Implementing Comprehensive HIV/STI Programmes with Sex Workers Implementing Comprehensive HIV/STI Programmes with | Page 143

5 Clinical and Support Services Involve sex workers and community outreach workers in clinic operations Sex workers are capable of engaging at many levels of STI clinic operations, including management. Involvement of sex workers increases the sense of ownership and makes the clinic more acceptable and sustainable. STI services should promote meaningful participation of sex workers. Clinics should formalize sex worker involvement by specifying how sex workers may be involved in developing, managing and monitoring services. Professional development should be an integral part of community empowerment, allowing sex workers to learn and be mentored to provide clinical services. Sex workers involved in the clinic operations should be trained to undertake their tasks, should maintain confidentiality and should be remunerated for their work. Box 5.7 Case example: Community involvement in clinic operations in Uganda and India In Uganda, sex workers supported government clinics in taking steps to make the services more acceptable to community members, and became involved in clinic operations. In Mysore, India, sex workers have undergone formal training in nursing. Twelve sex workers who have completed their degree are now employed as nurses at the clinic. Provide an appropriate and high-quality STI service package Providing high-quality services encourages STI patients to seek care regularly. Figure 5.5 shows the factors that ensure quality in STI services. Figure 5.5 Ensuring high-quality STI services Essential components • Technically sound • Effective • Efficient • Safe • Accessible • Interpersonal relations (trust) • Continuity of services • Physical infrastructure and comfort • Informed choice Inputs to ensure quality Quality will lead to… • Range of services (STI, SRH, HIV, primary health care) • Increased sex worker knowledge and satisfaction • Programme management support: ›› policy support and guidelines ›› programme structure ›› resources and commodities (drugs, lab supplies, condoms) • Appropriate health-careseeking behaviour—develop community norm • Capacity-building: ›› clinic staff and sex worker training ›› monitoring and supervision • Increased coverage, uptake and retention • Improved individual and community health • Sex worker involvement in clinic operations and monitoring (feedback from sex workers) • Coordination with community-led outreach • Referral mechanism • Continuity of services 121