Reducing HIV Prevalence and Risk Among Female Sex Workers in Guyana
Sex workers in Guyana are a socially excluded and marginalized group. Guyana’s 2004 behavioral and biological surveillance survey (BBSS) found that HIV prevalence among female sex workers was 26.6%; only a small proportion of this group had been reached with programs aimed at making them less vulnerable to HIV, and, if HIV positive, less likely to transmit the virus to others. This highlighted the need for a targeted, holistic HIV prevention program for female sex workers in Guyana.
Thus, in 2005, when the USAID/Guyana HIV AIDS Reduction and Prevention Project I (GHARP I) was launched, one of its priority areas was providing HIV prevention services to most-at-risk populations (MARPs), including sex workers. The project addressed this priority area by providing technical support to local USAID-funded NGOs working with most-at-risk populations throughout Guyana.
Initially, GHARP I’s program for sex workers focused primarily on increasing HIV awareness. Through the local NGOs, the project recruited sex workers and trained them as peer educators to relay HIV prevention messages to other sex workers. This approach, however, did not stem HIV prevalence among Guyana’s sex workers. In response, GHARP re-examined their existing strategy and studied similar programs around the world. Research revealed that, in addition to increasing HIV awareness, an effective program for MARPs should also focus on risk reduction. This finding was especially important as the research also revealed that many people most at risk do not consider themselves at high risk of contracting HIV.
GHARP II Shifts Focus to Risk Reduction
In 2009, when USAID launched GHARP II, led by Management Sciences for Health (MSH) and partners Howard Delafield International and AIDS Healthcare Foundation, the program’s focus shifted to risk reduction through quality combination prevention interventions. The goals of this approach were to raise risk awareness, empower sex workers to overcome barriers to accessing health services, and sensitize health providers to create an enabling environment for most-at-risk populations to access testing, treatment, and care.
The project recruited skilled social workers to help sex workers assess their individual risks and develop personalized risk-reduction plans. Further, the social workers conducted regular counseling with the clients to ensure compliance with their risk reduction plans.
In addition to risk reduction interventions, GHARP II also provides sex workers with social and economic support to help them develop new professional skills, thereby enabling them to transition out of sex work. The project offers sex workers job readiness training, psychosocial support, substance abuse counseling, and welfare services.
In partnership with GHARP II, one NGO, United Bricklayers (UBL), helped 10 sex workers to developed professional skills in food and nutrition. This group now runs a catering business from their homes that serve offices in their area. UBL trained another sex worker to run a hair-dressing business from her home during the day and work as a security officer at night. In partnership with the Ministry of Human Services and Social Security, UBL also trained five sex workers in suicide prevention and peer counseling. This group is now employed through the Ministry as school counselors helping girls complete their secondary education.
One year after beginning their partnership with GHARP II, UBL reported a 40% increase in the number of sex workers reached through their program. More heartening was the fact that 80% of these clients also accessed voluntary HIV counseling and treatment. UBL’s Prevention Coordinator, Juanita Burrowes said, “I really feel good about the work we are doing. The trainings provided by GHARP II have empowered me to serve our clients in a meaningful way”.
GHARP II is also working with an NGO called Artists in Direct Support (AIDS). This organization recently helped two of their clients gain employment outside of sex work, and helped one of the clients access alimony so she could better support her son. In addition to professional progress, one of AIDS’ social workers also reports that hygiene and life skills training have notably improved the appearance and mannerisms of many her sex worker clients.
As a step toward supporting continuity of these interventions, GHARP II is now conducting training of trainers workshops to ensure that the skills remain within the NGOs and sex worker groups. GHARP II is also encouraging and supporting the NGOs to conduct these trainings on their own. This will ensure that female sex workers continue receiving quality services through the prevention program at the NGOs, even after the GHRAP II project comes to an end.