title: 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.
authors: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: dkerrig1@jhu.edu.
authors: Deanna
authors: D
authors: Kerrigan
authors: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Caitlin E
authors: CE
authors: Kennedy
authors: Global Network of Sex Work Projects (NSWP), Edinburgh, Scotland, UK.
authors: Ruth
authors: R
authors: Morgan-Thomas
authors: University of Manitoba, Manitoba, Winnipeg, MB, Canada.
authors: Sushena
authors: S
authors: Reza-Paul
authors: Bar Hostess Empowerment and Support Program, Nairobi, Kenya.
authors: Peninah
authors: P
authors: Mwangi
authors: Asia Pacific Network of Sex Workers (APNSW), Bangkok, Thailand.
authors: Kay Thi
authors: KT
authors: Win
authors: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Allison
authors: A
authors: McFall
authors: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Virginia A
authors: VA
authors: Fonner
authors: UN Population Fund, New York, NY, USA.
authors: Jennifer
authors: J
authors: Butler
mesh_terms: D019058:Community Networks; D017280:Condoms / Q000706:statistics & numerical data; D003695:Delivery of Health Care / Q000458:organization & administration; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D011209:Power, Psychological; D011477:Sex Work; D060386:Sex Workers / Q000523:psychology*; D012749:Sexually Transmitted Diseases / Q000517:prevention & control