Prevention for Key Affected Populations

What Works

Female Sex Workers
  • Comprehensive prevention programs that include components such as peer education, medical services, and support groups, can be effective in enabling sex workers to adopt safer sex practices.
  • Clinic-based interventions with outreach workers can be effective in increasing condom use among sex workers.
  • Policies that involve sex workers, brothel owners and clients in development and implementation of condom use can increase condom use.
  • Providing accessible, routine, high quality, voluntary and confidential STI clinical services that include condom promotion can be successful in reducing HIV risk among sex workers.
  • Peer education can increase protective behaviors.
  • Interventions targeting male clients can increase condom use and thus reduce HIV risk for sex workers.
Women Drug Users and Partners of Male IDUs
  • Opioid substitution therapy, particularly maintenance programs with methadone and buprenorphine, leads to reduction in HIV risk behavior among male and female IDUs, and is safe and effective for use by pregnant women.
  • Comprehensive harm reduction programs, including needle exchange programs, condom distribution, substitution therapy and outreach, can reduce HIV risk behaviors and prevalence among male and female IDUs.
  • Peer education can increase protective behaviors among IDUs.
  • Instituting harm reduction programs for IDUs in prisons can reduce HIV prevalence in female prison populations.
Women Prisoners and Female Partners of Male Prisoners
  • Harm reduction strategies such as education, peer distribution of clean needles and condom provision within prisons can reduce the risk of HIV infection and IDU use in female prison populations.
  • Making opioid substitution treatment available in prisons can be effective in reducing HIV transmission.

Some women are particularly at risk of HIV acquisition due to their occupational exposures, their behavior or that of their sexual partner(s), their sexual identity and/or their sexual orientation. These women live in particularly challenging situations. These groups of women—sex workers, injecting drug users (IDUs) or female partners of IDUs, transgendered people, migrant women and female partners of male migrants, women prisoners and female partners of male prisoners, women and girls in complex emergencies and women who have sex with women—have specific needs in prevention and are often marginalized within their societies. It is key to addressing the needs of women and girls to acknowledge the specific needs of these marginalized groups of women.

While public health epidemiology can clarify which groups in which countries are the most at risk of HIV acquisition, an understanding is needed of the fluidity between some groups. For example, sex workers are rarely considered as the focus of PMTCT programs, despite abundant evidence that sex workers get pregnant and have children. In some parts of the world, substantial overlap occurs between sex work and drug use: an estimated 20–50% of female injecting drug users in Eastern Europe and 10–25% of female IDUs in Central Asia are involved in sex work (Rhodes et al., 2002 cited in Pinkham et al., 2008). In many places, HIV prevalence among IDU sex workers is higher than it is among either non-sex worker IDUs or non-IDU sex workers (Pinkham and Malinowska-Sempruch, 2008. Further, in many countries, prison is a common experience for IDUs (Du Cros and Kamarulzaman, 2006). While the numbers of women who have sex with women (WSW), particularly those who are at risk of HIV acquisition, are small, WSW have been ignored and are therefore included here.

The prevention needs of the groups of women listed below and the overlap between them must be considered for HIV prevention planning to be maximally effective. These groups are discussed in more depth in sections A through G of this chapter.