Implementing Comprehensive HIV/STI Programmes with Sex Workers Implementing Comprehensive HIV/STI Programmes with | Page 132

5 Clinical and Support Services

• Migrant sex workers and sex workers without documentation may experience significant barriers
to accessing ART services. Programmes serving sex workers should be as flexible as possible to
achieve the goal of universal access to care and treatment.
Integrated or “one-stop-shop” services may be one of the best ways of providing a fully comprehensive
range of HIV and related health services. This may be possible in some settings where a number
of services are available, such as voluntary HTC, clinical services including ART and treatment of
HIV-related infections, contraception, antenatal services, cervical screening, legal advice, condoms,
vaccinations, STI and viral hepatitis screening.
Community support for ART
Additional community elements that could be provided in parallel with formal clinical services to
improve ART and health care for sex workers include:
• trained community outreach workers to accompany sex workers to clinics to receive ART. This
should be provided only if the sex worker wants it. Community outreach workers should be trained
to understand and respect the confidentiality of the sex worker receiving treatment.
• community support and empowerment groups for HIV-positive sex workers.
• community committees to monitor service delivery, and feedback loops to ensure appropriate,
accessible and high-quality treatment
• community safe spaces (drop-in centres).

Box 5.4

Case example: Managing care and treatment for
male sex workers in Kenya
Health Options for Young Men on HIV, AIDS and STIs (HOYMAS—www.hoymas.org) started in 2009 as a
support group for male sex workers in Nairobi, Kenya. It now provides services for more than 1,200 male
sex workers, more than half of whom are living with HIV. HOYMAS is owned, led and designed by the
community. It provides a comprehensive range of HIV and health services in a safe space, with a nurse
on site to help with daily issues of prevention, care and treatment. Services include:
• A place to rest for people on ART
• Medicine storage—men who do not have a safe place to store their ARVs may keep them at the centre
and collect them when needed
• Nutritional support for those with HIV, and in particular to help those taking ARVs
• Peer support (“my brother’s keeper” programme)
• Home visits to sick members
• Referrals for other services, e.g. legal and post-violence support
• Distribution outlet for condoms and lubricants and information and education communication materials
HOYMAS also networks with government-managed health services to sensitize health workers to the
clinical needs of men who have sex with men and male sex workers. HOYMAS’ community outreach
workers liaise between the centre and five district hospitals and provide training to health workers on men
who have sex with men and HIV issues.

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