Prevention and treatment of HIV and other sexually transmitted infections for sex workers in low- and middle-income countries

Prevention and treatment of HIV and other sexually transmitted infections for sex workers in low- and middle-income countries: Recommendations for a public health approach

Report by: World Health Organization (Dec. 2012)

Executive Summary Policy Recommendations:

Good practice recommendations
1. All countries should work toward decriminalization of sex work and elimination of the
unjust application of non-criminal laws and regulations against sex workers.
2. Governments should establish antidiscrimination and other rights-respecting laws
to protect against discrimination and violence, and other violations of rights faced
by sex workers in order to realize their human rights and reduce their vulnerability to
HIV infection and the impact of AIDS. Antidiscrimination laws and regulations should
guarantee sex workers’ right to social, health and financial services.
3. Health services should be made available, accessible and acceptable to sex workers
based on the principles of avoidance of stigma, non-discrimination and the right to
health.
4. Violence against sex workers is a risk factor for HIV and must be prevented and
addressed in partnership with sex workers and sex worker led organizations.


Evidence-based recommendations
1. We recommend a package of interventions to enhance community empowerment
among sex workers. (strong recommendation, very low quality of evidence)
2. We recommend correct and consistent condom use among sex workers and their
clients. (strong recommendation, moderate quality of evidence)
3. We suggest offering periodic screening for asymptomatic STIs to female sex workers.
 (conditional recommendation, low quality of evidence)
4. We suggest offering female sex workers, in settings with high prevalence and limited
clinical services, periodic presumptive treatment for asymptomatic STIs. (conditional recommendation, moderate-to-high quality of evidence)
5. We recommend offering voluntary HIV testing and counselling to sex workers. (in line with existing WHO guidance)
6. We recommend using the current WHO guidance on the use of antiretroviral therapy
for HIV infection in adults and adolescents for sex workers living with HIV. (in line with existing WHO guidance)
7. We recommend using the current WHO recommendations on harm reduction for sex
workers who inject drugs. (in line with existing WHO guidance)
8. We recommend including sex workers as targets of catch-up HBV immunization
strategies in settings where infant immunization has not reached full coverage. (in line with existing WHO guidance)
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