Community empowerment approach to HIV prevention among sex workers

Introduction Brief overview of sex workers’ involvement in the HIV response The concept of ‘community empowerment approach to HIV prevention’ Key components of community empowerment approach Examples of good practice in sex worker-led HIV programming

Sex workers and HIV epidemic The outbreak of HIV epidemic contributed to widespread scapegoating of sex workers as ‘vehicles of disease’ Sex workers pictured in the media as ‘threat to the public health’ and ‘pools of contagion’ Governmental initiatives to control the spread of HIV by controlling sex workers (mandatory testing, isolation, quarantine)

Sex workers’ involvement in HIV response – local interventions Since the early days of the HIV epidemic, sex workers around the world mobilised to provide fellow sex workers in their local communities and countries with condoms and HIV prevention education.

Sex workers’ involvement in HIV response – international mobilisation II World Whore Congress held in the European Parliament in Brussels (Belgium), 1986 (The International Committee for Prostitutes Rights) II International Conference for NGOs working on AIDS in Paris (France), 1990 (NSWP founded) International Sex Worker Meeting at the X International AIDS Conference in Yokohama (Japan), 1994 (APSWN launched) International AIDS Conference in Geneva (Switzerland), 1998 (NSWP as partner organisation)

Sex workers’ involvement in HIV response – international mobilisation Sex workers’ involvement in development of international policies and recommendations around sex work and HIV: Development of Global Working Group on HIV and Sex Work Policy re-working UNAIDS Guidance Note on HIV and Sex, 2007 Revised UNAIDS Guidance Note issued in 2009 Establishment of an Advisory Group, co-chaired by NSWP and UNAIDS, to support and advise UNAIDS on issues related to HIV and sex work

Sex workers’ involvement in HIV response – demanding access, demanding rights 2002 - 2012

Sex workers’ involvement in HIV response – demanding funding for HIV programming Sex workers protesting against President’s Emergency Plan for AIDS Relief (PEPFAR) Anti- Prostitution Pledge at the UNAIDS headquarters in Brussels (Belgium), 2010 ‘PEPFAR kills sex workers!’ http://www.youtube.com/watch?v=ZeBIPHZGOE0

Sex workers’ involvement in HIV response – demanding sex workers’ participation Sex worker rights activists interrupt press conference at the XIX International AIDS Conference, Washington DC, 2012 ‘Nothing about us, without us!’ https://www.youtube.com/watch?v=FB_1fQZ8Ydg

Sex workers’ involvement in HIV response – demanding sex workers’ participation The Sex Worker Freedom Festival in Kolkata (India), 21-26 July 2012 ‘The alternative International AIDS conference’ http://www.youtube.com/watch?v=ve5Cftui0eM

‘Sex workers are not the problem; we are part of the solution!’ Sex workers’ involvement in HIV response - demanding sex workers’ participation ‘Sex workers are not the problem; we are part of the solution!’

Sex workers’ involvement in HIV response – demanding sex workers’ participation XXI International AIDS Conference, Melbourne (Australia), 2014 Sex workers’ pre-conference and satellite session on sex work and HIV Special issue of Lancet on sex work and HIV

Importance of sex workers’ involvement in HIV response Sex workers’ groups and organisations should be made essential partners and leaders in designing, planning, implementing and evaluating health services. (WHO, 2012) Sex worker leadership is critical to ensuring that social and structural factors affecting their health, human rights and well-being are understood and addressed in generating and sustaining effective response to HIV. (World Bank, 2013)

Measuring effectiveness of community-led responses to HIV Community-led HIV prevention interventions in sex workers are associated with significant reductions in HIV and STI outcomes and could avert the HIV epidemic among sex workers: 32% reduction in the odds of HIV infection... 39% reduction in the odds of gonorrhoea… circa 25% reduction in the odds of chlamydia… almost 50% reduction in the odds of syphilis… three-fold increase in consistent condom use with clients… among sex workers reached by community-led HIV programming. (Kerrigan et al., 2013; Kerrigan et al., Lancet, 2014)

Defining community empowerment approach to HIV Community empowerment-based response to HIV is a process whereby sex workers take individual and collective ownership of programmes in order to achieve the most effective HIV responses, and take concrete action to address social and structural barriers to their broader health and human rights.

