Implementing Comprehensive HIV/STI Programmes with Sex Workers Implementing Comprehensive HIV/STI Programmes with | Page 69

3 Community-led Services

3.2.2 Steps in implementing community-led outreach
Several steps are required to establish community-led outreach in a community of sex workers:
A.
B.
C.
D.

Map the community and design the outreach strategy with them
Recruit and train community outreach workers
Implement and manage outreach
Foster leadership opportunities for community outreach workers

A. Map the community and design the outreach strategy with them
Establishing a strong community-led outreach system involves the programme team, sex workers
and other people at sex work locations. Reliable data collection and meaningful consultations with
sex workers and other key individuals and institutions help to ensure that the programme provides
acceptable and accessible services to the greatest possible number of community members, and
that it is seen as useful by the community and receives its support.
Understanding where sex workers are and how to reach them is essential. This starts with
programmatic mapping and size estimation (see Chapter 6, Box 6.4 and Figure 6.5). Once mapping
focuses on individual sex work locations within a coverage area, the participation of community
members is needed to help assess the quality of services and characteristics of the environment,
as well as the relative risks and vulnerabilities of individual sex workers.
The steps for local consultations to inform mapping are:
1. Recruit a core group of sex workers to participate in the mapping. They should be people with
detailed knowledge of the locations and preferred working habits in the community.
2. Work with the sex workers to develop maps that identify sex work locations (such as bus
stations, brothels, bars, military barracks, etc.) in the most densely populated locations in the
coverage area (Figure 3.2). Also identify service points, e.g. places where condoms are available
(or a commercial establishment where they could be sold if there is a condom social marketing
programme) (see Figure 3.3).
3. With the core group of sex workers, id entify and build rapport with “key informants” in these
locations, including other sex workers and brothel or bar owners and managers. Through group
discussions with the key informants, arrive at consensus estimates of the number of sex workers
at each location (see Figure 3.4). Record this information for follow-up to recruit community
outreach workers once strategic planning for outreach is done.
4. Plan services using the information from the key informant meetings, including where to locate
them, and the best timing for them. In order to maximize access to services, clinics and drop-in
centres should be located near the areas with the greatest density of sex workers. Additional service
components should also be considered. For example, if many sex workers in an area have children,
a low-cost health check-up for children may be added to services offered by the clinic; and if police
are considered to be a major problem, violence response interventions should be prioritized.
5. Through the key informants, meet and build rapport with additional sex workers who could
become community outreach workers.
Safeguarding sex workers in mapping
Key informants: The influence of key informants, such as brothel or bar owners and managers, on
the lives of sex workers should always be considered when doing mapping. While they may be able
to promote condom use and service referral and offer protection against harassment and violence,

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