Implementing Comprehensive HIV/STI Programmes with Sex Workers Implementing Comprehensive HIV/STI Programmes with | Page 127

5 Clinical and Support Services

Self-testing
Reports suggest that HIV rapid tests are being sold and used for self-testing in an increasing number
of countries, and sex workers and their clients may be using HIV tests for self-testing. Guidance on
self-testing will be issued by WHO by 2014. Key issues relating to self-testing among sex workers are:
• There are potential benefits and risks of self-testing. One benefit may be to make HIV testing
acceptable to people who currently avoid HIV testing in facilities. People who could benefit from
regular retesting may find self-testing more convenient than returning to a facility frequently. The
risks of self-testing include operator error or mistakes, misinterpretation of results, and lack of
confirmation of HIV-positive results. Lack of counselling may result in depression and lack of access
to treatment among those who test HIV-positive.
• It is an abuse of HIV testing in any form—including self tests—for employers, brothel owners or
clients to force a sex worker to be tested. Coercing a person to use a self-test does not constitute
voluntary testing.
• Any person who tests HIV-positive on the basis of a self-test should be informed of the need for
confirmatory testing at an HTC site, health facility or laboratory.
• All persons using self-tests, including sex workers, should be counselled that a negative test result
is not a reason to stop using condoms, because persons recently exposed to HIV may have a
negative result on self-testing but be infectious.
Partner and family testing
Voluntary testing of regular partners, spouses and family members is available in many settings.
When a sex worker tests HIV-positive, it is often helpful to offer voluntary counselling and testing to
members of the family or household. Sex workers living with HIV should be supported to disclose
their results to trusted family members, and voluntary HTC should be available to their partners,
children and other family members.

C. Follow-up
Prevention services
• All persons, including sex workers, regardless of HIV status, should be informed about prevention
services, including condoms and lubricants (see Chapter 4).
• Male sex workers who have female sex partners should be informed about the protective effects
of male circumcision and referred to voluntary medical male circumcision services. Potential sideeffects and the waiting period prior to resuming sexual activity should be carefully explained. The
protective effect of male circumcision for men who have sex with men remains unclear. (See
resources in Section 5.9.)
Connection to care and supportive services
Every person who tests HIV-positive should be offered care, support and treatment that is respectful
and acceptable. Programmes serving sex workers, especially when providing voluntary HTC, should
take responsibility to ensure that those who are HIV-positive are empowered to:
• enroll in care at a site that is acceptable to them and respectful of them
• participate in community-led support groups
• return for all follow-up visits.

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