1

Community
Empowerment
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2 Community
mobilization
Addressing and structural
Starting, managing, interventions
monitoring and scaling
Violence against
up a programme Sex Workers
from both a centralized and
community perspective

6
Programme 3
Management and Community-led
Organizational Services
Capacity-
building 1
Community
Empowerment

5 4
Clinical and Condom and
Support Lubricant
Services Programming

Fundamental prevention,
care and treatment
interventions

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Whats in this chapter?

Community empowerment is the foundation for all of the interventions and approaches described
in this tool. This chapter:
defines community empowerment and explains why it is fundamental to addressing HIV and
STIs among sex workers in an effective and sustainable way (Section 1.1)
describes eight elements of community empowerment, with examples from a number of
programmes (Section 1.2).

The chapter also presents:

examples of indicators to measure the empowerment of sex worker organizations (Section 1.3)
a list of resources and further reading (Section 1.4).

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1.1 Introduction

2012 Recommendations:1 Evidence-based Recommendation 1

In the context of sex work and HIV programming, community empowerment is a process whereby
sex workers take individual and collective ownership of programmes in order to achieve the most
effective HIV responses, and take concrete action to address social and structural barriers to their
broader health and human rights.2

The interventions delivered through a community empowerment model include sustained engagement
with local sex workers to raise awareness about sex worker rights, the establishment of community-
led safe spaces (drop-in centres),3 the formation of collectives that determine the range of services
to be provided, as well as outreach and advocacy.

The 2012 Recommendations state that community empowerment is a necessary component of sex
worker interventions and should be led by sex workers. The benefits are high, there are no harms and
the required resources are relatively low. The values and preferences survey4 found that sex workers
see community empowerment as an absolutely necessary component of health interventions for
improving their living and working conditions, developing strategies for health and rights interventions,
and redressing human rights violations.

Sex workers take charge of the community empowerment process by mobilizing with other sex
workers to develop solutions to the issues they face as a group, and by advocating for their rights
as sex workers and as human beings.

Community empowerment is also a broader social movement that supports the self-determination
of sex workers. It requires governmental, nongovernmental, public, private, political and religious
institutions and organizations to address and remove the social exclusion, stigma, discrimination
and violence that violate the human rights of sex workers and heighten associated HIV risk and
vulnerability.

Community empowerment includes working towards the decriminalization of sex work and the
elimination of the unjust application of non-criminal laws and regulations against sex workers, and
recognizing and respecting sex work as a legitimate occupation or livelihood.

Investing in community empowerment is not only the right thing to do but makes good sense.
Female, male and transgender sex workers are disproportionately affected by HIV. Strategies for

1 Prevention and treatment of HIV and other sexually transmitted infections for sex workers in low- and middle-income countries: recommendations for a public health approach.
WHO, UNFPA, UNAIDS, NSWP, 2012.
2 In most contexts in this tool, community refers to populations of sex workers rather than the broader geographic, social or cultural groupings of which they may
be a part. Thus, outreach to the community means outreach to sex workers, community-led interventions are interventions led by sex workers, and community
members are sex workers.
3 A safe space or drop-in centre is a place where sex workers may gather to relax, meet other community members and hold social events, meetings or training.
See Chapter 3, Section 3.3 for details.
4 A global consultation conducted with sex workers by NSWP as part of the process of developing the 2012 Recommendations.

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HIV prevention among sex workers (such as peer-led education and control of sexually transmitted
infections) are more effective and sustainable when conducted within a community empowerment
framework. From Kenya to Ukraine, Brazil to Thailand, India to the Dominican Republic, investment in
community-led organizations of sex workers has resulted in improved reach, access, service quality,
service uptake, condom use and engagement by sex workers in national policies and programmes.
Scaling up comprehensive, community empowerment-based HIV interventions helps prevent
significant numbers of new HIV infections, particularly in settings with high rates of HIV.

