Implementing Comprehensive HIV/STI Programmes with Sex Workers Implementing Comprehensive HIV/STI Programmes with | Page 145

5 Clinical and Support Services

Box 5.8

Addressing the needs of male and transgender sex workers
Male and transgender sex workers need gender-specific interventions and services. Some male sex
workers are heterosexual or bisexual while others identify as gay (homosexual). WHO guidelines for the
Prevention and treatment of HIV and other sexually transmitted infections STIs among men who have sex
with men and transgender people (2011) recommend the following:
• Men who have sex with men and transgender people with symptomatic STIs should seek and be offered
syndromic management and treatment (in line with existing WHO guidance).
• Offer periodic testing for asymptomatic urethral and rectal N. gonorrhoeae and C. trachomatis infections,
using nucleic acid amplification test (NAAT) rather than culture.
• Offer periodic serological testing for asymptomatic syphilis infection.
• Men who have sex with men and transgender people should be included in catch-up HBV immunization
strategies in settings where infant immunization has not reached full coverage (in line with existing WHO
guidance).
It is essential to involve male and transgender sex workers in designing, implementing and monitoring STI
services. In any setting, clinic standards should be adapted to ensure that gender-specific and appropriate
services are provided. The model of service delivery depends on the specific context and on inputs from
the male and transgender sex workers. In some settings, services for female sex workers may be adapted
to provide services for male and transgender sex workers (e.g. offering services at specified times so that
female, male and transgender sex workers may be seen separately at the same clinic). In some settings,
clinics for men who have sex with men have provided services for male and transgender sex workers; in
others, dedicated services for the sex workers have been established.

C. Periodic presumptive treatment

2012 Recommendations: Evidence-based Recommendation 4

The 2012 Recommendations state that:
1. PPT should be implemented only as a short-term measure in settings where STI prevalence is
high, e.g. >15% prevalence of N. gonorrhoeae and/or C. trachomatis infection.
2. PPT for gonorrhoea and chlamydial infection should always be free, voluntary and confidential,
and include counselling and informed consent.
3. PPT for gonorrhoea and chlamydial infection should only be offered as part of comprehensive
sexual health services (including community empowerment, condom programming, STI screening,
STI treatment and care) and while HIV/STI services are being further developed.
4. There should be ongoing monitoring of the possible benefits and harm that sex workers could
experience from being offered PPT.

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