Implementing Comprehensive HIV/STI Programmes with Sex Workers Implementing Comprehensive HIV/STI Programmes with | Page 131

5 Clinical and Support Services

Box 5.3

Understanding and addressing concerns about ART
Like many people, sex workers may have fears and concerns about ART, and outreach and support
programmes should understand and address fears or misconceptions about the possible adverse effects
of ARVs.
As ART is now recommended for people earlier in their infection, those with HIV who are asymptomatic
require careful counselling to understand why it is beneficial to initiate ART before feeling unwell or having
symptoms. The benefit of adhering to prescribed treatment and maintaining a suppressed viral load of HIV
to support good health and prevent treatment failure, as well as the benefit of ART in reducing the risk of
HIV transmission, should be fully discussed. This may happen over several sessions, if necessary, checking
whether the sex worker understands the issues and answering any questions.
Knowledge of the current community understanding of ART issues is imperative so that programmes,
clinicians, counsellors and outreach workers may address any concerns with accurate and appropriate
information.

Sex worker-specific ART services
There are several key clinical service delivery elements specific to sex workers that may make access
to ART easier, more acceptable and more effective, and support adherence to ART and retention in
care:
• flexible clinic hours (weekends, evenings)
• clinical services at sites located near places of work
• “no appointment needed” and drop-in services available
• “emergency” drug pickups available when running out of ARVs
• family-centred services for sex workers with children
• patient-held records for sex workers who may seek ART at different sites
• respectful and non-judgemental staff attitudes.
Additional considerations when providing ART for sex workers may include:
• Drug treatment services available in the same or nearby location.
• Potential co-morbidities, such as cervical cancer, other STIs, HBV and hepatitis C (HCV).
• Addressing social vulnerabilities, including injecting drug use, other substance use, and violence
that may affect access to treatment, adherence and retention, and lack of continuity of care and
treatment interruptions (due to imprisonment, migration).
• All programmes referring sex workers to clinical sites providing ART should ensure that these
services adhere to international standards of care outlined in this tool as well as address other key
support, care and social services.
• Contraception and antenatal care services (including prevention of mother-to-child transmission
for HIV-positive pregnant women) should also be available, and links to services supported, where
needed.
• In order to meet the needs of mobile sex workers, health providers should also be flexible in
interpreting national guidelines on the quantities of drugs to dispense at one time.
• The range of clinical support services for sex workers should be tailored to address the specific
needs of male, female and transgender sex workers.

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