Implementing Comprehensive HIV/STI Programmes with Sex Workers Implementing Comprehensive HIV/STI Programmes with | Page 93

3 Community-led Services

Monitoring community access to services and community agency
The following indicators have been used in behavioural surveys and qualitative research to gauge sex
workers’ access to services and their levels of self-efficacy (the belief in one’s ability to take actions
under specific circumstances) and collective agency (the choice, control and power to act as a group).
They have been used as standalone indicators for advocacy purposes, and in indices for academic
research, where they can be compared in order to determine predicators and mediators of behaviour
and HIV and STI risk, and to show the degree of community empowerment.
The indicators are assessed by questioning sex workers on their levels of confidence and their actions
and opinions about different situations, most of which represent potential or actual barriers to safety
and health. (“You” in the question refers to the sex worker.)
• Self-efficacy for condom use: How confident are you in your ability to use a condom with each
client:
›› even if he gets angry?
›› even if he offers more money for sex without a condom?
›› even if you have been using alcohol or drugs?
• Self-efficacy for STI clinic service use: How confident are you about going to the clinic for STI
services, even if health workers:
›› know that you are a sex worker?
›› treat you badly?
›› don’t provide the specific service you need (e.g. no anal exam, no drugs)?
• Self-efficacy for HTC clinic service use: How confident are you about going to the clinic for HTC
services, even if health workers:
›› know that you are a sex worker?
›› treat you badly?
›› will not keep your visit confidential?
• Self-efficacy for clinic service use: How confident are you about going to the clinic for treatment,
even if health workers:
›› know you are a sex worker?
›› treat you badly?
›› record your name and address as part of registration?
• Self-confidence to speak openly: How confident are you about giving advice to fellow sex
workers, or speaking your opinion in front of a large group of people?
• Collective agency: Have you negotiated with or stood up to the following individuals in order to
help a fellow sex worker:
›› police?
›› brothel owner/manager?
›› gang member?
›› client?
›› regular partn er?

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