Joseph Kamanga is the Chief of Party/Project Director for the Corridors of Hope III project in Zambia. The COH III project is implemented by FHI 360 with two local NGOs, in 10 major border and transport hubs of Zambia.
HIV and AIDS continue to be a major developmental challenge for Zambia, as well as other countries in sub-Saharan Africa. The HIV prevalence in Zambia is currently estimated at about 13% among the sexually active population, which remains one of the highest HIV prevalence rates in the world.
The Revised National AIDS Strategic Framework (R-NASF 2014-2016) for Zambia recognizes female sex workers as one of the key populations in the HIV response in Zambia. Current evidence shows that a female sex worker is over two times more likely to become infected with HIV and other STIs than are other women in the general population. There are numerous reasons for this scenario, which include engaging in unprotected sex for higher pay, inability to negotiate safer sex (including consistent use of condoms), lack of access to appropriate health services, social stigma and criminalization, sexual violence, and drugs and alcohol abuse. Sex workers’ clients, the majority of whom may be married men and may have other girlfriends, contribute to transmission of infection to and from sex workers and into and from the general population.
It has been 30 years since the first case of HIV was reported in Zambia. Despite targeted interventions to provide HIV treatment to key populations, sex workers, in particular, continue to face barriers to accessing quality HIV prevention and treatment services. In November 2012, I and some other FHI 360 staff in Zambia visited the Bridge Project implementing the Aastha Project in Mumbai, India to gain insight on how to tailor services to the needs of key populations.
Motivated by what we learned from our trip to India, the Corridors of Hope III project/FHI 360 in Zambia, with support and endorsement of the National AIDS Council of Zambia, produced and launched the minimum package of services for sex workers (MPSSW) and standard operating procedures (SOPs) to ensure quality HIV/STI prevention services for sex workers in Zambia. The MPSSW and SOPs were developed with active participation of female sex workers. After these documents were developed, the COH program trained 145 female sex workers as peer promoters of the guidelines.
The SOPs and MPSSW were designed with the aim of helping implementing agencies effectively design, implement, manage, and monitor quality HIV interventions for female sex workers in Zambia in a harmonized and coordinated manner. The SOPs provide step-by-step guidance on how to standardize service delivery mechanisms and assess and improve the quality of the interventions.
Though the MPSSW and SOPs are a work in progress, they provide context and detailed steps for the development of the strategy, structure, individual responsibilities, and monitoring plan for an HIV/STI prevention program. While the minimum package and SOPs were developed for the Corridors of Hope III project, they can be replicated in any setting because the documents explain the fundamental concepts of each strategy. Each SOP has been written to provide the reader with a comprehensive understanding of that specific strategy, as well as links to other related programs to provide a broader perspective. On behalf of COP, I would like to thank our partners and community members who have been instrumental in testing and implementing the strategies described in the documents. It is my hope that the SOPs and MPSSW included here (Final SOP Zambia 7-3-2015, Final MPS Zambia 6-10-2014) will guide your work in ensuring that sex workers achieve the highest quality HIV/STI prevention services possible.