Implementing Comprehensive HIV/STI Programmes with Sex Workers Implementing Comprehensive HIV/STI Programmes with | Page 126

5 Clinical and Support Services

Procuring essential supplies
• Procurement of supplies to conduct HIV testing is usually done by the agency or organization
providing the services.
• A programme serving sex workers that wishes to provide voluntary HTC on-site should work with
local health authorities to obtain training and authorization to provide HTC, as well as the needed
supplies.
• It may be helpful to obtain handouts or other informational material about the importance of HIV
testing to distribute to sex workers.
Management
Refer to Chapter 6. For information specific to the management of voluntary HTC services, please
refer to the WHO Handbook for improving HIV testing and counselling services.5

B. HTC service delivery
Pre-test information
• The pre-test session should focus on basic HIV information and information about the HIV testing
process, and ensure that testing is voluntary.
• A risk assessment may be used to develop a risk reduction plan that is specific to the situation
of the client. However, it is not necessary to investigate the sex worker’s behaviours, number of
partners, injecting drug use and other information unless the client volunteers this information.
Post-test counselling
This counselling is provided when the test results are ready to be given to the client.
• Information about what is needed in the post-test counselling session may be found in the WHO
publication Delivering HIV test results and messages for re-testing and counselling in adults.
• Sex workers who are found to have HIV infection should be offered immediate referral for longterm care and treatment at a clinic or hospital whose staff are respectful of sex workers. They
should also receive counselling about how to avoid transmitting HIV to others.
• All people, including sex workers, who are found to be HIV-negative should be provided with riskreduction information specific to their individual risks, given access to condoms and lubricant, and
counselled on strategies to negotiate safer sex. (See also Chapter 4.)
• Mental health issues, such as anxiety and depression, should be assessed if the counsellor has
been trained in these areas. Referral to a clinician with training in mental health may be helpful.
(See also Section 5.8.)
Repeat testing
• Sex workers who test HIV-negative should be advised to return for repeat testing after four weeks.
They should also seek re-testing at least annually. See Delivering HIV test results and messages
for re-testing and counselling in adults for more detailed information on repeat testing for sex
workers and others at high risk for HIV infection.
• Some programmes serving sex workers and others at high risk offer those who test negative repeat
HTC at regular intervals. This repeat testing may be done every three months or whenever a sex
worker requests it, and should be offered at least annually as recommended by WHO for persons
at higher risk. Repeat HIV testing should also be offered whenever there is a new STI diagnosis.
5 Details on this and other WHO publications mentioned in this chapter may be found in Section 5.9.

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