Key components of community empowerment approach Community empowerment is a holistic approach based in human rights framework and combining variety of behavioral, community and structural interventions.

Community empowerment (1) Strategy linking community mobilisation with interventions addressing social and structural factors contributing to sex workers’ vulnerability to HIV. Community empowerment means: promotion of cohesion among sex workers development and strengthening of sex worker collectives and organisations assuring meaningful participation of sex workers in the design, implementation, monitoring and evaluation of HIV programming sustaining sex workers’ movement

Community empowerment (1) Community empowerment also means : shaping policy and creating enabling environments struggling for the recognition of sex workers’ human and labour rights advocating for decriminalisation of sex work and other legal reforms fighting against discrimination, stigma and other human rights violations addressing barriers to sex workers’ health and well-being Community empowerment includes working towards the decriminalisation of sex work and the elimination of the unjust application of the non-criminal laws and regulations against sex workers, and recognising and respecting sex work as legitimate occupation or livelihood. (WHO, 2013)

Addressing violence against sex workers (2) Interventions preventing and responding to violence against sex workers are critical element of community-led HIV programming. These might include: gathering data on violence and other human rights violations experienced by sex workers advocacy for law reform and change in law-enforcement practices sensitization workshop for the police and other law- enforcement agencies promotion of safety and security among sex workers provision of legal, psychological and other services for sex workers facing violence

Community-led services (3) Community-led outreach Strong link between organisation and sex worker community Best strategy to reach the most marginalised, invisible and hard-to-reach sex workers Effective way to promote HIV-services and prevention education Safe spaces (drop-in centers) A place for sex workers to socialize and relax Platform for community mobilisation Asylum and shelter for those fleeing violence or facing homelessness Telephone and Internet support

Condom and lubricant programming (4) Condom and lubricant programming is about providing sex workers with means to and knowledge on how to protect themselves against HIV and other STIs: It means: providing sex workers with evidence-based HIV/STIs prevention education distributing high-quality male and female condoms and water-based lubricants providing sex workers with skills to correctly and consistently use condoms building capacity of sex workers to negotiate condom use with clients

Clinical and support services (5) Community empowerment-based approach to HIV involves providing sex workers with services tailored to their needs and expectations. These might include: HIV counselling and testing STIs screening harm reduction programming drug and alcohol use counselling information on gender reassignment surgery and hormonal therapy It also means: linking sex workers with trusted and sensitized service providers training and sensitization of medical personnel on sex workers’ rights and health needs advocating for acceptable, affordable, accessible, confidential and respectful services for sex workers monitoring quality and respectfulness of services

Building organizational capacity (6) Organisational capacity-building is a comprehensive approach to strengthening an organisation so that it can implement its own vision and strategy. Among others, it consists of: Building strong organisational structure and management. Enhancing stability of community-led HIV programming by applying democratic principles in decision-making processes. Enhancing sustainability and continuity of community-led programming in changing and unfavourable funding environment. Developing and implementing procedures enabling organisations to effectively respond to different crisis and emergency situations. Establishing critical alliances and partnerships.

Good practice in sex worker-led HIV programming In 2013 NSWP has conducted a global project to identify and document best practices undertaken by sex workers in carrying out programmes related to sex work and HIV. This report highlights the contribution of 20 community-led organisations and illustrates the great work being done by and for sex workers around the world.

Best practices in sex worker-led HIV programming Offer services that meet sex workers’ actual needs! Recognise the diversity within the sex worker community and ensure inclusion of all sex workers in your programming! Raise sex workers’ awareness about their rights and applicable legislation on sex work and HIV! Aim at community empowerment and mobilisation! Address social and structural factors which contribute to sex workers’ vulnerability to HIV and deter them from accessing HIV-related services! Exchange of knowledge and experience with other sex worker collectives, organisations, and networks! Be flexible and creative in determining tools and strategies of action!

Best practices in sex worker-led HIV programming Run services effectively and smoothly! Build coalitions and alliances with stakeholders who support sex workers’ rights and can contribute to the reduction of their vulnerability to HIV! Engage with the government, policy-makers and law-enforcement agencies! Engage with media and make sex workers’ voices heard in the public sphere! Ensure that funding sources have sex workers’ best interests at heart! Don’t give up!