Community empowerment for sex workers means:

sex workers coming together for mutual assistance
removing barriers to full participation
strengthening partnerships among sex worker communities, government, civil society and local
allies
addressing collective needs in a supportive environment
leading the process themselves: sex workers know best how to identify their priorities and the
context-appropriate strategies to address those priorities
meaningful participation of sex workers in all aspects of programme design, implementation,
management and evaluation
providing money and resources directly to sex worker organizations and communities, which
become responsible for determining priorities, activities, staffing, and the nature and content of
service provision. Ultimately, sex worker-led organizations may become the employers of relevant
staff (doctors, nurses, social workers, outreach workers), rather than sex workers being solely
volunteers, community outreach workers5 or employees.

Community empowerment is more than a set of activities; it is an approach that should be integrated
into all aspects of health and HIV programming. It is the cornerstone of a human-rights-based approach
to HIV and sex work and, as such, underpins all the recommendations and components presented
in this tool.

1.2 Key elements of community empowerment

The process of community empowerment is, by definition, driven by sex workers themselves. It
is therefore impractical to adopt a prescriptive, inflexible approach to implementing community
empowerment initiatives. However, various sex worker groups throughout the world have identified
some key elements of community empowerment (Figure 1.1).6

The approach is flexible and adaptable to individual community needs. There is no fixed order in
which the elements should be addressed; the process may flow from working with communities
of sex workers to community-led outreach, the development and strengthening of collectives (sex
worker-led organizations and networks) and, consistent with local needs and contexts, shaping human
rights-based policies and creating an enabling environment for a sustainable movement.

5 In this tool, community outreach worker is used to mean a sex worker who conducts outreach to other sex workers, and who is not generally full-time staff of an HIV
prevention intervention (full-time staff might be called staff outreach workers or also simply outreach workers). Community outreach workers may also be known by
other terms, including peer educators, peer outreach workers or simply outreach workers. The terms community or peer should not, however, be understood or
used to imply that they are less qualified or less capable than staff outreach workers.
6 Particular acknowledgement for some of these elements is made to Veshya Anyay Mukti Parishad (VAMPSex Workers Collective against Injustice) and Sampada
Grameen Mahila Sanstha (SANGRAMRural Womens Organization: Meena Seshu, General Secretary) in India.

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This process represents a paradigm shift, from sex workers being recipients of services to the self-
determination of sex worker communities. Community empowerment builds a social movement
where the communitysex workerscollectively exercise their rights, are recognized as an authority,
and are equal partners in the planning, implementation and monitoring of health services.

Figure 1.1 Key elements of community empowerment among sex workers

Working with
communities
of sex workers

Fostering sex
Sustaining the worker-led
movement outreach

Shaping policy Developing

and creating Community sex worker
enabling Empowerment collectives
environments

Adapting to
Strengthening
the collective local needs
and contexts

Promoting a
human-rights
framework

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1.2.1 Working with communities of sex workers

Community empowerment is a process that takes significant time and effort, especially since in
many contexts sex work is stigmatized and criminalized. Trust, empathy and respect are important
for all partners. Building trust involves treating sex workers with dignity and respect, listening to
and addressing their concerns, and working with them throughout the process of developing and
implementing an intervention. The goal is to cultivate a programme that is eventually run entirely
by sex workers, and where sex worker-led organizations are respected as partners by officials and
service providers in health, law enforcement and social services.

Box 1.1

Meaningful participation
Meaningful participation means that sex workers:
choose how they are represented, and by whom
choose how they are engaged in the process
choose whether to participate
have an equal voice in how partnerships are managed.

The meaningful participation of sex workers is essential to building trust and establishing relationships
and partnerships that have integrity and are sustainable (see Box 1.1). This may be challenging for
service providers who are more accustomed to establishing the parameters within which services
are provided, and prescribing how relationships or partnerships are to be conducted. As sex workers
and sex worker organizations become more empowered, there will be greater expectations of
power-sharing and power-shifting (see Chapter 6, Section 6.2.8). In the initial stages of community
empowerment, sex workers may have less experience in organizing as a group. National, regional
and global sex worker-led networks are able to provide essential technical assistance and support
(see Chapter 6, Section 6.6). Allies also have an important role in facilitating meaningful participation
of sex workers, with community self-management the shared goal.

