NSWP welcomes the launch today of the ‘Prevention and Treatment of HIV and other sexually transmitted infections for sex workers in low- and middle-income countries: Recommendations for a public health approach’. The guidance was developed jointly with WHO,UNFPA, UNAIDS and NSWP who conducted the qualitative survey of sex worker values and preferences relating to the interventions being considered.
The report is designed for use by national public health officials and managers of HIV/AIDS and STI programmes, NGOs and health workers, but will also be of interest to international funding agencies, health policy-makers and advocates. It combines good practice recommendations derived from ethics and human rights principles, with technical evidence-based recommendations supported by scientific evidence AND the lived experiences of sex workers across the globe.
NSWP particularly welcomes the recommendations that governments should work towards the decriminalisation of sex work and elimination of the unjust application of non-criminal laws and regulations against sex workers which exacerbate sex workers vulnerability to HIV and STIs. In addition we welcome the recommendation that HIV prevention and treatment programmes need to include interventions to enhance community empowerment among sex workers that is sex worker-led and we particularly welcome the recommendation set out in the document that redefines the ethical use of periodic presumptive treatment (PPT) for sex workers. It emphasises that PPT should only be used as an emergency short term measure under the strictest of conditions and while comprehensive sexual health services are being developed and that PPT must only be offered if its uptake is voluntary, not imposed as part of a coercive or mandatory public health regime.
Good practice recommendations include:
- All countries should work toward decriminalisation of sex work and elimination of the unjust application of non-criminal laws and regulations against sex workers
- Governments should establish antidiscrimination and other rights respecting laws to protect against discrimination and violence, and other violations of rights faced by sex workers in order to realise their human rights and reduce their vulnerability to HIV infection
- Health services should be made available, accessible and acceptable to sex workers based on the principles of avoidance of stigma, non-discrimination and the right to health
- Violence against sex workers is a risk factor for HIV and must be prevented and addressed in partnership with sex workers and sex worker led organisations.
Technical recommendations include:
- A package of interventions to enhance community empowerment among sex workers
- Correct and consistent condom use among sex workers and their clients
- Offering periodic screening for asymptomatic STIs to female sex workers
- Offering female sex workers, in settings with high prevalence and limited clinical services, periodic presumptive treatment for asymptomatic STIs
- Offering voluntary HIV testing and counselling to sex workers
- Using the current WHO recommendations on the use of antiretroviral therapy for HIV-positive general populations for sex workers
- Using the current WHO recommendations on harm reduction for sex workers who inject drugs
- Including sex workers as targets of catch-up HBV immunisation strategies in settings where infant immunisation has not reached full coverage
These recommendations mark a significant advance in evidence-based guidelines for designing and implementing effective HIV and STI prevention and treatment interventions for sex workers.
You can download these recommendations (52 page PDF) in English below.
You can read WHO's policy brief on these recommendations on their website here.