What Works for Women and Girls

EVIDENCE1. Comprehensive prevention programs that include components such as peer education,medical services, and support groups, can be effective in enabling sex workers to adoptsafer sex practices.A 2002 cross-sectional study randomly selected 1,512 female sex workers from tworegions in southern and northern Karnataka, India and evaluated the impact of sexworker collectives on condom use and HIV/STI knowledge. NGO-operated femalesex worker collective programs are often managed by older sex workers and not onlyprovide members with condoms and STIs/HIV education, but also offer literacytraining, medical care, and legal support for sex workers. The study found that thecollectivization of female sex workers was correlated with better HIV knowledge andincreased condom use. Female sex workers who were either members of collectives orhad been in touch with peer educators “have knowledge that condom use can prevent[infections] and HIV,” (Halli et al., 2006: 742). Multiple logistic regression analysisfound that collectivized sex workers had almost 16 times the odds of regularly usingcondoms with clients, reporting using condoms with clients 97% of the time. The studyalso found that condom usage and HIV/STI increased incrementally, in proportion togreater involvement with collectives, suggesting “in the southern Indian context, collectivizationdoes add incrementally to the effect of peer education in reducing STI/HIV/AIDS-related risk behavior” (Halli et al., 2006: 747). (Gray II) (sex workers, peer education,condom use, India)A study of sex workers in Côte d’Ivoire found that increased national HIV/AIDS preventioncampaigns have yielded significant increases in condom use and declines in prevalenceof HIV and other STIs. Outcomes showed consistent condom use increasedamong sex workers from baseline measurements of 20% to 78% between 1992 and1998, while reported condom use with most recent clients also increased from 63%to 91%. HIV infection rates decreased among female sex workers from 89% to 32%;for gonorrhea from 33% to 11%; for genital ulcers from 21% to 4%; for trichomoniasisfrom 26% to 11%; and for syphilis from 21% to 2%. However, infection from chlamydiaincreased from 5% to 7%. Due to sharp increases in demand, the clinic doubled its sizeby the end of the study in 1998. In response to intensified media and social marketingprograms initiated by the Ministry of Health, Clinique de Confiance, a confidentialSTD/HIV clinic, began inviting sex workers and their stable partners to attend peereducation programs for instruction on disease transmission and prevention in 1992.Sex workers were also encouraged to access a wide range of free services includingthe distribution of condoms (both male and female) and lubricating gels, gynecologicalexaminations, general physicals and STD/HIV diagnosis, counseling, and treatment.The study reviewed multi-year cross-sectional studies conducted among users of theclinic and biannual community-based surveys between 1991 and 1997 in order to determineHIV/STD prevalence and socio-demographic trends among sex workers. Although80 CHAPTER 4 PREVENTION FOR KEY AFFECTED POPULATIONS