Reducing barriers and improving access to HIV prevention services among FSW in Kingston Jamaica
M. Scott, J. Rodgers, L. Byfield
Ministry of Health, National HIV/STI Programme, Kingston, Jamaica
Issues: Sex work remains illegal in Jamaica. Female sex workers are a highly mobile heterogeneous group that are often victims of discrimination and violence. These factors along with absence of legislation perpetuate their status as social outcasts and impacts health seeking behavior. Notwithstanding the dynamics of the population HIV prevalence rate among FSW in Jamaica has remained at 9% since 2005. This presentation reflects the strategy to increase sustained reach to FSW with prevention services.
Description: Site based rapid voluntary counseling and testing at bars, exotic clubs, massage parlors and streets were conducted. Approximately 300 sex workers in the metropolis of Kingston and St. Andrew were reached. Outreach workers conducted weekly site visits over six months. The intervention achieved a testing rate of 90% and self reported condom use increased by 30%. Referrals were made for STI screening and treatment. Sex workers, patrons and clients were engaged in risk reduction conversations, condom skills building activities, condoms and lubricants distribution. Repeat site visits built the trust of sex workers, staff, club operators and patrons. This resulted in little resistance to the intervention. The relationship built with the population provided a unique opportunity to understand the dynamics of sex work, increase access to prevention services and unearth factors that drive risky behaviour.
Lessons learned: Sex workers willingly accessed site based services due to the elimination of long waiting periods. They were receptive to outreach workers and encouraged by interest in their welfare. Social vulnerability issues of FSW need to be addressed. Over 70% are illiterate; many are undocumented further isolating them and reducing opportunity for social mobility and access social services.
Next steps: Programmes are being developed to address social vulnerability. Empowerment workshops, life skills training, and linkages into social security systems are priority areas. A series of empowerment workshops is currently being implemented.
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