Partnerships are crucial but must be built and maintained in a way that does no harm to sex workers.
Social exclusion, punitive laws and the normalization of violence, stigma and discrimination not only
impact the daily lives of sex workers but influence policy-makers and affect the attitudes of officials
and service providers. All partners should share the responsibility for supporting the shift from sex
worker disempowerment to sex worker empowerment. Given that 116 countries criminalize some
aspects of sex work, and the vast majority of countries have other punitive laws that are used against
sex workers, safeguards need to be built into partnerships to ensure that sex workers do not face
a backlash for organizing, do not fear that identifying themselves as sex workers will lead to arrest
and harassment, and do not experience further stigmatization from health-care providers.

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1.2.2 Fostering sex worker-led outreach

There is a difference between programmes that are done for sex workers and those led by sex
workers (Table 1.1). This element in the community empowerment process requires service providers
to reflect on how they can support a move from providing services to sex workers to sex worker
organizations themselves ultimately becoming the employers of service providers.

Sex worker-led initiatives operate under the principle that sex workers are best equipped to help each
other learn not only to protect themselves from risks to their health and safety, but also to promote
and protect their human rights.

Sex workers should be the driving force in targeted programmes addressing HIV and sex work. It is
not enough to consult with sex workers before creating a programme. Rather, programmes should
be based on sex workers needs, perceptions and experiences.

Table 1.1 Comparison of programme approaches from a community empowerment perspective

Done for sex workers Done with/Led by sex workers
Programmes sometimes focus on how sex workers Programmes focus on sex workers collectively
can protect others from disease, and how society identified needs and develop appropriate solutions.
can be protected from sex workers.
Community discusses its needs before developing
Often assume that knowledge and power reside a programme, and sex workers are engaged in all
with the programme staff and managers. stages of planning and implementation.
Involve sex workers in programme implementation Involve sex workers as equal partners in
commonly as volunteers, not as equal partners. programme implementation, more commonly as
paid employees or as community outreach workers
working with the community, not for an external
organization.
Monitoring focuses on goods and services Monitoring focuses on quality of services and
delivered and targets to be achieved. programmes, community engagement, community
cohesion and community acceptance, as well as
adequacy of service coverage.
Focus on building relationships within the health Focus on building relationships within sex worker
system with health-care providers. Less emphasis communities as well as between sex workers and
is placed on building relationships among sex other organizations, service providers, human
worker groups. rights institutions and similar groups.

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Box 1.2

Sex worker-led outreach programmes

Sex worker-led outreach programmes focus on:
the needs and experiences of sex workers themselves, not what programmers think sex workers need
the sex worker-led outreach process itself, with an emphasis on ways of protecting sex workers, rather
than an emphasis on process indicators (for example, counting the number of condoms distributed is
part of a programme, but should not be seen as an end in itself)
stimulating community empowerment and creating a collective identity among sex workers.

In order to ensure the trust and confidence of sex workers, it is important to employ educators and
outreach workers who are themselves sex workers. This is because sex workers:
share a common experience that may decrease internalized stigma and increase self-worth and
collective solidarity
are likely to be more comfortable discussing intimate details associated with sex work with
someone who is experienced and knowledgeable
are more likely to follow up on referrals to services, adhere to treatments and engage in health-
seeking and health-protective behaviours if they trust the person providing the advice
have knowledge of the sex work industry that can inform outreach activities to clients, managers,
law enforcement and health-care providers.

However, sex workers should not be limited to these roles in community-led programmes. Rather,
they should be given the opportunity to participate in all other levels of the programme, including
decision-making on programme implementation, management and governance. Capacity-building
and mentoring should be a priority to enable sex workers to take up these positions.

1.2.3 Developing sex worker collectives

Forming any type of sex worker group or organization will only be successful if the process is initiated
and led by the community. A common first step in developing community cohesion is providing a
safe space (drop-in centre) where sex workers can come together to socialize and discuss issues.
This can be an empowering exercise in and of itself (see Box 1.3) and helps sex workers identify
common issues and a sense of purpose and connectedness. However, safe spaces are only one way
to initiate group processes. Sex workers may also come together over key issues that affect them
individually but that require a group response, such as addressing violence, bribes and harassment;
or they may identify common needs such as child care; or seek information as new (and frequently
undocumented) migrants.

