STI-AIDS Intervention Programme

A baseline study identified two different categories of sex workers in Ghana: older, home-based workers known as "seaters," and younger, mobile workers known as "roamers." Because roamers, who operate in hotels, nightclubs, and on the streets, are difficult to reach, the programme initially directed its efforts to seaters. The first step was to identify and build relationships with the leaders and gatekeepers of the sex workers' community, including landlords, "queen mothers," hotel owners, and pimps. After explaining the purpose and potential benefits of the programme to the landlords and queen mothers, they, in turn, sensitised and mobilised the sex workers. Once the seaters became involved in the intervention, they introduced project personnel to the roamers' community.

The programme combines outreach and clinic-based services. With regard to the former, community health nurses visit seaters in their homes to educate them about health issues; teach them negotiation skills; distribute information, education, and communication (IEC) materials; and promote and sell condoms. They also encourage sex workers to visit clinics operated by the programme for medical care and STI screening. To reach roamers, the project turned to peer educators. Sex workers and their leaders helped identify potential peer educators, who then received two days of training on reproductive physiology, STIs, project interventions, and interpersonal communications.

The programme operates clinics where sex workers can seek treatment for general ailments as well as STIs. They pay for this treatment, although drugs are sold to them at cost. The syndromic approach is used to manage STIs, and complicated cases are referred to a specialist. During their clinic visits, patients also are shown slides and counseled on STIs and encouraged to buy condoms. To encourage sex workers to come the clinic for active screening, outreach workers schedule visits at their convenience and offer free treatment for any medical problems discovered. Screening begins with a health talk explaining its benefits and the procedures involved. Health workers then record each woman's sexual and medical history, perform a general and gynecological examination, and collect a variety of specimens. Women who test positive for STIs, excluding HIV, are called back for treatment. Following this initial screening, sex workers are asked to return quarterly for follow-up screening during which no samples are taken.

The programme also engages in advocacy with local police officials, explaining how they can contribute to preventing HIV/AIDS in vulnerable groups, and organises activities on STIs and HIV/AIDS for the general population.

HIV/AIDS, Reproductive Health, Women.

WAPTCA claims that few sex workers in Ghana want to know their HIV/AIDS status, and that HIV/AIDS testing is not made compulsory despite its high prevalence among this population. Women who do want to know their HIV/AIDS status are counseled beforehand as well as afterward.

In order to recover costs and become sustainable, the project sells condoms to sex workers instead of distributing them for free. The project stocks two brands of latex condoms, so that the sex workers have a choice. The project has also introduced a female condom to sex workers; 27 peer educators were trained to sensitise their colleagues about use of the female condom.