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Global HIV, Hepatitis and STIs Programmes
The Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes leads the development and implementation of the global health sector strategy on the elimination of the diseases as public health threats.

Sex workers

Sex workers face an increased burden of sexually transmitted infections (STIs) and blood-borne infections. Globally, female sex workers are estimated to be 30 times more likely to be living with HIV than other women of reproductive age. In 2019, the Joint United Nations Programme on HIV/AIDS estimated a mean HIV prevalence of 36% among sex workers. The average reported prevalence of active syphilis among sex workers is 10.8% (range 5.8% to 30.3%) (WHO, GHO, 2020). While less is known about the prevalence or incidence of other STIs and viral hepatitis infections among sex workers, increased rates have been documented in different contexts around the globe.

Sex workers face high levels of stigma and criminalization almost everywhere. Modelling studies indicate that decriminalizing sex work could lead to a 46% reduction in new HIV infections in sex workers over 10 years, while eliminating sexual violence against sex workers could lead to a 20% reduction in new HIV infections.

WHO supports countries in their efforts to: address these structural barriers, ensure human rights for sex workers, and to implement a comprehensive package of HIV and other STI services through community-led approaches.

A number of priority health interventions can target prevention of HIV and other STIs among sex workers.

Health interventions

  • Prevention (condom, pre-exposure prophylaxis, etc.) 
  • Harm reduction interventions (needle and syringe programmes, opioid substitution therapy, naloxone)
  • Behavioural interventions
  • HIV testing services
  • HIV treatment and care
  • Prevention and management of tuberculosis, hepatitis and mental health
  • Sexual and reproductive health interventions

Structural interventions

  • Supportive legislation, policy and funding including decriminalization of behaviours (e.g. drug use and possession, sex work, same-gender sex)
  • Addressing stigma and discrimination 
  • Available, accessible and acceptable health services
  • Community empowerment
  • Addressing violence

Publications

Policy brief: Consolidated guidelines on HIV, viral hepatitis and STI prevention, diagnosis, treatment and care for key populations

The 2022 Consolidated guidelines on HIV, viral hepatitis and STI prevention, diagnosis, treatment and care for key populations outline a public health...

Biobehavioural survey guidelines for populations at risk for HIV

The guidelines fill a gap in providing tools for surveying HIV prevalence in key populations, and the included questionnaires may also inform general population...

Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations

In this consolidated guidelines document on HIV prevention, diagnosis, treatment and care for key populations, WHO brings together all existing guidance...

Tool to set and monitor targets for HIV prevention, diagnosis, treatment and care for key populations

This supplement provides technical guidance to assist countries in planning and monitoring efforts to address HIV among key populations: men who have sex...

HIV AND YOUNG PEOPLE WHO SELL SEX

Key populations at higher risk of HIV include people who sell sex, men who have sex with men (MSM), transgender people and people who inject drugs. Young...

Implementing comprehensive HIV/STI programmes with sex workers: practical approaches from collaborative interventions

This tool offers practical advice on implementing HIV and STI programmes for and with sex workers. It is based on the recommendations in the guidance document...

Prevention and treatment of HIV and other sexually transmitted infections for sex workers in low- and middle-income countries

The objective of this document is to provide technical recommendations on effective interventions for the prevention and treatment of HIV and other sexually...