Module VII Session two
STI Management in MARPs
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Module Objectives
At the end of this module participants will
be able to:
• Understand epidemiology of STI/HIV in
MARPS
• Describe guiding principles while
delivering services to MARPS
• Describe management approaches of STIs
in MARPS
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Definition
Countries have different MARPS definition
depending up on their HIV prevalence
across different population group.
The Ethiopia HIV Investment Case identify
female sex workers (FSW) and their clients
like, long distance drivers and daily
laborers, as Most At Risk Population
(MARPS) for HIV and sexually transmitted
infections.
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Epidemiology
According to 2013 MARPS survey, the HIV
prevalence among FSW is 24.7% and 4.9%
in truck drivers. And the prevalence of
syphilis is four times higher than the
general population.
The reported vaginal discharge and genital
ulcer in the last 12 months among the
FSWs was 11.5 % & 7.9% respectively and
9-12% prevalence of STI among daily
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laborers.
Epidemiology….
These group acts as a core or bridging
population in the transmission of HIV
and STI for the general population.
Thus, reaching these groups with high-
quality preventive and curative
services is essential for community
control of STI.
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Why FSWs and their clients are
special target Group?
Participation in high-risk sex
Sex with multiple partners
Frequency of partner change
Higher levels of symptomatic or untreated
STIs
Limited access to health services
(economic and other social factors)
Stigma and marginalization especially for
FSW
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What factors might FSWs and their
clients hinder from seeking health care
services?
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Guiding Principles
Accessible services
• Conveniently located
• Open at convenient timing
• Integrated services/co-located
Acceptable services
Affordable Services and
Appropriate services
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Factors affecting Acceptability of services
Health Care Providers(HCPs) attitude
and behavior (related to)
• Religious beliefs
• Personal principles, moral judgment
• Societal norms and values
• Fear
• Poor understanding and poor knowledge
• Inadequate skills to work with FSWs
and their clients
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Some ways to improve Health Care
Providers (HCPs) attitude and
behavior
Educate service providers on how to deal with
MARPS especially FSWs.
Changing the attitudes of service providers – to
be more caring and less judgmental/stigmatizing.
Re-affirm the code of practice i.e. treating all
patients/clients equally, confidentially and with
privacy.
Train HCPs on basic skills in the management of
STIs in FSWs and their clients.
Neutral/supportive language and appropriate
body language.
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Affordability
Consider cost of services
Free or subsidized services like
condom and STI drugs
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Points to consider while working
with FSWs and their clients
Respect FSWs’ human rights and accord
them basic dignity (e.g. services are
voluntary)
Respect FSWs’ and their clients views,
knowledge and life experiences
Ensure interventions do no harm
Recognize that FSWs and their clients
are part of the solution, as they are
usually highly motivated to improve
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their health and well-being
Build capacity and leadership among
FSWs in order to facilitate participation
and community ownership
Include clients/partners/controllers or
gatekeepers
Adapt to the diversity of FSWs and
their clients settings and people
involved
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Who should deliver
services?
All service delivery points including:
Public
Private
NGO and
Faith Based Facilities
Needs to design their service delivery
points to be as friendly as possible to
FSWs and their clients .
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Management of STI in Female Sex
Workers and their clients
It follows the same syndromic STI
management
But with more focus on risk reduction and
correct and consistent usage of condoms
and counseling to improve condom-
negotiating skills;
Arranging for treatment of regular partners
(whenever possible)
Arranging for follow-up examinations and
regular attendances for medical check-ups.
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Syndromic/clinical screening should be done
Practical remarks for periodic screening
STI testing should not be coercive or
mandatory.
Syphilis screening requires minimal training
and laboratory equipment, and is
inexpensive
Clinical STI screening should be part of a
package of comprehensive prevention and
STI care services and it should be done
every month.
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Thank You!
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