Implementing Comprehensive HIV/STI Programmes with Sex Workers Implementing Comprehensive HIV/STI Programmes with | Page 122

5 Clinical and Support Services

5.1 Operational principles for clinical and support services
Providing appropriate, accessible and acceptable clinical and support services for sex workers presents
unique challenges because of the stigma and discrimination often faced in clinical settings. However,
clinical services can be a focus for community empowerment if sex workers are involved in their
design, implementation and monitoring.1 This also encourages uptake of services by sex workers.
It is essential to build trust between health-care providers and sex workers receiving services. This
may be done, in part, by following these overarching principles:
1. Voluntary and informed consent: Sex workers have the right to decide on their own treatment
and the right to refuse services. Health-care providers should explain all procedures and respect
the sex worker’s choice if he or she refuses examination or treatment.
2. Confidentiality: Confidentiality of patient information, including clinical records and laboratory
results, should always be maintained to protect the privacy of sex workers. Sex workers should
be allowed to provide identifying information other than their official birth name (identification
papers or biometric data should not be required). Continuity of services may be assured by
assigning an enrolment number.
3. Appropriate services: Clinical services should be effective, of high quality, provided in a timely
manner and address the needs of sex workers. Health services should be in line with international
standards, current best practices and guidelines.
4. Accessible services: Clinical services should be offered at times and places convenient for sex
workers. Where possible, services should be integrated or closely linked so that a broad range
of health services can be accessed at a single visit (see Section 5.1.1).
5. Acceptable services: Health-care providers should be discreet, non-judgemental, non-stigmatizing
and trained to address the special needs of sex workers.
6. Affordable services: Services should be free or affordable, bearing in mind the cost of transport
and lost income opportunities for sex workers visiting a service provider.
Figure 5.1 shows how these principles may be put into practice through coordinated activities at each
level of a prevention programme for HIV and sexually transmitted infections (STIs).

5.1.1 Service delivery and integration
Although different clinical services are divided into separate sections within this chapter, the goal of
effective programme planning should be to create delivery models with the fewest barriers for people
to access services. Clinical and nonclinical services are often complementary, and coordinating the
two may also be appropriate. Approaches to make services more user-friendly include:
• co-locating interventions and cross-training providers
• involving the community in the development, promotion, delivery and monitoring of services
• training non-sex worker staff in a culture and duty of care towards sex workers
• taking steps to ensure that law enforcement activities do not interfere with sex workers’ access
to services.

1 In most contexts in this tool, “community” refers to populations of sex workers rather than the broader geographic, social or cultural groupings of which they may
be a part. Thus, “outreach to the community” means outreach to sex workers, “community-led interventions” are interventions led by sex workers, and “community
members” are sex workers.

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