Implementing Comprehensive HIV/STI Programmes with Sex Workers Implementing Comprehensive HIV/STI Programmes with | Page 66

3 Community-led Services

3.1 Introduction
Community-led services, in which sex workers take the lead in delivering outreach and overseeing
an HIV prevention programme, have demonstrated significant benefits in terms of HIV outcomes.1
They also enable sex workers to address structural barriers to their rights, and empower them to
change social norms to achieve a sustained reduction in their vulnerability that goes beyond HIV.
Community-led services are interventions designed, delivered and monitored by sex workers (or
with sex workers) that:
• build adequate and reliable access to commodities (condoms, lubricants, and needles and syringes)
and clinical services through outreach and referrals
• respond to violence against sex workers and implement other structural interventions
• offer a progressive approach to behaviour and social change that strengthens not only knowledge
but also skills and systems, in order to make prevention, care and treatment viable and sustainable
• feature formal and informal systems for the community to provide feedback to enhance the quality
of clinical and other services and to engage in other ways, such as with social services beyond
the HIV prevention programme.
Involving sex workers as individuals and as a community creates a foundation for strong HIV
interventions, for a more enabling environment and for community empowerment. It also makes
programmes more efficient and effective. With sustained support, community-led services may develop
into strong initiatives that address structural barriers and underlying conditions of vulnerability and risk.
Community-led services incorporate tools and methods for frontline workers that also support
programme management. A community-led approach ensures that sex workers have a leading role
in interventions, including in their design, implementation and oversight. Many kinds of interventions
can incorporate a community-led approach. This chapter describes three of the most important for
scaling up HIV prevention programmes with sex workers: community-led outreach, safe spaces
(drop-in centres) and community committees and advisory groups (Figure 3.1).

Box 3.1

Implementation of best practice for sex worker programmes
HIV prevention interventions are often implemented by nongovernmental organizations (NGOs). In some
contexts it is challenging to immediately engage sex workers to do outreach with the sex worker community,
and in the initial phase of a programme (the first year, for example), NGO staff may need to take a lead role
in outreach. Where this is the case, the programme should be designed so that sex workers are recruited,
trained and involved as quickly as possible and take on increasing responsibility within the programme.
Some of the guidance in this chapter is written assuming that the implementing organization2 is an NGO
that is not formed entirely of sex workers. The guidance should be interpreted differently if implementation
is being done by sex worker community-led organizations. Chapter 1 offers a vision and examples of highquality, sustainable programmes run by community-led organizations.

1 In most contexts in this tool, “community” refers to populations of sex workers rather than the broader geographic, social or cultural groupings of which they may
be a part. Thus, “outreach to the community” means outreach to sex workers, “community-led interventions” are interventions led by sex workers, and “community
members” are sex workers.
2 An implementing organization is an organization delivering a prevention intervention to sex workers. It may be a governmental, nongovernmental, or community-led
organization, and may work at a state, district or local level. Sometimes an NGO provides services through sub-units at multiple locations within an urban area, and in
this case, each of those sub-units may also be considered an implementing organization.

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