Implementing Comprehensive HIV/STI Programmes with Sex Workers Implementing Comprehensive HIV/STI Programmes with | Page 124

5 Clinical and Support Services

5.2 Voluntary HIV testing and counselling
5.2.1 Introduction

2012 Recommendations:2 Evidence-based Recommendation 5

Voluntary HIV testing and counselling (HTC) is an essential entry point to HIV prevention, and to
care and life-sustaining treatment for people with HIV. By combining personalized counselling with
knowledge of one’s HIV status, HTC can motivate behaviours to prevent HIV transmission, and
persons living with HIV can access supportive counselling, treatment for opportunistic infections
and antiretroviral therapy (ART).
Voluntary HTC services should be part of an integrated programme of HIV prevention, care and
treatment, so that sex workers, their partners and their families have access to HTC as frequently as
required, at times and locations that are convenient. Counselling and testing services should adhere
to the “5 C’s” principles described below, and should be delivered respectfully and without coercion,
judgement, stigma or discrimination.
Respondents to the values and preferences survey3 stressed that in order for ART to be more widely
available to sex workers, more sex workers must know their HIV status. Respondents unanimously
expressed disapproval of mandatory or coercive testing.

5.2.2 Types of HIV testing and counselling and delivery
HTC services may be provided in a variety of settings, including:
• mobile community outreach
• health facilities
• safe spaces (drop-in centres)4
• bars, clubs and brothels
• homes or households.
Finger-prick blood sample or mouth swab are preferred collection methods. They can be performed
by a trained community worker; these methods may also be more acceptable to people who have
injected drugs and may have difficulty with venous blood access or have concerns about drug use
disclosure.

2 Prevention and treatment of HIV and other sexually transmitted infections for sex workers in low- and middle-income countries: recommendations for a public health approach.
WHO, UNFPA, UNAIDS, NSWP, 2012.
3 A global consultation conducted with sex workers by NSWP as part of the process of developing the 2012 Recommendations.
4 A safe space or drop-in centre is a place where sex workers may gather to relax, meet other community members and hold social events, meetings or training.
See Chapter 3, Section 3.3, for details.

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