170 The Global HIV Epidemics among Sex Workers
We found that all 10 studies which met the inclusion criteria included not only a community empowerment approach focused on the organizing and mobilization of sex workers, but also included some minimum form of the three most common HIV prevention elements conducted among sex workers, including: 1) peer education or education between sex workers describing HIV transmission and risk factors and the importance of safer sexual behaviors including condom use; 2) condom distribution and/or condom social marketing; and 3) the promotion of or greater access to sex worker friendly clinical services for the screening and treatment of STIs. Table 4.1 offers illustrative examples of the key components of the community empowerment based comprehensive HIV prevention interventions documented, signaling those elements with an asterisk which were common to all 10 studies included in the analysis. Table 4.1 Select Examples of Community Empowerment-based Comprehensive HIV Prevention Individual and Interpersonal Levels:
Community and Structural Levels:
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•
•
• • •
Peer education and outreach promoting HIV prevention and collective actiona
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Enhanced access to STI/ HIV prevention, testing and treatmenta
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Provision of free condoms through clinics, outreach, public eventsa
Counseling reinforcing protective behaviors and destigmatization
Increased provision of sexual and reproductive health services
• • •
Collective activities and events to encourage stigma reduction and promote social integrationa Practical skills building workshops on topics such as literacy, savings, and violence preventiona
Forging of government, NGO and communitybased partnerships to support sex workersa Mobilization to engage sex workers in public life and increase dialogue on sex workers’ rights
Support for the formation of an association of sex workers, led and run by sex workers Distribution of materials and local media messages destigmatizing sex workers
Sources: Adapted from Lippman et al.; Lippman, Chinaglia et al. 2012. a. Intervention elements found in all 10 studies from the WHO systematic review on community empowerment and HIV prevention among sex workers in lower-middle income countries
This review found positive trends regarding the impact of community empowerment interventions among female sex workers on HIV-related outcomes, including HIV infection, STI infection, and condom use. Two observational studies measured the impact of community empowerment on HIV infection itself. The combined effect size was significantly protective (OR: 0.84, 95% CI: 0.709, 0.988). For condom use, one randomized controlled trial demonstrated a significant improvement in consistent condom use with all clients (Beta: 0.3447;