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

“Because of fear of discrimination, many sex workers do not want to take HIV test. MyCD4 count was 71 when I got HIV tested for the first time; with the right treatment andthe support I have received from my friends and community members, it is now 930.Improvements in my health status is a testimony of the positive impact of HIV testingand treatment.”Shantamma Gollars, Outreach Worker, VAMP PlusMaking HIV treatment and carereal for sex workers living with HIVOverall antiretroviral therapy coveragein the Asia-Pacific region is only 44%,lower than global average of 54%for low-income and middle-incomecountries.Source: Together we will end AIDS, UNAIDS, 2011.For people living with HIV, timely access toantiretroviral therapy not only saves lives and sustainsgood physical health, fully effective therapy preventsnew HIV infections. This provides a compellingcase for challenging the barriers to HIV testing andtreatment. 51 The vast majority of people living withHIV who are eligible for treatment are not receivingit. Sex workers are particularly disadvantaged inthis regard. Unfavourable conditions in health caresettings, usually stemming from stigma, threaten theiraccess to HIV treatment. 52VAMP Plus has developed a service delivery modelthat delivers continuity of care, improving access toboth VCT and HIV treatment for sex workers who testHIV positive. Their peer-based outreach and educationprogramme encompasses HIV testing and treatmentrelated literacy, pre- and post-test counsellingon HIV and accompanied referral for HIV testing. Allof the outreach sessions are individualised, focusingon one-to-one personal interaction, the benefits oftesting and consequences of results and accompaniedreferral to VCT centres. This has proved effective in improvinguptake of VCT. The key strength of VAMP Plusis their community centered, peer led approach thatfacilitates understanding of and access to HIV testingand access to HIV treatment, care and support for thosewho need it.Two key challenges were identified in the courseof documentation: Often there is a disconnectbetween HIV prevention and treatment services.This disconnection can be exacerbated by theway programmes are funded. HIV preventionprogrammes are commonly funded to includecondom programming, peer outreach and education,STI diagnosis and treatment and VCT. Organizationsthat implement HIV prevention programs often do notreceive funding support for follow-up support requiredto facilitate access to HIV treatment for sex workers.Programmes such as VAMP Plus have developed toaddress the reality of sex workers lives, having madea decision to test for HIV, yet too often unsupportedin accessing HIV treatment and care when the resultis positive. The kind of support required, as the VAMPPlus exemplifies, requires considerable time andskills — individual counselling and psychosocialsupport, accompanied referrals, treatment literacy,support with treatment adherence and engaging withhealth services to address stigma and create communityconfidence to access services. Disincentives to HIVtesting mean that sex workers living with HIV oftenonly discover their HIV status when they are alreadyseriously ill and the efficacy of treatment is reduced.Efforts to improve sex worker communities’ knowledgeabout the value of timely HIV treatment will encouragesex workers to test for HIV.Experience in the region indicates that there isinadequate attention to funding this work, a vitalconnection between sex workers and the healthsystem. Yet, it is precisely this kind of approach that canensure sex workers living with HIV have access to HIVtreatment and care. Community-based interventionsthat build sex workers’ understanding of and facilitateaccess to HIV treatment and care should be funded asintegral part of HIV treatment scale up.Page 22