The recommended kind of sex worker organization is a collective. This means that sex workers
organize themselves together as a group. They jointly (collectively) decide on priorities for the whole
group, agree on a group process for making decisions, and on a common set of rules for being
together as a group. Ultimately a collective (i.e. a sex worker-led organization or network) acts in the
interest of the whole group rather than for individual benefit. It is up to sex workers to decide when
a collective should be formed, and there is no standard timeframe for doing so.

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It is crucial to note that community-led (i.e. sex worker-led) processes and organizations are not
synonymous with generic community-based organizations (CBOs). In community-led organizations,
power and decision-making lie in the hands of community members (sex workers), whereas in a CBO,
power may reside only with some members of the community, or with non-community members who
act as administrators. It is the self-determining and self-governing nature of an organization, and its
commitment to pursue the goals that its own members have agreed upon, that make it a collective.

Box 1.3

Bringing sex workers together

Organize group activities at safe spaces (drop-in centres) based on the interests of the group members.
Plan activities for special occasions, such as the International Day to End Violence against Sex Workers
(17 December).
Invite sex worker activists or community outreach workers from neighbouring areas to speak at a
gathering of local sex workers.

Sex worker organizations come into being in various ways. Two primary ones are:
growing out of a community empowerment process or other process supported by another
organization, including national, regional or global sex worker-led networks
sex workers independently forming an organization.

The advantage of the first is that the partner organization may be able to support the process through
funding, the provision of space, assistance with activities and advocacy to remove any barriers. This
support is often necessary and welcome and should include connecting the local group to existing
national and regional sex worker-led networks. However, if a sex worker organization is to be a true
collective, ownership must rest with the community, and its form and function should be based on
the needs and priorities identified by its members. It is crucial that the outside partner understand
that the organization needs to be given the freedom to find its own way.

In some cases, sex worker groups hire consultants to lead them through the process of forming
an organization, or receive crucial support from one or two nongovernmental organization (NGO)
employees. Alternatively, they may do it themselves with the help of a partner NGOs lawyer, or with
support from national or regional sex worker-led networks. An organization experienced in project
management, financial management, monitoring and reporting, communication and fundraising can
help build the capacity of sex workers by providing training and opportunities to practise skills.

1.2.4 Adapting to local needs and contexts

Sex workers face diverse legal, political, social and health environments. Sex work may be criminalized
or an accepted occupation; it may be predominantly establishment-based or street-based. Sex workers
may be undocumented migrants, highly mobile or selling sex in their own locality. HIV programmes
need to be sensitive to the diversity of cultures of people working in the sex industry. What it means
to be part of a sex work community varies depending on the culture, ethnicity, language, location
and socioeconomic position of the particular sex workers. As a result of these different contexts,

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different sex work communities have different needs and challenges that may be addressed through
community empowerment initiatives.

Flexibility, responsiveness and adaptability are essential in implementing community empowerment

initiatives. Intervention goals need to be aligned with and address sex workers needs, even if these
change over time. Box 1.4 shows how sex worker organizations in India and Kenya have adapted
their programming to local needs and contexts.

