Speech from Deanna Kerrigan at the LINKAGES Rights in Action Conference

1. Towards a Sustained Community
Empowerment Based Response
to HIV among Sex Workers:
Evidence, Progress & Data Gaps
Deanna Kerrigan, Associate Professor
Department of Health, Behavior & Society

2. Burden
0 10 20 30 40
SSA
EE
LAC
Asia
MENA FSW
Adult women
0 10 20 30 40
SSA
EE
LAC
Asia
MENA
FSW
Adult women
Global HIV
prevalence:
11.8%
Increased odds
of HIV infection:
13.5
Kerrigan et al. 2012. The Global HIV Epidemics among Sex Workers. Washington, DC: The World Bank.
Baral et al. 2012. The Burden of HIV among Female Sex Workers in LMIC. Lancet Infectious Disease.
36.9
%
10.9
%
1.7%
5.2%
6.1%

3. Structure
• Sex workers’ risk for HIV infection
occurs in a context characterized by
powerful structural constraints
• Criminalization of their profession
and a lack of basic labor rights
• Decriminalizing sex work could
reduce transmission by 33-46%
• Multiple, intersecting forms of
stigma, discrimination & violence
• Eliminating sexual violence could
reduce transmission by 17-20%
Shannon et al. 2015. The Global Epidemiology of HIV among Sex Workers: Influence of Structural Determinants. The Lancet.

4. Response
Community empowerment-based
response to HIV is a process by
which sex workers take collective
ownership of programs to achieve
the most effective HIV outcomes
and address structural constraints
• It is an approach that is set
within a broader health and
human rights framework
• Shapes and creates synergy
across components (biomedical,
behavioral, structural) WHO, UNFPA, UNAIDS, NSWP, & The World Bank. (2013).
Implementing comprehensive HIV/STI programmes with sex workers:
practical approaches from collaborative interventions. Geneva.

5. Evidence
Systematic review and meta-analysis (n=30,325 from 22 studies) of the
effectiveness of community empowerment among FSW in LMIC
Significantly associated with improvements in all HIV outcomes
Outcome Combined odds ratio
from meta-analysis
95% confidence interval
HIV 0.68 0.52, 0.89
Gonorrhea 0.61 0.46, 0.82
Chlamydia 0.74 0.57, 0.98
High-titre syphilis 0.53 0.41, 0.69
Consistent condom use with:
All clients 3.27 2.32, 4.62
New clients 3.03 1.89, 4.86
Regular clients 2.90 2.22, 3.78
Kerrigan et al. 2015. A Community Empowerment Approach to the HIV Response among Sex Workers. The Lancet.

6. Gaps
• Population & Location
• Male & transgender sex workers
• Sub-Saharan Africa
• Measurement & Pathways
• Social cohesion and community
mobilization, layered stigma
• Additional HIV Outcomes
• Access to ART, viral suppression,
and PrEP uptake and adherence
• Non HIV Outcomes
• Violence, reproductive health,
substance use, financial security

7. Examples
Abriendo Puertas (Opening
Doors): Dominican Republic
Project Shikamana (Stick Together): Tanzania
Both projects examining social
and structural pathways of
community-led responses on
HIV outcomes among FSW
including those living with HIV

8. Sustainability
Support and make visible
community empowerment
responses to HIV that include
community driven operations
research that examines how to
not only achieve but sustain
improvements in HIV, health &
human rights outcomes, with
specific attention to the role of:
• Community led organizations
• Ownership & decision making
• Control over resources
• Meaningful partnerships
Photo courtesy of the Bar Hostess
Empowerment and Support Programme, Kenya