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

Lessons learned acrossthe region providea compelling case forscaling up condomsocial marketing as aneffective strategy for:• promoting condom use among male clients;• creating supportive social norms for condomuse, both within the sex industry and widercommunity;• a sustainable, cost-effective approachto availability of high-quality affordablecondoms and lubricants;• generating flexible resources for communitybasedorganizations.needs of MSM and transgender people, includingsex workers. For example, Dark Blue addressthe sexual health of MSM and transgendersex workers through ensuring access to STI diagnosisand treatment services and psychosocialsupport to increase self-esteem and improvehealth seeking behaviour.Effectively addressing the sexual healthneeds of MSM and transgender sex workersincludes ensuring:• taking a sexual history that includes attentionto anal sex, particularly to include this in history-takingfrom men who may not appear tobe having male-to-male sex• counselling about safer sex, including effectiveapproaches to couple counselling for marriedMSM• sensitivity to MSM and TG — particularly important forTG who have experienced rejection, humiliation anddiscrimination in health services• psychosocial support to increase general health, selfesteemand general capacity to reduce risk of acquiringor transmitting HIV and other STIs• attention to sexual health beyond HIV/STIs — includinganal health, penile and prostate cancer screeningand hormone treatment and care for transgenderpeople. 41Improving access and uptake ofVCT and HIV treatmentGood quality HIV VCT is important so that people canmake an informed decision to test, know their status,reflect on risk reduction strategies for themselves and/or others, and identify their preferred course of actionshould their test result be positive.Country-specific data reveals a need to improveuptake of HIV testing among sex workers in manycountries in the region. The median reported coveragein 2010 was 34% for female sex workers (range4%–79%) in 20 countries reporting data. 42 Countrydata show strong efforts are still required in manycountries in the region. For example, the percentage ofsex workers who had an HIV test in the last 12 monthswas 43.8% in Viet Nam and 38.2% in China, 50.4%among venue based workers and 65.2% among malesex workers in Thailand and 54.6% among femalesex workers in Nepal. Indonesia at 79.4% in Indonesia,71% in Myanmar showed better results. Indonesiaand Myanmar indicate better results; 79.4% and 71%respectively. 43To improve sex workers’ access to VCT, and HIVtreatment should they require it, there is a need tocomprehend the factors that undermine access, andlook to the ways these barriers are being addressed.For example, it is well established that stigma is animpediment to testing. It reduces quality of care,Page 20