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Chapter 9: Challenges for IPC Program Development (Continued) |
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Key issues to Consider When Reaching Specific Target Populations Commercial sex workers People enter sex work for a variety of reasons. Economic need often drives people to engage in sex work; perhaps it is the only or best paying employment option. Others are forced or coerced into sex work through violence, trafficking, or debt bondage. Others freely choose sex work as their occupation. Entry into sex work can also be rooted into socio-cultural traditions, beliefs, or norms that perpetuate gender inequalities. Sex work is not monolithic, and it is important to understand and consider the drive behind sex work when defining your target population. Certain factions of sex workers may not even identify with the term “sex worker.” It is therefore important for programmers to work with endogenous target group definitions rather than those imposed by program planners or donors.
IPC programs can also link to STI, VCT, or other health services to make such services more accessible, acceptable, and affordable to the target population. In addition, a focus on quality of care that patients receive can influence how well sex workers comply with treatment recommendations and whether they would return to the clinic or health center for future care. |
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Significantly higher rates of HIV infection have been documented among sex workers and their clients as compared to most other population groups within a country. HIV often spreads among sex workers before spreading into the general population. A number of factors may heighten sex workers’ vulnerability to and risk of HIV infection. Stigmatization and marginalization can result in isolation that can limit sex workers’ access to legal, health, and social services. Laws and policies to protect sex workers and their clients are often non-existent or inadequately enforced. Limited information, skills, and negotiating power may lead to behavior that puts sex workers at a higher risk for HIV transmission. Lifestyle factors such as violence, alcohol, and drug use may also increase risk. Increasing mobility among sex workers makes effective and sustainable prevention work more difficult. Understanding these challenges can help guide IPC program development. 
IPC interventions that focus on individual behavior change must specifically address the traditional and cultural sexual behaviors in the local sex work environment and take into account the various forms of sex work that occur there (e.g. brothel-based, indirect or occasional sex work, male sex work, or transgender sex work). Outreach initiatives can be employed for particularly hard to reach populations. For a population that is so frequently marginalized and may be skeptical or untrusting of outsiders, peer education can be a useful strategy. While you may opt not to utilize peer education specifically, IPC programs should involve target group members in program design and implementation. Involvement and support of target group members can help improve the chances of program success. 
