The HIV and Sex Work Collection - Joint Programme Monitoring ...

contact increased condom use by clients. 29 Echoingthese findings, Durjoy (page 94), USHA Cooperative(page 85), and SWING (page 57) found thatsocial marketing strategies, combined with repeatedoutreach contact with sex workers and their clients,have the greatest impact on consistent use of condoms.Another positive outcome of these condom socialmarketing programmes is that they provide flexibleresources for community-based organizations. Forinstance, from an initial capital investment of US$ 100,SWING’s (page 57) revolving fund from this programmetotalled more than US$ 13 000 by June 2009. 30During 2010–2011, USHA Cooperative (page 85)made a profit equivalent to US$ 19 500. Such profitshave been used to fund activities that do not receivedonor support.Effective linkages between HIVand sexual and reproductive healthfor sex workers 31The rationale for improving sexual and reproductivehealth (SRH) for key affected populations and linkingSRH and HIV services is well documented. 32 In June2011, Member States of the United Nations agreed toachieve bold new targets including:• reducing sexual transmission of HIV by 50% by 2015and• eliminating new HIV infections among children. 33To realize these targets in this region, linkages betweensexual and reproductive health (SRH) and HIV servicesto address the SRH needs of sex workers are crucial. Forfemale sex workers, ensuring effective linkages willreduce unintended pregnancies and improve accessto antenatal, delivery and post natal care includingaccess to the antiretroviral drugs both for the mothers’own health and to prevent infection to their childduring pregnancy, delivery and breastfeeding.However, programmatic experience in doing so islimited. 34 Realizing these synergies in practice makes‘people sense’ and ensures effective use of availablefinancial and human resources.There has been considerable progress in eliminatingnew HIV infections through integrating Preventionof Mother to Child Transmission (PMTCT) withinmaternal child health (MCH) services. However, thishas led to a focus on HIV testing of pregnant womenwho attend MCH services, and often female sex workersat higher risk HIV are not accessing MCH services.Criminalization of sex work and high levels of stigmaand discrimination undermines sex workers’ access tohealth services including MCH. 35 This underscore theimportance of HIV testing within HIV programmes forsex workers and the need to provide effective referralto MCH/PMTCT for pregnant sex workers living withHIV.Moreover, there are serious gaps in familyplanning counselling and access to the full rangeof contraception for sex workers. 36 The provision ofcondoms alone as protection against HIV, STIs andpregnancy does not address the realities of femalesex workers’ lives, as workers and women given:• low condom use among non-commercial partners; 37• high rates of abortion, indicating unmetcontraceptive need; 38• condoms are less effective in preventing unwantedpregnancy compared with other contraceptivemethods; 39• high levels of sexual violence; 40A number of case studies indicate that improvingsex workers’ understanding of their sexual andreproductive health rights is a focus of their educationefforts. However, very few focus on delivering SRHrelated services or building referral networks withgovernment and private providers of SRH services,beyond STI diagnosis and treatment.Page 18