HIV prevention among Commercial Sex Workers in a post-conflict setting

Issues: Commercial sex workers (CSW) are vulnerable to HIV transmission due to many reasons, like large numbers of sexual partners, high rates of sexually transmitted diseases (STD) affecting them and their inconsistent use of condoms. Targeting them with specific HIV prevention interventions is crucial even in generalized epidemics, as it is the case in Uganda. The Northern Uganda Malaria AIDS and TB (NUMAT) Programme endeavoured to address this problem in Northern Uganda, where, as a result of the two-decade war, many girls and women have resorted to sex work to earn a living.

Description: With the assistance of local organizations, police and Social Welfare offices, the program has approached and engaged CSW in HIV&AIDS prevention dialogue, using a peer-based intervention, where volunteering behavior change agents were trained to deliver prevention messages and distribute condoms to their peers. A HIV counseling and testing outreach was eventually conducted following an explicit demand by the CSWs.

Lessons learnt: Out of 50 CSWs who tested (median age 23 years, range 17-28), 13 (26%) were found to be HIV-positive and subsequently referred for follow-up and further HIV-related care to nearby ART-providing health facilities.

Recommendations: Although CSWs usually operate covertly and they are often elusive to any attempt in approaching them, preventive interventions are possible and can be successful if they are peer-based. VCT is a feasible preventive option that can raise awareness of one's HIV status, guide on protecting behaviors or direct for further care.