5 Clinical and Support Services
Box 5.1
Case example: Comprehensive care with and for sex workers in Kenya
Comprehensive services with and for sex workers have been provided in Kenya for a number of years. Prevention education and condom distribution are provided in“ hot spots” by outreach workers, most of whom are trained sex workers. HTC is provided in clinics as well as at outreach sites. All persons found to be HIV-positive are referred to a nearby clinic, although sex workers may choose alternate locations if they prefer, and they move from site to site as they choose. Clinics are open in the evenings and on Saturdays and offer comprehensive care including pre-ART care, prevention and treatment of opportunistic infections, support groups and long-term ART. Additional services, such as diagnosis and treatment of other STIs and cervical cancer screening are also available. These projects, located in all the major cities of Kenya, have advisory committees that include sex workers and advocates, and operate with the support of the Ministry of Health. As of June 2013, over 40,000 sex workers and family members had received services through these comprehensive programmes throughout the country.
5.2.3 Essential activities for voluntary HTC services for sex workers A. Preparation Appropriate preparation for delivering HTC services includes building community awareness and demand, training providers, selecting locations and times to deliver services, and procuring supplies.
Community awareness and building demand for voluntary HTC
• Community members should be informed about the benefits of knowing one’ s HIV status and about the availability of treatment if they are infected with HIV. Even with awareness-raising activities for the general public or key populations, sex workers may not know about services that are respectful of sex workers or provided by trained and qualified sex workers.
• As part of awareness-raising campaigns, sex workers should be informed of their right to confidentiality and consent and their right to refuse HIV testing if they choose.
Training providers and community outreach workers
• Training in HTC should follow national and international standards( see Section 5.9).
• Training for counsellors who will provide HTC to sex workers should include additional training on:
›› the duty to be respectful and non-judgemental
›› the specific needs of sex workers
›› the absolute requirement to maintain confidentiality, not only about HIV results, but also about any other information provided during the counselling session, including the sex worker’ s engagement in sex work.
Location and timing of services
• Both the location and the timing of voluntary HTC services should be responsive to the needs and requests of sex workers. In some settings, this might mean providing services during evening hours or weekends, such as“ moonlight HTC”, which has been provided in a number of countries.
• Community settings may be more attractive than health-care institutions.
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