HIV Programs for Sex Workers: Lessons and Challenges for Developing and Delivering Programs

Abstract

There is evidence that HIV prevention programs for sex workers, especially female sex workers, are cost-effective in several contexts, including many western countries, Thailand, India, the Democratic Republic of Congo, Kenya, and Zimbabwe. The evidence that sex worker HIV prevention programs work must not inspire complacency but rather a renewed effort to expand, intensify, and maximize their impact. The PLOS Collection “Focus on Delivery and Scale: Achieving HIV Impact with Sex Workers” highlights major challenges to scaling-up sex worker HIV prevention programs, noting the following: sex worker HIV prevention programs are insufficiently guided by understanding of epidemic transmission dynamics, situation analyses, and programmatic mapping; sex worker HIV and sexually transmitted infection services receive limited domestic financing in many countries; many sex worker HIV prevention programs are inadequately codified to ensure consistency and quality; and many sex worker HIV prevention programs have not evolved adequately to address informal sex workers, male and transgender sex workers, and mobile- and internet-based sex workers. Based on the wider collection of papers, this article presents three major clusters of recommendations: (i) HIV programs focused on sex workers should be prioritized, developed, and implemented based on robust evidence; (ii) national political will and increased funding are needed to increase coverage of effective sex worker HIV prevention programs in low and middle income countries; and (iii) comprehensive, integrated, and rapidly evolving HIV programs are needed to ensure equitable access to health services for individuals involved in all forms of sex work.

Remaining Gap in HIV Testing Uptake Among Female Sex Workers in Iran

“…For many FSW, the Internet has become as an important tool for communicating with friends and sexual partners. Given the considerable number of mobile- and Internet-based sex workers, developing and piloting educational programs to promote HIV testing in social media, smart phones, and cyberspace could be a viable option for future interventions [32, 33]. Moreover, strategies to simplify and improve access to health centers where HIV testing is provided could increase HIV testing among FSW [34].…”

The Role of Sex Work Pay in Moderating the Effect of Mobile Phone Solicitation on Condom Practices: An Analysis of Female Sex Workers in India

“…This may result in less ability to screen out high-risk clients compared to FSWs who are using mobile phones exclusively. While these rationales require further study and confirmation, we believe they demonstrate a line of enquiry into understanding a new, more hidden sexual risk environment for FSWs that are not often captured with traditional FSW research and practice strategies [1,4]. …”

“…While mobile phone use among Indian Female Sex Workers (FSWs) to connect with clients have consistently increased, strategies to integrate mobile phones into HIV/AIDS initiatives for FSWs have been limited, particularly in regard to HIV prevention [1–4]. The unique considerations required for sex work populations contribute to the challenge of designing effective strategies [5,6].…”

Consistent Condom Use by Married and Cohabiting Female Sex Workers in India: Investigating Relational Norms with Commercial Versus Intimate Partners

“…One of the major achievements of India’s HIV/AIDS response has been the promotion of consistent condom use (CCU) between female sex workers (FSW) and clients. As a result, FSW in India now have HIV prevalence below 3% (2, 3). …”