Implementing Comprehensive HIV/STI Programmes with Sex Workers Implementing Comprehensive HIV/STI Programmes with

5 Clinical and Support Services 5.7.3 Cervical cancer screening Human papilloma virus (HPV) is an STI that can cause cervical cancer. Cervical cancer screening promotes early detection of precancerous and cancerous cervical lesions and prevents serious morbidity and mortality. Information and services for cervical cancer screening and treatment should be provided to sex workers. It is recommended that cervical screening be performed for every woman aged 30–49 at least once in her lifetime. Screening may be done through visual inspection with acetic acid (vinegar), conventional Pap smear or HPV testing. Pre-cancerous and cancerous lesions should be treated immediately. Women who are HIV-positive should be screened for cervical cancer regardless of age. Priority should be given to maximizing coverage of the risk age group and to ensuring complete follow-up of women with abnormal screening test results. 5.7.4 Screening for other cancers Screening for breast cancer, ano-rectal and prostate cancer should be part of routine care, and links to treatment services should be provided. 5.7.5 Clinical care for survivors of sexual assault Where possible, clinical care for survivors of sexual assault should be linked with community-led responses to violence (see Chapter 2, Section 2.2.6). • Offer first-line support to survivors of sexual assault by any perpetrator. • Take a complete history to determine what interventions are appropriate, and conduct a complete physical examination (head-to-toe, including genitalia). • Offer emergency contraception to women presenting within five days of sexual assault, and ideally as soon as possible after the assault to maximize effectiveness. • Consider offering HIV post-exposure prophylaxis (PEP) for women presenting within 72 hours of a sexual assault. Use shared decision-making with the survivor to determine whether HIV PEP is appropriate. • Survivors of sexual assault should be offered prophylaxis for: ›› chlamydia ›› gonorrhoea ›› trichomonas ›› syphilis, depending on the prevalence. The choice of drug and regimens should follow national guidelines. • Hepatitis B vaccination without hepatitis B immunoglobulin should be offered as per national guidelines. • Psychological support and care should be offered, including coping strategies for dealing with severe stress. Interventions up to three months post-trauma • Continue to offer support and care. • If the survivor has mental health problems, provide evidence-based mental health services that are accessible, available and follow the WHO mhGAP Intervention Guide. 127

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