5 Clinical and Support Services
Link and integrate services The majority of programmes providing services to sex workers focus on HIV and other STIs. However, sex workers and their families have the same needs for primary health care as anyone else. Sex workers may also experience problems associated with alcohol and drug use.
Programmes should work to provide a full range of health and social services. These should be accessible on site or by referral, without fear of discrimination. Services may be added incrementally based on sex workers’ priorities, the feasibility of providing services, and alternative solutions. HIV, SRH, HBV immunization, TB, and drug and alcohol dependency treatment are discussed in other sections of this tool.
Sex workers whose HIV, SRH and other health issues cannot be met or managed appropriately by the programme’ s services should be referred to other facilities. Referral networks should be established depending on anticipated needs( see Figure 5.6). Clinics should compile a referral list of recommended providers, including names, addresses, telephone numbers and operating hours. Whenever necessary( e. g. due to perceived barriers to accessing services), accompanied referral should be considered.
Figure 5.6 STI referral network
Sexual and reproductive health services
Pregnancy test Family planning services
Family planning counselling for sex workers
• Sexual history
• Menstrual hygiene
• Promote family planning methods
• Assess need and counsel on basket of family planning choices
Treatment of reproductive tract infections
Reproductive tract cancer screening( cervical, breast, anorectal and prostatic)
Care for unintended pregnancy( post-abortion care)
Services for gender-based violence
Primary health care
• Pregnancy and antenatal services
• Paediatric care
Social and legal services
STI Clinic
Community services
• Health-care-seeking behaviours
• Coordination with outreach
• Community engagement
• STI clinic committee
HIV prevention and links to treatment and care
STI services
• Syndromic case management
• Routine STI screening including syphilis screening
• Presumptive treatment for STIs
STI / HIV counselling and psychosocial support
Condom promotion
Links to treatment and care
• Referral for HIV testing
• Management of opportunistic infections
• Referral to ART centres
• Referral for TB DOTS
• Ensure treatment adherence
HIV care support groups
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