Implementing Comprehensive HIV/STI Programmes with Sex Workers Implementing Comprehensive HIV/STI Programmes with | Page 129

5 Clinical and Support Services

5.3 Antiretroviral therapy
5.3.1 Introduction

2012 Recommendations: Evidence-based Recommendation 6

The increased availability of and access to ART has significantly decreased HIV-related illness as well
as deaths due to HIV. Recent advances in HIV treatment, and the success of community advocacy
for increased availability of affordable drugs, have resulted in substantial improvements in the quality
of life of people living with HIV throughout the world. Although access in resource-limited settings
is usually not as comprehensive as in industrialized countries, free or subsidized ART services are
now widely available in many countries with high HIV prevalence.
The treatment principles and recommendations for antiretroviral drug (ARV) use by sex workers are the
same ones applicable for all people with HIV infection. All sex workers with HIV and/or tuberculosis
(TB) should have access to ART and to anti-TB drugs and services. In addition to the clinical benefit to
the HIV-positive sex worker, providing ART has the potential to prevent HIV transmission by reducing
viral load.
Sex workers may face greater challenges than the general population in accessing HIV care and
treatment services and, once started on ART, to retention in care and adherence to treatment.
This is often because of stigma and discrimination in health-care settings and the inflexibility and
inconvenience of service provision. Other barriers to successful ART provision for sex workers
include mobility, criminalization of sex work and uncertain immigration or legal status, which may
prevent them from accessing free ART in settings where only country nationals are entitled to free
medical care.
However, providing ART to sex workers is feasible and is as effective as in the general population.
Programmes providing outreach or services to sex workers should ensure that sex workers know
where to go for treatment and are supported in their access to ART and TB medications.
Respondents to the values and preferences survey7 supported the use of the same ART protocols as
for other adults with HIV. The need for universally accessible treatment was emphasized, including
access to treatment for migrants and those without legal documents.

7 A global consultation conducted with sex workers by NSWP as part of the process of developing the 2012 Recommendations.

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