Box 1.4

Case example: Local needs and contexts in India and Kenya

VAMP (Veshya Anyay Mukti Parishad), a sex worker organization in southern India supported by SANGRAM
(Sampada Grameen Mahila Sanstha, an HIV organization), has adapted its programmes to directly address
the needs of sex workers, who face financial exclusion and significant stigma and discrimination from health
authorities. Community-led processes have resulted in sex workers being trained to support community
members access to non-stigmatizing, subsidized health care. This is done by negotiating access to a range
of government service providers and providing support for sex workers in financial difficulty. The result is
strong collectives of sex workers empowered to claim and exercise their rights, improving the health and
welfare of individual sex workers, their communities and their families.
In Kenya, frequent problems with law enforcement officers became an issue for collective action by sex
workers. The Bar Hostess Empowerment and Support Programme (BHESP) developed a programme in
Nairobi to train local sex workers as paralegals. They studied local and national laws that affect sex work
and the human rights of sex workers. The paralegals now educate other sex workers about their rights, help
those who need legal advice and document human-rights violations, such as arbitrary arrest. Each paralegal
works as an advocate responsible for 1015 other sex workers. They are trained to identify the specific
issues group members may have and to request additional resources from BHESP staff when needed.
The result is strong and empowered sex workers who know the law and the rights of sex workers and
are able to mount straightforward challenges to arbitrary arrest and detention. Similar paralegal systems
are being implemented by the Womens Legal Centre, which is funded by the Open Society Foundations
in Cape Town, South Africa, among others. Such programmes addressing local needs and contexts build
individual competencies and community resilience.

1.2.5 Promoting a human-rights framework

Promoting and protecting the human rights of sex workers is central to all community empowerment
processes. The 2012 Recommendations specifically address the human rights of sex workers.

2012 Recommendations: Good Practice Recommendation 2

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The strength of the collective and the partnerships that have been built are crucial to promoting
a human-rights framework. Challenging stigma and discrimination, mobilizing support, educating
community members on the universality of human rights, and changing the attitudes of the wider
(non-sex worker) community are activities that test the most robust of organizations and networks.
Two examples (Box 1.5) illustrate the importance of partnerships and the centrality of community
empowerment in achieving structural shifts.

Box 1.5

Case example: Promoting human rights and social entitlements

with police and government in Thailand and Brazil
Criminalizing the possession of condoms violates sex workers right to health, but in Thailand it is a
common practice of local law enforcement, despite a government directive intended to prevent it. Sex
Workers in Group (SWING), a community-led organization, has developed an innovative and pragmatic
partnership to involve police cadets in its outreach programme. Cadets are offered three-week internships
working alongside SWING volunteers to promote condom use. At the end of the internship, the cadets
give a presentation to all 1,200 police academy students. As a result of this programme, sex workers have
experienced less police harassment and fewer arrests. Furthermore, the police interns have become
promoters and protectors of the human rights of sex workers, changing police culture from the inside.
In Brazil, the sex worker-led organization DavidaProstituio, Direitos Civis, Sade has for years fought
stigma and discrimination surrounding sex work. It has partnered with the Brazilian government to establish
policy committees, run mass media campaigns to change community attitudes and has been instrumental
in shaping the governments response to AIDS. One of Davidas most important successes has been its
advocacy with the government to recognize sex work as a profession, guaranteeing sex workers the same
rights as all other workers, including receiving a pension upon retirement.

1.2.6 Community systems strengthening (strengthening the collective)

Forming any collective is challenging, but maintaining and strengthening it is even more difficult.
Community-led movements around the world face significant barriers, including inadequate funding,
too few paid staff, complex community needs, political opposition to their existence, competition for
resources from within and outside their communities and lack of recognition of the importance of
their populations. Sex worker organizations and networks, as collectives, face all of these challenges
and more. The marginalization and lack of visibility of sex workers within legal, social and economic
structures at all levels of society means that their organizations and networks are typically underfunded
and undervalued.

A strong community-led organization is characterized by vibrant membership, increasing financial

independence, greater political power and wider social engagement. There are several ways this is
achieved (see Box 1.6). When implementing an HIV response, governments, donors, the broader
civil society movement, local organizations and multilateral agencies have a responsibility to provide
sustainable support to sex worker organizations and networks. Such support should not be tied
to particular donor-driven ideologies that conflict with the needs and priorities determined by the
community. This risk can be mitigatedand more productive funding strategies negotiatedif the
community empowerment process has progressed to the stage where decision-making power is
vested within the community-led organization.

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Community systems strengthening is a mechanism to ensure meaningful participation of community-

led organizations within the wider policy and programmatic systems of the state, and to address
and resolve internal issues and conflicts. At the local level, this means sex worker organizations and
networks participate as members on planning, funding and implementation committees and other
relevant bodies, ensuring that the needs of the sex worker community are addressed. It may also
mean that within a sex worker organization, or across a number of organizations, community-led
structures are put in place to monitor, decide upon or otherwise address key issues of concern to
the community. These may include violence-reduction strategies, allocation of community housing
or functioning of community financial cooperatives.

