Implementing Comprehensive HIV/STI Programmes with Sex Workers Implementing Comprehensive HIV/STI Programmes with | Page 77
3 Community-led Services
programme about how to make services more available and accessible, and how to ensure that sex
workers use them regularly. They also ensure that the quality of services is high and that there is no
coercion at the facility. Community outreach workers may also offer ongoing post-test counselling
and ensure that those who test positive and disclose their status are linked to care.
Structural interventions: Community outreach workers mobilize members of their community to
take part in initiatives to address stigma and discrimination, confront violence and harassment by
police, and create social support systems, e.g. securing access to schooling for sex workers’ children.
Community-led services: Community outreach workers offer insights from their direct contact with
the programme and the community that are essential for programme planners and policy processes
at local, national and global levels.
Managing outreach
Management of outreach happens at two levels: the community outreach worker manages his or her own
outreach to sex workers; and programme staff supervise and support the community outreach workers.
Figure 3.6 Illustrative example of management of a sex worker’s needs by a community outreach
worker
Community-led outreach
Direct services
Providing condoms and
lubricant
Personal support through
behaviour change
communication and interpersonal communication
Responding to violence
Links
Introduction to community group
Assistance to get voluntary HIV testing
and counselling
Assistance to get antiretroviral therapy
Assistance to get reproductive health
services
Follow-up
Ongoing post-test
counselling and support
Support for adherence to
treatment
Links to community care
Links to other support services
Community outreach workers as outreach managers
The community outreach worker uses a prevention and case management approach for each sex
worker, consisting of several steps that are re-assessed and repeated, as circumstances require.
1. Assess the range of needs of the individual sex worker, using a standardized tool (see “Microplanning” below).
2. Develop a plan of action with the sex worker based on needs that can be addressed.
3. Provide commodities, information and counselling to ensure that the sex worker is committed
to addressing those needs with community support.
4. Facili tate referrals to other services, as needed.
5. Follow up referrals with support and information, as needed.
6. Re-assess and evaluate the needs of the individual on a regular basis.
Figure 3.6 above presents an example of the ways a community outreach worker may support a sex
worker through direct services, links and follow-up.
55