Implementing Comprehensive HIV/STI Programmes with Sex Workers Implementing Comprehensive HIV/STI Programmes with | Page 133

5 Clinical and Support Services

Treatment literacy
Treatment of AIDS and other conditions, such as hepatitis, is continually changing, and it is important
for sex workers to be up-to-date with recent developments so they can be fully informed and involved
in their treatment. Sex worker-led treatment literacy programmes help sex workers stay informed
about and understand issues relating to their treatment.

Box 5.5

Case example: Sex worker treatment literacy in Asia
The Asia Pacific Network of Sex Workers (APNSW) integrates sex worker-specific issues into the Treatment
Literacy and Advocacy training conducted by the International Treatment Preparedness Coalition and Asia
Catalyst. There is a dual focus on treatment literacy and advocacy. The real-life impact of side-effects of
ARVs is examined and the reluctance of sex workers to start ART is discussed. The sessions explore how
best to integrate adherence into the sex workers’ working environment, e.g. for those who work in bars
or work irregular hours.
The sex worker-specific workshops aim to form better relationships across at-risk populations, i.e. between
sex worker groups and other groups. APNSW also takes a high profile in treatment activism, especially
around threats to access to generic medicines.

Pre-exposure prophylaxis
The 2012 Recommendations do not include guidance on the use of pre-exposure prophylaxis (PrEP)
for sex workers. Separate guidance, issued in 2012 by WHO, on PrEP for HIV-serodiscordant couples,
men and transgender women who have sex with men at high risk of HIV, encourages countries
that wish to introduce PrEP for these particular groups to consider doing so through demonstration
projects to ascertain its acceptability and how best to deliver it safely and effectively. It is recognized
that adherence to PrEP is key to its effectiveness as a prevention strategy and that it may offer an
additional HIV prevention option for some people who choose to use it.

5.4 Tuberculosis and sex workers
The 2012 Recommendations do not include a specific recommendation on TB. Diagnosis, prevention
and treatment of TB in sex workers should follow national and international guidelines for treatment of
TB in adults. The current global policy and guidelines on HIV-associated TB, at the time of printing, are:
• WHO Policy on collaborative TB/HIV activities: guidelines for national programmes and other
stakeholders (2012)
• WHO Guidelines for intensified tuberculosis case-finding and isoniazid preventive therapy for
people living with HIV in resource-constrained settings (2011)
People living with HIV are around 30 times more likely to develop TB than those who are HIV-negative,
and they are at increased risk of dying from TB. People who use drugs and people with a history of
incarceration are also at increased risk of developing TB, regardless of HIV status. While there are
limited data on the association between TB and sex work, sex workers living with HIV, sex workers
who inject drugs, and sex workers exposed to poor, cramped working and living conditions, including
brothels or prisons, are at increased risk of developing TB, including multidrug-resistant TB.

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