166   The Global HIV Epidemics among Sex Workers
The efforts are intended to assist policy makers and program planners in making decisions about resource allocation in the context of constrained funding environments across population groups and varied epidemic contexts. It will also enable researchers to focus the next generation of intervention research, including research around the scale-up and roll-out of novel interventions such as community empowerment-based, comprehensive HIV prevention which is developed and owned by the sex worker community in a given context and epidemic setting.
Interventions Overview and Descriptions A range of HIV prevention interventions have been developed over the past two decades in response to the need for improved HIV prevention among sex workers. These interventions span biomedical, behavioral and structural approaches to HIV prevention and care among sex workers. The demonstrated efficacy of many of these interventions suggests significant promise in reducing the global epidemics of HIV among sex workers if carried out to scale. Many of the leading interventions developed to prevent HIV infection among sex workers have been tested in the context of concentrated epidemics, thus, the impact of their widespread implementation across epidemic scenarios has not been well characterized. It is currently unclear if and how proven approaches to preventing HIV among sex workers can be adapted to generalized HIV epidemic settings and if adapted what their impact on curbing HIV incidence might be. In order to respond to such questions, we conducted mathematical modeling exercises on distinct and combined approaches to HIV prevention among sex workers described herein. HIV prevention interventions are often categorized into three general areas: 1) Biomedical interventions that may include STI screening and management and increased access to ART; 2) Behavioral interventions including strategies such as peer education, condom distribution and social marketing, and HIV counseling and testing; and 3) Structural interventions focused on addressing social and economic inequalities through community and economic empowerment and the promotion of a supportive legal and policy environment for sex worker’s rights. Ultimately, a comprehensive and combination approach to HIV prevention is understood by the sex worker community (NSWP 2011) and the field of HIV prevention (UNAIDS 2009) as optimal in reducing HIV infection and is in turn what we modeled in relation to sex workers. We started however by examining the evidence for separate components of what might be a combination or comprehensive approach to HIV prevention