5 Clinical and Support Services
Related operational considerations include:
• the use of single-dose combination antibiotics for high cure rates
• enhanced condom promotion, including ensuring quality and accessibility to reduce rates of reinfection
• enhanced sex worker-led outreach to increase knowledge, coverage and use of services
• enhanced support for safer working conditions to increase opportunities for condom negotiation
• use of PPT as an emergency response only with these other components to reinforce STI control and HIV prevention with sex workers and their clients
• phasing out of PPT as soon as possible, e. g. after six months, even if prevalence has not declined, as other measures should by then be in place to maintain control.
The values and preferences survey concluded that the potential risks of PPT to sex workers outweigh the potential benefits. Sex workers reported harmful consequences from the introduction and use of PPT, and ongoing monitoring of the possible harm that sex workers could experience from PPT was requested. There was unanimous agreement from the values and preferences survey, and from participants at the related validation meeting, that PPT should only be offered when sex workers have access to all relevant information, including about side-effects, and only when uptake is voluntary and not imposed as part of a coercive or mandatory public-health effort.
D. Viral hepatitis
2012 Recommendations: Evidence-based Recommendation 8
HBV is transmitted between people by contact with the blood or other body fluids of an infected person. Sexual contact and injecting drug use also transmit the virus. Risky sexual practices and sex work are associated with HBV infection in different regions of the world. Fortunately, highly effective vaccines against the virus are available. WHO recommends three doses of the vaccine for complete immunization and protection against potential HBV infection. WHO has also published Guidance on prevention of viral hepatitis B and C among people who inject drugs.
Like HBV, HCV is transmitted through contact with the blood or other body fluids of an infected person. Most HCV infections occur through the use of contaminated injection equipment among persons who inject drugs or in medical settings. HCV can also be transmitted by sexual contact, and the group at greatest risk is HIV-infected men who have sex with men. There is no vaccine to prevent HCV infection, but it can be cured with treatment. WHO is developing guidance for HCV treatment, and has published Guidance on prevention of viral hepatitis B and C among people who inject drugs.
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