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PLoS MedicineVolume 12, Issue 6, 1 June 2015, Article number e1001808, 11p

HIV Programs for Sex Workers: Lessons and Challenges for Developing and Delivering Programs(Review)(Open Access)

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  • World Bank, Global HIV/AIDS Program, Washington, DC, United States

Abstract

There is evidence that HIV prevention programs for sex workers, especially female sex workers, are cost-effective in several contexts, including many western countries, Thailand, India, the Democratic Republic of Congo, Kenya, and Zimbabwe. The evidence that sex worker HIV prevention programs work must not inspire complacency but rather a renewed effort to expand, intensify, and maximize their impact. The PLOS Collection “Focus on Delivery and Scale: Achieving HIV Impact with Sex Workers” highlights major challenges to scaling-up sex worker HIV prevention programs, noting the following: sex worker HIV prevention programs are insufficiently guided by understanding of epidemic transmission dynamics, situation analyses, and programmatic mapping; sex worker HIV and sexually transmitted infection services receive limited domestic financing in many countries; many sex worker HIV prevention programs are inadequately codified to ensure consistency and quality; and many sex worker HIV prevention programs have not evolved adequately to address informal sex workers, male and transgender sex workers, and mobile- and internet-based sex workers. Based on the wider collection of papers, this article presents three major clusters of recommendations: (i) HIV programs focused on sex workers should be prioritized, developed, and implemented based on robust evidence; (ii) national political will and increased funding are needed to increase coverage of effective sex worker HIV prevention programs in low and middle income countries; and (iii) comprehensive, integrated, and rapidly evolving HIV programs are needed to ensure equitable access to health services for individuals involved in all forms of sex work. © 2015 David Wilson.

Indexed keywords

EMTREE medical terms:behavior changedisease transmissionhealth care planninghealth care policyhealth programhealth servicehumanHuman immunodeficiency virusmental healthprostitutionReviewcost benefit analysisdeveloping countryfemalehealth care deliveryHIV Infectionsmaleprogram developmentprogram evaluationsex workertransmission
MeSH:Cost-Benefit AnalysisDeveloping CountriesFemaleHealth PrioritiesHealth Services AccessibilityHealth Services Needs and DemandHIV InfectionsHumansMaleProgram DevelopmentProgram EvaluationSex Workers

Funding details

Funding sponsor Funding number Acronym
United States Agency for International Development
See opportunities by USAID		USAID
Bill and Melinda Gates Foundation
See opportunities by BMGF		BMGF
World Bank Group
See opportunities by WBG		WBG
Department for International Development, UK Government
See opportunities by DFID		DFID

  • 1

    Many HIV prevention programs focused on sex workers have been internationally financed, including the first sex work programs in the Democratic Republic of the Congo, Kenya, Cameroon, and Zimbabwe [–]. Sex worker HIV prevention programs in West Africa were highly reliant on the Canadian International Development Agency regional SIDA-1, 2, and 3 programs [], and many programs closed when international financing ended. India’s first programs in Tamil Nadu were financed by the United States Agency for International Development in 1992, and subsequent statewide programs were financed by the United Kingdom Department for International Development, the United States Agency for International Development, and later the Bill and Melinda Gates Foundation [], and the National AIDs Control Programme (NACP)-1, 2, and 3 programs were cofinanced mainly by the Government of India and the World Bank. India has successfully transitioned from international to domestic financing and now largely finances its own HIV program, including sex work interventions. India did so by developing mechanisms for the government to contract civil society partners to implement sex worker HIV prevention programs, developing financial and performance monitoring systems, and by progressively increasing the domestic share of the financing of the national HIV response. []. In 2012, the Joint United Nations Programme on HIV/AIDS (UNAIDS) reported that over 90% of all sex worker HIV prevention programs in low and middle income countries relied on international funding []. This must be urgently addressed, with domestic financing for sex worker HIV prevention programs where feasible.

  • ISSN: 15491277
  • Source Type: Journal
  • Original language: English
  • DOI: 10.1371/journal.pmed.1001808
  • PubMed ID: 26079267
  • Document Type: Review
  • Publisher: Public Library of Science

  Wilson, D.; World Bank, Global HIV/AIDS Program, Washington, DC, United States;
© Copyright 2021 Elsevier B.V., All rights reserved.

Cited by 31 documents

Wilson, A. , Wang, Y.Y. , Chen, R.
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Prevalence and factors associated with HIV epidemic among female sex workers in Pakistan: Results of the fifth round of integrated biological and behavioural surveillance
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Musyoki, H. , Bhattacharjee, P. , Sabin, K.
A decade and beyond: learnings from HIV programming with underserved and marginalized key populations in Kenya
(2021) Journal of the International AIDS Society
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