Implementing Comprehensive HIV/STI Programmes with Sex Workers Implementing Comprehensive HIV/STI Programmes with | Page 16

Introduction

Introduction
Sex workers have been among the populations most affected by HIV since the beginning of the
epidemic more than 30 years ago. In both concentrated and generalized epidemics, HIV prevalence is
considerably higher among sex workers than in the general population. There are numerous reasons
for this, including the type of work in which sex workers engage, unsafe working conditions, barriers
to the negotiation of consistent condom use, and unequal access to appropriate health services.
Sex workers often have little control over these factors because of social marginalization and the
criminalization of sex work. Violence, alcohol and drug use in some settings also increase vulnerability
and risk.
Much has changed in the response to HIV over the last three decades, especially in the areas of
prevention, testing and treatment. What remains missing is a respectful and inclusive response to
marginalized and vulnerable populations, including sex workers. This is seen in countless individual
stories, as well as in discriminatory laws, regulations and policies, including those that prohibit noncitizen, migrant and mobile sex workers from receiving life-saving medications.
All sex workers have a fundamental human right to the highest attainable standard of health. Healthcare providers have an obligation to provide services to sex workers, regardless of the legal status
of sex work and sex workers. Health workers, programme managers and national leaders should
ensure that all sex workers have full, adequate and equal access to HIV prevention methods and
commodities, and HIV testing services and HIV treatment, guided by the principle of health for all
and human rights.

The purpose of this tool
In 2012 the World Health Organization (WHO), the United Nations Population Fund (UNFPA), the
Joint United Nations Programme on HIV/AIDS (UNAIDS) and the Global Network of Sex Work
Projects (NSWP) developed a guidance document on Prevention and treatment of HIV and other
sexually transmitted infections for sex workers in low- and middle-income countries.1 This document,
referred to in this publication as the “2012 Recommendations”, sets out technical recommendations
on effective interventions for the prevention and treatment of HIV and other sexually transmitted
infections (STIs) among sex workers. The recommendations are summarized following this
Introduction.
Following the dissemination of the 2012 Recommendations, many parties expressed a need to
know how to implement them. This publication responds to that need by offering practical advice
on implementing HIV and STI programmes for sex workers. It contains examples of good practice
from around the world that may support efforts in planning programmes and services, and describes
issues that should be considered and how to overcome challenges.

1 Prevention and treatment of HIV and other sexually transmitted infections for sex workers in low- and middle-income countries: recommendations for a public health approach.
Geneva: WHO, UNFPA, UNAIDS, NSWP, 2012.

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