Box 1.6

Strengthening management and organizational capacity

Create a fair and transparent method for making decisions within the organization.
Ensure that the process for carrying out and managing activities is participatory, transparent and has
accountability.
Establish a transparent operational system for managing human and financial resources.
Sex workers should be in control of the planning, implementation and monitoring of the collective and
its activities, including identifying indicators for monitoring.
Support the growth of group membership and advancing of the groups goals and objectives.
Encourage cooperation and learning from other sex worker-led organizations and networks nationally
and internationally.

To help achieve sustainability, it is important to invest time and resources into building leadership among
sex workers through their involvement in trainings, conferences, project design, implementation,
evaluation, research and fundraising activities, and their participation in the wider sex worker rights
movement. (See also Chapter 3, Section 3.2.2, part D.)

It is also essential to develop the organizational skills and capabilities of the collective as a whole.
This may involve enhancing business and management skills among group members, strengthening
leadership and management or developing resource mobilization activities (Box 1.7). The guidance
of allies and partners, as well as other sex worker-led organizations, may assist with the process.

Box 1.7

Case example: Generating income as a collective

Enhancing business and management skills among group members may lead to income-generating
activities for the collective:
Sex workers from Ashodaya Samithi in Mysore, India used World Bank funding to start a restaurant
staffed by sex workers, which helps challenge the stigma and discrimination they face. Profits support
a home-care programme for sex workers living with HIV.
In Brazil, the sex worker organization Davida created its own fashion line, Dapsu, whose proceeds help
fund the organizations social, cultural and HIV prevention activities.
In India, leaders of the Sonagachi Project registered a consumer cooperative to increase sex workers
economic security through access to credit and savings programmes, handicraft production, condom
social marketing and evening child-care centres.
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Financial management is another key component of organizational sustainability. It can be developed

in a number of ways depending on the potential capacity of the organization, its resources and the
complexity of its finances. An organization may manage its finances in-house or may outsource the
work to another local organization. Regardless of the size of the organization, important components
of a strong financial management system include:
well-documented financial systems and financial controls
financial files documented and audit-ready
financial reporting procedures known and understood by members
an adequate number of qualified financial staff, depending upon the complexity and size of the
organization.

Community systems strengtheningstrengthening the collectivealso involves developing

procedures to sustain group operations, including a transparent and democratic process to
elect leaders, as well as the mentoring of new leaders and planning for succession. Sex worker
organizations are often started by a small number of dynamic individuals. However, to be sustainable,
these organizations must ensure strong leadership and organizational management and invest in
developing future leaders. This requires resources for leadership training and capacity-building as well
as connections with national, sub-regional, regional and global networks of sex workers to exchange
knowledge, experience and support. Organizational leadership and management activities include:
strategic planning that reflects the organizations vision and mission
leadership that includes a broad range of staff and other community members in organizational
decision-making and ensures sharing of information across the organization
processes in place to manage change and seek new opportunities.

Developing a wider base of skills and leadership within the collective and linking with other
organizations can help ensure the sustainability of a sex worker organization in the face of changing
donor funding or changing leadership in other governmental or nongovernmental organizations.

1.2.7 Shaping policy and creating enabling environments

2012 Recommendations: Good Practice Recommendation 3

Community empowerment processes reach beyond the community to influence policy and create
enabling environments. For example:
HIV programmes should take affirmative steps to promote the universality of human rights for sex
workers, including their rights to health, dignity and lives free from violence, discrimination and
stigma. (For details on addressing violence, see Chapter 2.)
National strategic health plans should recognize sex workers heightened HIV risk and vulnerability
and ensure that integrated, high-quality health services are available, affordable and accessible for
female, male and transgender sex workers.

