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 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.
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 % and 7.9 % respectively
and 9-12% prevalence of STI among daily
laborers.
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Epidemiology continued
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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Ask?
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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Factor 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.
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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 female sex workers’ human rights
and accord them basic dignity (e.g. services
are voluntary)
Respect female sex workers’ and their clients
views, knowledge and life experiences
Ensure interventions do no harm
Recognize that female sex workers and their
clients are part of the solution, as they are
usually highly motivated to improve their
health and well-being
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Cont’d
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 STIs in Female Sex
Workers and their clients
It follows the same syndromic STI
management
More focus should be given 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)
Syndromic/clinical screening should be done
on regular basis ( at least every 3 months)
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Thank You!!!
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