5 Clinical and Support Services
Programmes serving sex workers should take extra efforts to support links to care, such as identifying a trusted peer( or community outreach worker) 6 to accompany HIV-positive sex workers to care, support and treatment services. However, this should only be done with the sex worker’ s consent.
5.2.4 Quality assurance of services
In the design and development of voluntary HTC services, special attention should be paid to establishing effective and acceptable links to services, quality assurance of testing and appropriate testing strategies to confirm positive test results in line with national guidelines. See Section 5.9 for tools for quality assurance testing.
5.2.5 Voluntary HTC performed by community outreach workers and lay counsellors
Voluntary HTC may be more acceptable to sex workers when the testing and counselling are performed by a trusted peer, i. e. another sex worker. Adequate training, ongoing performance support and monitoring are essential for all staff performing HIV testing at the community level, including health workers, programme staff and community outreach workers. Community outreach workers are an effective part of the voluntary HTC workforce. Community outreach workers who provide HTC should receive certified training in line with national HTC guidelines. Opportunities for professional development and promotion to supervisory, management and leadership roles should always be available for community outreach workers.
Box 5.2
Case example: Outreach to provide HIV testing and counselling in Ghana
Pro-Link, an NGO, provides HIV prevention services to sex workers in five regions of Ghana. One project site in a low-income area of the capital, Accra, serves a catchment area of approximately 90,000 residents. Outreach activities have identified at least 50 locations and brothels in the community, with an estimated 5,000 sex workers. Pro-Link has trained 54 community outreach workers, sponsors community support groups and savings clubs, and has operated a drop-in centre since 2008, staffed by outreach workers and a nurse who provides STI screening and treatment, voluntary HTC, and follow-up care for those living with HIV.
Miriama, a sex worker who has been trained in on-site HIV rapid testing, counselling and follow-up care, provides HTC outreach services at locations where women work, including on the rooftop of a brothel. When a sex worker tests HIV-positive, Miriama makes sure that the sex worker goes to a nearby clinic for confirmatory testing and enrolment in care and treatment, if needed. Miriama manages to create private spaces even where there are no walls, ensures confidentiality even with the brothel owner downstairs, and expresses an accepting and loving approach to the sex workers she serves, many of whom are very young.
6 In this tool,“ community outreach worker” is used to mean a sex worker who conducts outreach to other sex workers, and who is not generally full-time staff of an HIV prevention intervention( full-time staff might be called“ staff outreach workers” or also simply“ outreach workers”). Community outreach workers may also be known by other terms, including“ peer educators”,“ peer outreach workers” or simply“ outreach workers”. The terms“ community” or“ peer” should not, however, be understood or used to imply that they are less qualified or less capable than staff outreach workers.
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