Implementing Comprehensive HIV/STI Programmes with Sex Workers Implementing Comprehensive HIV/STI Programmes with | Page 68

3 Community-led Services

Box 3.2

Community-led outreach and community empowerment
When done well, community-led outreach is the part of the programme that reaches the largest proportion
of the community, most regularly and with the most direct personal rapport. Community outreach workers’
understanding and personal investment in the welfare of their community is as essential to the success of
an intervention as the services they offer. Therefore they should be respected and engaged meaningfully.
This has two important implications:
• The term “community” should never be understood or used to imply that community outreach workers
are less qualified or less capable than non-community staff outreach workers.
• Community outreach workers are not volunteers; they should be remunerated for their work at a rate
comparable to that of other staff, and should have the opportunity to progress to permanent paid positions
in the implementing organization.

3.2.1 What community outreach workers do
Community outreach workers typically perform a number of key functions:
• Meet regularly (e.g. monthly) on a one-to-one basis with sex workers in their assigned area.
Depending on the density of the sex worker community, a ratio of one community outreach worker
to 35–65 sex workers is feasible (see also Chapter 6, Table 6.4).
• Assess the HIV prevention, care and support needs of each sex worker and develop a plan to
address these needs through the programme and the community.
• Assess how many condoms the sex worker requires based on their usual sexual activities, and
distribute the required number to cover the period until the next contact with the sex worker.
• Promote safe spaces (drop-in centres) with the community (see Section 3.3 below).
• Encourage sex workers to visit clinics for sexually transmitted infection (STI) check-ups, explain
the services, refer STI cases from the field and accompany those referred to clinics if requested
to do so. Advocate for sex workers’ access to services if they encounter difficulties.
• Support sex workers to get voluntary HIV counselling and testing (HTC), and ensure that they are
accompanied to referrals if requested. (See Chapter 5, Section 5.2.)
• Accompany HIV-positive sex workers to treatment centres if requested, and track and encourage
their adherence to antiretroviral therapy. (See Chapter 5, Section 5.3.)
• In programmes that provide services to people who inject drugs, provide clean needles and syringes
and other harm reduction commodities to sex workers who inject drugs, and provide referrals to
medical services as needed. (See Chapter 5, Section 5.5 for detailed information.)
• Provide information on sexual and reproductive health and refer sex workers to services as needed.
• Help to manage crisis response systems (see Chapter 2, Box 2.9). Give information on additional
support systems for sex workers facing violence.
• Take part in community committees and advisory groups (make recommendations to improve
clinic/staff relations, outreach, safe spaces) and community mobilization activities, and provide
feedback from the field on ways to improve the programme.

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