A community empowerment approach to the HIV response among sex workers: effectiveness, challenges, and considerations for implementation and scale-up

Abstract

A community empowerment-based response to HIV is a process by which sex workers take collective ownership of programmes to achieve the most effective HIV outcomes and address social and structural barriers to their overall health and human rights. Community empowerment has increasingly gained recognition as a key approach for addressing HIV in sex workers, with its focus on addressing the broad context within which the heightened risk for infection takes places in these individuals. However, large-scale implementation of community empowerment-based approaches has been scarce. We undertook a comprehensive review of community empowerment approaches for addressing HIV in sex workers. Within this effort, we did a systematic review and meta-analysis of the effectiveness of community empowerment in sex workers in low-income and middle-income countries. We found that community empowerment-based approaches to addressing HIV among sex workers were significantly associated with reductions in HIV and other sexually transmitted infections, and with increases in consistent condom use with all clients. Despite the promise of a community-empowerment approach, we identified formidable structural barriers to implementation and scale-up at various levels. These barriers include regressive international discourses and funding constraints; national laws criminalising sex work; and intersecting social stigmas, discrimination, and violence. The evidence base for community empowerment in sex workers needs to be strengthened and diversified, including its role in aiding access to, and uptake of, combination interventions for HIV prevention. Furthermore, social and political change are needed regarding the recognition of sex work as work, both globally and locally, to encourage increased support for community empowerment responses to HIV.

The relationship between social, policy and physical venue features and social cohesion on condom use for pregnancy prevention among sex workers: a safer indoor work environment scale

“…Social cohesion has been described as a ‘structural component’ of community empowerment,37 which captures trust, mutual aid and solidarity among SWs. The role of community empowerment and social cohesion on SWs’ condom use has been well documented globally, including in WHO guidelines.…”

Human rights violations against sex workers: burden and effect on HIV

“…Community empowerment, grounded in sex worker insight and leadership,entails sex workers organizing, sharing experiences in a safe space, and prioritizing their own needs for human rights and health. 107 Empowerment-based HIV prevention demonstrates impact and cost-effectiveness in sexual risk reduction and HIV prevention for sex workers. 4,107 Yet the impact ofsex worker empowerment extends far beyond these endpoints.It is central in reforming harmful practices and shaping the broader social structure in which sex workers live and work.…”

“…107 Empowerment-based HIV prevention demonstrates impact and cost-effectiveness in sexual risk reduction and HIV prevention for sex workers. 4,107 Yet the impact ofsex worker empowerment extends far beyond these endpoints.It is central in reforming harmful practices and shaping the broader social structure in which sex workers live and work. In addition to policy reform, gains achieved through community empowerment include rights promotion across health, social and criminal justice sectors, including enabling sex workers’ access to bank accounts, microfinance programs and health insurance, as well as reductions in violence, and meaningful challenges of the social exclusion of sex workers and threats to their dignity.…”

Physical and Sexual Violence Affecting Female Sex Workers in Abidjan, Côte d'Ivoire: Prevalence, and the Relationship with the Work Environment, HIV, and Access to Health Services

“…27 Police-sex worker dialogues and sex worker-led interventions in India and other settings have been shown to have significant impact in addressing violence, increasing access to health and police protections, and reducing stigma. 28,29 …”