIV/STI Programmes with Sex Workers Pra CTICal aPProaCHeS from CollaboraTIVe InTerVenTIonS Implementing Comprehensive HIV/STI Programmes with Sex Workers Pra CTICal aPProaCHeS from CollaboraTIVe InTerVenTIonS WHO Library Cataloguing-in-Publication Data Recommended citation: World Health Organization, United Nations Population Fund, Joint United Nations Programme on HIV/AIDS, Global Network of Sex Work Projects, The World Bank. Implementing comprehensive HIV/STI programmes with sex workers: practical approaches from collaborative interventions. Geneva, World Health Organization, 2013. 1.Prostitution. 2.HIV infections - prevention and control. 3.Sexually transmitted infections – prevention and control. 4.Sexual partners. 5.Unsafe sex. 6.Sexual behavior. 7.National health programs. I.World Health Organization. II.UNFPA. III.UNAIDS. IV.World Bank. V.Global Network of Sex Work Projects (NSWP). ISBN 978 92 4 150618 2 (NLM classification: WC 503.7) © World Health Organization 2013 All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press through the WHO web site (http://www.who.int/about/licensing/copyright_form/ en/index.html). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Cover photography courtesy of PJ Starr. Layout L’IV Com Sàrl, Villars-sous-Yens, Switzerland. Printed by the WHO Document Production Services, Geneva, Switzerland. Contents Acknowledgements ............................................................... vii Acronyms and abbreviations ........................................................ x Glossary .......................................................................... xii Introduction ....................................................................... xiii Chapter 1 Community Empowerment .............................................. 1 1.1 Introduction .................................................................. 4 1.2 Key elements of community empowerment ...................................... 5 1.2.1 Working with communities of sex workers ................................. 7 1.2.2 Fostering sex worker-led outreach ........................................ 8 1.2.3 Developing sex worker collectives ........................................ 9 1.2.4 Adapting to local needs and contexts ..................................... 10 1.2.5 Promoting a human-rights framework .................................... 11 1.2.6 Community systems strengthening (strengthening the collective) ............ 12 1.2.7 Shaping policy and creating enabling environments ........................ 14 1.2.8 Sustaining the movement ............................................... 15 1.3 Monitoring progress .......................................................... 16 1.4 Resources and further reading ................................................. 18 Chapter 2 Addressing Violence against Sex Workers................................ 19 2.1 Introduction ................................................................. 22 2.1.1 Contexts of violence ................................................... 24 2.1.2 Values and principles for addressing violence against sex workers ........... 25 Core values ........................................................... 25 Programming principles ................................................. 25 2.2 Promising interventions and strategies ......................................... 26 2.2.1 Community empowerment ............................................. 26 2.2.2 Building the capacity of sex workers ..................................... 26 2.2.3 Advocating for reforms ................................................. 27 2.2.4 Fostering police accountability ........................................... 29 2.2.5 Promoting the safety and security of sex workers .......................... 30 2.2.6 Providing health services to sex workers who experience violence ........... 32 2.2.7 Providing psychosocial, legal and other support services .................... 33 2.3 Management, monitoring and evaluation ........................................ 36 2.4 Resources and further reading ................................................. 38 Chapter 3 Community-led Services ................................................ 41 3.1 Introduction ................................................................. 44 3.2 Community-led outreach ...................................................... 45 3.2.1 What community outreach workers do ................................... 46 iiiiii 3.2.2 Steps in implementing community-led outreach ........................... 47 A. Map the community and design the outreach strategy with them ......... 47 B. Recruit and train community outreach workers .......................... 50 C. Implement and manage outreach ...................................... 54 D. Foster leadership opportunities for community outreach workers ......... 61 3.3 Safe spaces (drop-in centres) .................................................. 62 3.3.1 Establishing safe spaces ................................................ 63 Setting up the space ................................................... 63 Operating the space .................................................... 64 3.3.2 Other activities in the safe space ........................................ 65 3.4 Community-led quality improvement ........................................... 66 3.4.1 Community committees ................................................ 66 3.4.2 Other community-led approaches to reinforce quality of clinical services ...... 68 3.4.3 Community quality assurance in monitoring and evaluation .................. 68 Monitoring quality of community service implementation ................... 68 Monitoring community access to services and community agency ........... 71 3.5 Resources and further reading ................................................. 72 Chapter 4 Condom and Lubricant Programming .................................... 75 4.1 Introduction ................................................................. 78 4.2 Steps in effective condom programming ........................................ 79 4.2.1 Establishing accessible male and female condom and lubricant supplies for sex workers ................................................ 82 4.2.2 Multi-level promotion of male and female condoms and lubricants ........... 84 Community-led condom promotion ....................................... 85 Destigmatizing condoms in the broader social environment ................. 87 4.2.3 Creating an enabling environment for condom programming ................ 88 4.2.4 Specific considerations in condom programming ........................... 90 A. Condom programming with male and transgender sex workers ........... 90 B. Condom negotiation strategies ........................................ 90 C. Condom programming with clients of sex workers ...................... 90 D. Condom social marketing programmes with sex workers ................ 91 4.3 Condom programme management ............................................. 92 4.3.1 Roles and responsibilities in condom programming ........................ 92 4.3.2 Programme monitoring ................................................. 92 4.3.3 Evaluation ............................................................. 92 4.4 Resources and further reading ................................................. 95 Chapter 5 Clinical and Support Services ........................................... 97 5.1 Operational principles for clinical and support services ........................... 100 5.1.1 Service delivery and integration ......................................... 100 5.2 Voluntary HIV testing and counselling .......................................... 102 5.2.1 Introduction .......................................................... 102 5.2.2 Types of HIV testing and counselling and delivery ......................... 102 5.2.3 Essential activities for voluntary HTC services for sex workers .............. 103 A. Preparation .......................................................
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