Implementing Comprehensive HIV/STI Programmes with Sex Workers Implementing Comprehensive HIV/STI Programmes with | Page 137

5 Clinical and Support Services

5.6 STI services
5.6.1 Introduction

2012 Recommendations: Evidence-based Recommendation 3

Screening and treatment of sex workers for STIs is important to prevent the acquisition and
transmission of infections and to reduce reproductive health complications, such as pelvic inflammatory
diseases, infertility and congenital infections.
Provision of basic HIV and STI clinical services is an essential component of a comprehensive package
of services for sex workers and should be a priority in sex worker interventions. All sex workers should
have access to acceptable, effective and high-quality STI services. These should be human rightsbased, confidential, accessed voluntarily and without coercion, and provided after informed consent.
Well-trained and non-judgemental health-care providers build trust and confidence among sex workers,
who should be involved in service provision and not be seen as passive recipients of services.
An STI services package consists of case management for both symptomatic and asymptomatic
STIs. Comprehensive STI case management also includes the promotion and provision of condom
use, support for compliance with treatment, risk reduction counselling and partner management.
Once established and scaled up, services may be expanded in scope to meet the broader health
needs of sex workers.
Respondents to the values and preferences survey8 expressed unanimous support for periodic
voluntary screening for STIs.

5.6.2 STI services for sex workers
Regular screening for asymptomatic infections among sex workers using laboratory tests is costeffective given the high rates of STIs, and can reduce STI prevalence over time. It is therefore
essential to invest in STI screening. Where laboratory diagnosis is available, laboratories should be
staffed by qualified personnel with adequate training to perform technically demanding procedures,
with quality assurance systems in place.
Absence of laboratory tests should not be a barrier to screening sex workers for STIs. A regular STI
check-up is an opportunity to reinforce prevention and address other health needs. The check-up may
consist of probing for symptoms of STIs and checking for signs of cervical and ano-rectal infections,
including speculum and proctoscopic examination.
Provision of effective services to sex workers with STI symptoms should be a priority for STI
services. Symptomatic STI patients may be aware they are infected and are more likely to seek
care. In resource-poor settings where reliable STI testing is not feasible, WHO has recommended a
syndromic approach (locally adapted) to manage symptomatic infections.
8 A global consultation conducted with sex workers by NSWP as part of the process of developing the 2012 Recommendations.

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