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Sex Worker Harm Reduction Initiative Project Directory
From OSI
Published in June 2001, the directory is a comprehensive listing of IHRD's sex worker initiative grantees, IHRD partner organizations and Technical Advisors, and additional contacts for funding, training, and technical assistance. The directory provides descriptions of grantees' work in harm reduction and sex work and offers background information on this IHRD initiative.

The 100% Condom Use Policy: a Sex Workers' Rights Perspective
100% Condom Use Policy (CUP) programmes that aim to reduce HIV among female sex workers are being implemented or planned in several countries in Asia, Latin America and Africa. As a result of claims made about the role of 100% CUP in reducing national HIV epidemics, UNAIDS and other key agencies promote the programmes as a "best practice". The NSWP has a different view of the theory and practice of 100% CUP. Our view is based on ethical analysis and on real evidence from the field.

This paper from the Swedish Ministry of Foreign Affairs Expert Group on Development Issues calls for a new approach to sexuality and development. It argues that development policy has mainly concentrated on reproductive issues, or on the negative aspects of sexuality such as HIV infection and sexual violence. While these remain as significant challenges, it is also important to promote the right to sexual pleasure and fulfilment. There has been a tendency to ignore the connection between sexuality and poverty, and the paper argues that analysing this connection should be included in all policy and programmes tackling poverty.

The paper recommends that policymakers build on the existing positive sexual rights framework and support people’s right to sexual fulfilment, pleasure and well-being. As well as being an important right in itself, a sexual rights approach can also play an important role in promoting safer sex and reducing HIV transmission. It is important to acknowledge the role of power relations based on gender, class and race in the construction of sexuality and to promote equality in all sexual relationships. The paper recommends a democratic, inclusive approach to developing policy and programmes on sexuality. Stigmatised groups such as LGBT (lesbian, gay, bisexual and transgender) communities and sex workers should be supported by finding out what they themselves want rather than having Western models imposed on them.

This note, published by the World Bank, examines a donor-supported scheme in Nicaragua, which involved giving vouchers for sexual health services to commercial sex workers and their partners and clients. The highest rates of voucher redemption were among the poorest women and among groups with the highest initial rates of sexually transmitted infections (STIs). The programme reduced the prevalence of gonorrhea in the female sex worker population by about 5 per cent per year, and the prevalence of syphilis by 10 per cent per year. Women who attended follow-up consultations also stayed free of STIs for longer.

The cost of the scheme was low compared to consultations in public facilities. However, the note argues that reducing costs further by charging the beneficiaries is unrealistic and would exclude the poorest, who also have the greatest health needs. As it is, the costs to the beneficiaries in transport and lost income are significant, and for some constitute a reason not to use their voucher. The note concludes that the scheme provided access to, and increased the use of, high-quality, tailored sexual health services in a non-stigmatising manner for commercial sex workers and their regular sexual contacts. It also reduced the risk of STIs, including HIV, among the general population.

This is the report from a ground-breaking workshop on sexual rights held in Sweden. Some of the key issues discussed were:

• who defines a right and how are they defined?
• going beyond identity politics
• sexuality and morality
• women, men and transgendered people who sell sex for money.

Some of the key points were:

• there is a need to strike a balance between the autonomy and universality of rights and the contexts around the realisation of these rights
• we should begin to name sexual rights without shame, as what is unnamed is more likely to be unsupported, ignored or misunderstood
• it is important to support those with same-sex sexualities, or transgender and intersex genders in non-western settings, without imposing particular models of what it means to be lesbian, gay, bisexual or transgender
• sexuality is nothing new to development, but most interventions have focused on the negative issues such as population control, disease and violence
• the focus has been on encouraging people to say no to risky sex, rather than empowering them to say yes to, or ask for, safer and more satisfying sex
• there has been an assumption that poor people would not want to talk about sexuality
• as initiatives that promote sexuality education which embraces pleasure, openness and inclusion become more common, so do the efforts to stop these programmes
• hearing from ‘the ground’ rather than from researchers alone gives a new conceptual understanding and also ideas and knowledge on how to take these issues forward.

Recommendations from the workshop were:

• to mobilise political support, as well as financial resources, for programmes to be implemented and for activists to continue their struggle and be able to connect across borders
• to include and work with sex workers, listening to them and understanding their priorities, in the efforts that are made to combat prostitution and trafficking in persons for purposes of sexual exploitation
• to engage in and develop sexuality education which builds upon people’s curiosity about sex and encourages positive and inclusive approaches, as this is likely to make these initiatives more effective
• to engage in research grounded in action and informed by the diversity of people’s experiences, especially those who have been forced into silence.

