Implementing Comprehensive HIV/STI Programmes with Sex Workers Implementing Comprehensive HIV/STI Programmes with | Page 54

2 Addressing Violence against Sex Workers

Africa offered individualized counselling sessions to sex workers that included discussions
on safety strategies, including in relation to: use of alcohol and drugs; communication and
negotiation skills for different situations to avoid precipitating conflict; and ways to exit unsafe
situations.
›› Collaborative counselling with trained counsellors, using reflective listening to support individual
sex workers in identifying feasible steps to make themselves safer, and available local resources
in case they experience violence. The approach is supportive, non-judgemental and respectful
of the autonomy of the individual in making behaviour changes. In Mongolia, this approach was
found to reduce sex workers’ risk of violence from both clients and intimate partners.

2.2.6 Providing health services to sex workers who experience violence
Sex workers who experience physical, sexual and psychological violence may need medical care
in both the short and long term. In most settings there are hardly any specialized medical services
for those who experience violence. Therefore, it may be useful to consider integrating services for
those who experience violence into the broader set of HIV prevention, treatment and care and other
health services for sex workers. WHO has developed clinical and policy guidelines for the healthsector response to violence against women (see Section 2.4). While focused on all women, the
guidelines are also relevant to female sex workers, and some aspects are also relevant to male and
transgender sex workers.

Box 2.7

Topics for training health-care providers
in addressing violence against sex workers
• Basic information about violence, including laws and policies against violence with a focus on sex
workers.
• Identifying those who may be experiencing violence based on physical or psychosocial symptoms (e.g.
depression, anxiety, post-traumatic stress disorder, suicidality or self-harm, substance use, injuries).
• When and how to inquire about violence.
• Collecting forensic evidence for investigating sexual violence.
• Providing clinical and psychological care and treatment as per WHO recommendations.
• Where to refer for support services in the community.
• Providing non-judgemental care that does not stigmatize those who experience violence.
• Implications of mandatory reporting of violence (not recommended in the WHO guidelines).
Although not in the WHO guidelines on health-sector response to violence, in the context of sex work,
training may also include:
• human rights of sex workers
• laws and policies pertainin