Implementing Comprehensive HIV/STI Programmes with Sex Workers Implementing Comprehensive HIV/STI Programmes with | Page 107

4 Condom and Lubricant Programming Community-led condom promotion The condom promotion strategy may be developed in a workshop setting that should be led by, or at the very least include, sex workers who represent relevant sub-groups, including urban and rural, “new entrants” and “experienced”, “indoor”10 and street-based, and female, male and transgender sex workers. Providing sex workers with a space to engage and lead this process ensures a realistic understanding of their barriers to condom access, preferences for condom acquisition and current condom use with their clients. The resulting community promotion strategies should apply a holistic approach similar to the approaches to community-led services outlined in Chapter 3. Led by (or in consultation with) sex workers, multiple behaviour change intervention activities and materials (e.g. one-on-one counselling, role plays, flip charts, posters, video testimonies, etc.) may be developed in order to build needed skills and reinforce condom promotion messages. High-quality, community-led activities accompanied by high-quality tools and materials have proven effective in ensuring targeted promotion messaging and building condom-related skills. Behaviour change strategies should be designed to address a variety of personal barriers to condom use, including: • Knowledge of the health benefits of condoms and where they are available • Safer sex negotiation abilities11 • Condom skills-building (for both male and female condoms) • Appropriate use of safe lubricants Demonstrations of correct male and female condom use by community outreach workers may increase sex workers’ condom use skills and self-efficacy in condom use (i.e. the belief in their ability to use a condom even under challenging circumstances). Approaches should also facilitate sex workers’ ability to build support systems in their community in order to collectively identify ways to encourage consistent condom and lubricant use. Box 4.2 lists strategies for community-led condom promotion; the following page identifies some specific approaches that may be considered. Box 4.2 Condom promotional/educational strategies with sex workers • Evidence-based communication messages that create demand for safer sex. • Condom skills-building for both male and female condoms. • Information on choosing safe, effective lubricants and avoiding unsafe lubricants. • Training in safer sex negotiation skills, including how to negotiate condom use and strategies for reducing risk when no condom is available. • Addressing misconceptions around condom use, such as double condom use and female condom re-use. • Information on how to protect oneself when providing a broad range of sexual services, such as fulfillment of sexual fantasies, fetish sex12 and non-penetrative sexual services. • Specific discussions of the condom and lubricant needs of male-to-male anal sex, male-to-female anal sex, vaginal sex and/or male-to-transgender anal sex. • Providing risk-reduction education around common reproductive health misconceptions, including douching, washing after sex and preventing unintended pregnancies. 10 “Indoor” sex workers work in a variety of locations including their homes, brothels, guesthouses, bars, clubs and other sex work venues. 11 See Making Sex Work Safe (NSWP, 2011), pp.67–68 for condom negotiation strategies. 12 Fetish sex is when heightened erotic pleasure is gained from an activity, sensation or item that may differ from what society considers “normal” or traditional in relation to sexual activity. 85