Implementing Comprehensive HIV/STI Programmes with Sex Workers Implementing Comprehensive HIV/STI Programmes with | Page 112

4 Condom and Lubricant Programming

4.2.4 Specific considerations in condom programming
A. Condom programming with male and transgender sex workers
The types of sexual services provided by female, male and transgender sex workers vary, and
condom distribution and promotion programmes should take these differences into account and
ensure distribution of all commodities relevant to the types of sex provided by male and transgender
sex workers. For example, lubricants are particularly important for people practising anal sex, while
flavoured condoms may be important for oral sex.
• Promotional/educational programmes working with male sex workers should discuss topics such
as condom use when maintaining an erection is difficult, the side-effects of drugs used to treat
erectile dysfunction, risk reduction for fetish sex and use of female condoms for anal sex.
• Promotional/educational programmes working with transgender sex workers should provide
information on use of female condoms and safer sex after surgery, among other topics.
In all cases, programmes serving male and transgender sex workers should work with these
communities to understand their information and commodity needs, and tailor promotion and
information accordingly. Both male and transgender sex workers may be highly stigmatized and
programmes should provide psychosocial support, as needed. Male and transgender sex workers
should be served by community outreach workers of the same gender in order to maximize
understanding and the sharing of ideas between the sex workers and the community outreach
workers.

B. Condom negotiation strategies
The decision about whether or not to wear a condom—as well as the type of sex to have—usually
comes down to a specific negotiation between an individual sex worker and an individual client. In
order for condom promotion programmes to be successful, community outreach workers should
discuss condom and safer sex negotiation strategies during their meetings with sex workers to
enhance their negotiation “toolkits” and skills.
Negotiation tactics that have been identified by sex workers include:
• taking the client’s money prior to the sexual encounter so that clients cannot refuse to pay if a
condom is used
• taking the client to a known sex work venue where the rules of the venue require use of a condom
• negotiating with the client to engage in non-penetrative sex
• empowerment of the community; creating a community norm to refuse unprotected sex
• if all else fails, and if it is reasonably safe and feasible to do so, refusing the client if he will not
wear a condom.

C. Condom programming with clients of sex workers
Clients of sex workers often make the final decision as to whether or not condoms are used, but they
are frequently neglected in HIV prevention programmes. Countries that have successfully reduced
new infections among sex workers and their clients often took steps to change the attitudes and
behaviours of clients rather than focusing solely on the behaviour of sex workers.
As noted earlier, mass media campaigns are an important component of condom programming for
clients of sex workers, who are not easily reached by outreach alone. There should also be more

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