Implementing Comprehensive HIV/STI Programmes with Sex Workers Implementing Comprehensive HIV/STI Programmes with | Page 78

3 Community-led Services

Box 3.5

Case example: Sexual health diary
In Thailand, the Service Workers in Group Foundation (SWING) has worked with male sex workers to
develop a sexual health diary as a tool to help them monitor their own sexual risk and engage regularly
in self-diagnosis for STI symptoms. The diary gives them a way to track and maintain their preventive
behaviour, including STI screening and treatment. The sex worker records the following information on a
daily basis:
• number and type of sexual encounters (anal/oral/other):
››whether with customer or partner
››whether without condoms
››whether without lubricant
››whether with a condom used incorrectly
• STI symptoms (yes/no/not sure, for a list of different symptoms)
• any medical test or treatment (and for what symptoms), including STI screening and HIV test.
Each diary has enough pages for a month. The sex worker fills in a weekly summary sheet in the diary and
gives this to his outreach worker from the programme, and they discuss it. The information is also recorded
in the database and used for risk assessment and to customize services for the sex worker. When STI
symptoms are reported, the sex worker is encouraged to see a doctor for testing and treatment. Using the
diary is not a pre-condition for receiving any services from the programme, but it is widely used, and the
male sex workers report that they like it. SWING plans to adapt the tool for use by female sex workers.

Micro-planning
Micro-planning gives community outreach workers the responsibility and authority to manage their
own work. In this approach, community outreach workers use their knowledge of the community, and
the information they record during their contacts with sex workers, to prioritize and manage outreach.
In micro-planning, community outreach workers are trained to use tools to capture data on the
vulnerability and risk of each individual they serve, and the services they deliver. Micro-planning tools
are designed to be user-friendly, e.g. they are pictorial and can be used by people with low literacy
skills (see Figure 3.7). They may be adapted so that routine monitoring can be reported using a mobile
phone, in addition to recording data on paper.
Community outreach workers record data at each encounter with the sex worker, and aggregate them
onto a weekly or monthly reporting form (unless the data have already been submitted electronically),
with the assistance of a supervisor/manager, if necessary. Some of the aggregated information may
be reported by the programme according to regional or national reporting requirements, but its primary
purpose is to enable community outreach workers to analyse their outreach efforts and plan their
outreach according to the most urgent needs of the sex workers they are serving (e.g. those with
the highest risk or vulnerability, or those who have not been met for a significant period of time). The
community outreach worker may do this planning in the context of weekly review sessions with the
supervisor/manager (see “Supervising and supporting outreach” below).

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