This training manual assists community-based organisations to facilitate a community-driven process for addressing and reducing stigma and gender-based violence (GBV) in HIV/AIDS prevention initiatives.

The manual:

• explores three participatory tools, namely Participatory Learning and Action (PLA); Community-led action research (CLAR); and transformatory workshops.
• gives a general overview for conducting community-led action research
• provides a description of the CLAR process among the key populations of the SVRI project. This section also gives an overview of the action plans developed based on this process.
• presents the challenges and lessons learned in implementing a community-owned process to address stigma and gender-based violence, and Section six presents conclusions.

The report highlights several lessons learned:

• Ensuring their safety is a key way of building the confidence of frontline workers
• Be aware of the context and constraints of target populations, such as truckers’ helpers and disguised community-based sex workers, in order to reach and mobilise them.
• Ensure that the project is presented to target populations in a way that is meaningful to them.
• Participatory methodologies are extremely powerful even in short duration because they involve participants as active learners
• Involving adolescents in the intervention programs, at the recommendation of the community, provided a vital opportunity to clarify their doubts, build on their knowledge, and give them the opportunity to voice their concerns on reproductive health, sex and sexuality.
• The intervention activities created an enabling environment, which led to the acceptance of people living with HIV and AIDS, and their active participation in transformatory workshops and all other activities of the project.
• Networking with government, NGOs and community-based organizations and media has been a great support and strength to the project in creating a larger enabling environment.

The 100% condom use programme for sex workers is advocated by the WHO as important in STI (including HIV) prevention. This document provides details of how to asses outcomes and progress of these programmes.

The publication emphasizes the four main indicators to monitor and evaluate the 100% condom use programme in entertainment establishments. These indicators aim to quantify or measure the magnitude of progress toward achieving the objectives of the programme and give an indication of magnitude or direction of change over time. The indicators are:

• number of condoms distributed to outlets
• proportion of sex workers reporting condom use during last sex with client
• proportion of young female sex workers with HIV infection
• proportion of young female sex workers with chlamydial infection,/UL>

  Detailed instructions are given on how to carry out a study, with information on sampling, staff requirements, laboratory needs etc.

This article from the Journal of Sex Research reports high levels of awareness about HIV prevention methods among women sex workers in southern China. It shows the women are using a range of contraceptive practices, and different methods to prevent HIV and other sexually transmitted infections (STI). This indicates that there will be high levels of willingness to use vaginal microbicides and female condoms when these become available. However, promoting the use of these new female-initiated prevention methods will have to take account of the specific context of sex work, and also differences in knowledge and use of prevention methods according to age and ethnicity.

The study shows that the women were knowledgeable about the male condom, and the majority tried to insist on their partners using them. However, they also found negotiating condom use difficult and frequently had to resort to other, less reliable, methods. Promoting the use of microbicides will involve discouraging some of these other methods as their use would counteract the effects of the microbicide products. The article recommends using a range of culturally sensitive means to promote knowledge about new HIV prevention methods, including translating information into local languages and using oral communication. The research indicates that peer-delivered and site-based interventions are particularly effective in this context.

This report, from Save the Children (SC), explores the links between commercial sex work and food security in a fishing community in northern Zimbabwe. The authors found that one of the coping strategies for women during periods when they had little or no income or food would be to engage in commercial sex work (CSW). The authors argue that sex work needs be viewed form a livelihoods perspective if the underlying factors of sex work are to be addressed. Existing SC programming focuses more on the provision of information, education and condoms in order to reduce the risk of HIV transmission through commercial sex, rather than on livelihoods-related aspects.

The authors suggest two basic ways in which livelihoods programming could influence CSW. In order to prevent women from entering CSW, large-scale interventions such as SC food aid programmes could potentially have a role in supporting livelihoods and therefore help to reduce the need for women to engage in sex work. For those already engaged in CSW, but seeking a way out, income-generating projects should be considered. The authors also argue that promoting ‘safe sex’ to those engaged in CSW does not work because women are not in a position to negotiate condom use and, indeed, can make more money by not using condoms. The authors suggest that SC review its delivery channels for condom delivery and use and take these livelihood factors into consideration.

Thailand's sex industry is of core importance for the country's serious HIV problem. There is a strong male tradition of using commercial sex workers (CSW) before and during marriage. What are the psychosocial factors that affect the use of condoms by CSW? How can interventions increase the rate of condom use?

Patterns of risk behaviour and condom use among commercial sex workers (CSWs) have been heavily investigated in recent years. But what is known about the social context of these women's lives? What factors prevent them from having safer sex? Researchers from Population Services International investigate the lives of CSWs in Lusaka, Zambia.