Implementing Comprehensive HIV/STI Programmes with Sex Workers Implementing Comprehensive HIV/STI Programmes with | Page 55

2 Addressing Violence against Sex Workers

Recommendations for clinical care, psychological support and health services to those who experience
partner violence and sexual assault are:
• Provide immediate support to those who experience violence who present at a health facility.
Providers should ensure confidentiality, be non-judgemental, provide practical care, ask about the
history of violence, listen carefully without pressuring the person to talk, facilitate access to social
support, resources and services (e.g. legal if needed) and help develop a safety plan.
• Provide clinical care for those who experience sexual assault, including emergency contraception,
HIV and STI post-exposure prophylaxis (dosage and timing as per the recommendations in the
2013 WHO guidelines mentioned above) and access to abortion to the fullest extent of the law
for those who become pregnant. See also Chapter 5, Section 5.7.5.
• Provide psychological care, including information about symptoms of trauma and stress. For
symptoms such as depression, inability to carry out daily functions, or suicidal feelings, provide
care in accordance with WHO clinical protocols for mental-health problems.
• Health-care providers should be trained to provide services to those who experience violence (see
Box 2.7 for recommended training topics).
• A directory of medical, legal and social services for sex workers who experience violence should
be compiled and working arrangements established with service providers to accept referrals and
provide high-quality services.

2.2.7 Providing psychosocial, legal and other support services
Sex workers who experience violence often need a further range of immediate and longer-term
services. Services that may be provided according to local need and capacity include:
Community members trained to respond to sex workers who experience violence
Sex workers who experience violence or any other crisis may need a trained person to provide
immediate support and referrals. For example:
• In Kenya, KASH has a phone hotline that sex workers may call for immediate and ongoing support
in response to violence or other crises they may experience.
• In South Africa, the NGO Sisonke offers follow-up counselling and support to those who experience
violence.
• In India, as part of the Avahan AIDS Initiative, an integrated crisis response system has been
implemented, along with community empowerment of sex workers. The system has been
evaluated and shown to work (See Box 2.9).
Training in these types of activities may be led by knowledgeable sex workers and may cover: listening
and communication skills; prioritizing safety of sex workers; advocacy skills to work with the police,
social and health services, and media; knowledge of sex workers’ rights; dealing with police and local
government officials; counselling those who may be under psychological duress; and assessing risks
of harm. Training should take into account different learning needs and the diversity (e.g. ethnicity,
migrant status) of sex workers.
Legal support
This may require engaging or linking with lawyers or trained paralegals (e.g. sex workers trained as
paralegals) who can help negotiate with legal and judicial authorities about incidents of violence,
advocate on behalf of sex workers, and support training and sensitization of sex workers and others
on laws related to sex work.

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