What Works for Women and Girls

female injecting drug users in Eastern Europe and 10–25% of female IDUs in Central Asia areinvolved in sex work (Rhodes et al., 2002 cited in Pinkham et al., 2008). In many places, HIVprevalence among IDU sex workers is higher than it is among either non-sex worker IDUs ornon-IDU sex workers (Pinkham and Malinowska-Sempruch, 2008. Further, in many countries,prison is a common experience for IDUs (Du Cros and Kamarulzaman, 2006). Whilethe numbers of women who have sex with women (WSW), particularly those who are at risk ofHIV acquisition, are small, WSW have been ignored and are therefore included here.The prevention needs of the groups of women listed below and the overlap between themmust be considered for HIV prevention planning to be maximally effective. These groups arediscussed in more depth in sections A through G of this chapter.4A. Prevention for Key Affected Populations:Female Sex Workers“The strategy to end demandfor sex work has not workedanywhere so far.”(Sengupta and Tandon, 2008).Sex workers, whose work involves sex with multiple partners, are a key group of womenwho need access to HIV prevention and services, most notably programs that enhance sexworkers’ ability to use condoms. Pisani (2008) makes the case that sex workers should bereceiving much more attention in programming to promote condom use. Among sex workers,the median reported rate of condom use with their mostrecent client in 2008 was 86% in 56 low- and middleincomecountries (UNAIDS, 2009e). While some progresshas been made in providing HIV services for sex workers,much more remains to be done. Astoundingly, in 40% ofcountries with a generalized epidemic, no services for sexworkers were available in 2007 and worldwide less than50% of sex workers have access to VCT and to condomsthat could save them from acquiring HIV in the course of their occupation (UNGASS, 2008cited in Bertozzi et al., 2008).Sex Workers Are a Diverse PopulationUnprotected sex with multiple partners ultimately puts sex workers at risk of HIV, and humanrights violations and lack of safe and supportive working conditions renders sex workers particularlyvulnerable to HIV infection. The diversity of sex work means that interventions need tobe adapted to meet the needs of women in different settings. The sex work industry includesa broad range of workers operating in various locations including those who are street-based,brothel-based, those who work as escorts and those who work from their own homes. Somewomen exchange sex for cash or goods but do not see themselves as sex workers (Hawken et al.,2002). Women are sometimes trafficked into sex work. There is currently debate about how toassess whether a woman is trafficked or whether she is a sex worker (Vance, 2010; Bien-Aime,76 CHAPTER 4 PREVENTION FOR KEY AFFECTED POPULATIONS