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Law enforcement authorities must be involved in the promotion and protection of the human
rights of sex workers, and programmes to create enabling legal and policy environments should
be funded and supported.
Economic empowerment of sex workers is essential: sex workers should be accorded the same
rights as all other informal workers7 to safe and fair working conditions, with skills training and
education for life, access to bank accounts and fair credit programmes, and the same potential
to support their families and plan for their future as all other members of the wider community.
Donor organizations may support the process of sex worker empowerment by funding initiatives
to increase capacity among sex workers and support organizational development. It is important
to note that international agreements and policies at a global level may either facilitate or hinder
community empowerment among sex workers by allowing or restricting access to financial
resources by sex worker groups and collectives.

Box 1.8

Case example: South-South partnerships between

sex worker-led organizations
The Global Network of Sex Work Projects has spearheaded initiatives to strengthen South-South
cooperation among sex worker-led organizations. The rationale is to partner stronger, longer-established
sex worker-led organizations and networks with those in the process of strengthening their movement.
This enables sharing of experiences, learning new ideas and forming new alliances.
Following the Kolkata Sex Worker Freedom Festival in India in 2012, African sex workers undertook a study
tour to the Ashodaya Academy in Mysore, and the programmes of SANGRAM and VAMP in Sangli. This
study tour was followed up by a return visit by the Indian organizations to Kenya to discuss the establishment
of a learning site there and to participate in the African Sex Workers Alliance Strategic Planning Meeting.
Similarly, Bridging the Gaps, an international HIV programme, provides opportunities for sharing lessons
from HIV-related projects in Asia and Africa, including on community empowerment, capacity-building of
programme managers and identification of examples of good practice.
Such partnerships connect the local with the global, stimulating important knowledge-sharing and
contributing to strengthening the sex worker rights movement.

1.2.8 Sustaining the movement

To sustain themselves, sex worker-led movements should operate in solidarity with other social
movements, particularly those that also advocate for human rights. This may include movements of
other key populations who have similar experiences of heightened HIV risk and social exclusion, such
as men who have sex with men, people who use drugs and transgender people, some of whom are
sex workers, as well as organizations and networks of people living with HIV. Collaboration between
movements strengthens the collective response and ensures that communities are at the centre of
that response.

It is essential that development partners in lower- and middle-income countries, and governments
and national partners in all countries, actively support the sustainability of sex worker-led organizations
and networks. It is unreasonable to expect any group to grow from a small collection of individuals
to a movement whose members actively contribute to the national HIV response unless it receives

7 The International Labour Organizations Recommendation concerning HIV and AIDS and the World of Work, 2010 (No. 200) covers all workers working under all forms or
arrangements, and at all workplaces, including: (i) persons in any employment or occupation (Paragraph 2(a)).

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sustained support. The marginalization of sex workers within the broader economic and social
discourse makes sustainability of sex worker-led organizations and networks more challenging. It is
essential that, at this point in the community empowerment process, power has been transferred to
the community and that community advocates are respected partners in policy-making, irrespective
of the legal status of sex work.

A strong, healthy and vibrant civil society working in genuine partnership has been the backbone of
the HIV response for 30 years. As we move forward, sex worker organizations and networks should
be core members of that partnership.

1.3 Monitoring progress

It is important that communities monitor progress to improve the services they provide and shape
the services they receive. HIV programmes based on human rights and community empowerment
require that sex worker-led organizations set the parameters for monitoring and evaluation of
programmes across all stages of development, including the monitoring and evaluation of the sex
worker movement itself.

Short- and long-term objectives and goals need to be established that specifically address the
community empowerment process. As an example, monitoring community empowerment in relation
to HIV prevention, treatment, care and support and health services would measure sex worker
involvement in each of the following: how services are run, quality assurance, funding allocations,
training of health personnel to address stigma, and advocacy to address discrimination; rather than
simply whether a target percentage of sex workers has accessed a particular service.

In a community empowerment-based programme, monitoring and evaluation should not only

include services provided and health outcomes achieved, but should also attempt to monitor and
evaluate whether and to what extent the community empowerment process is occurring. Frequently,
programme indicators measure quantitative outputs, such as sex workers contacted and condoms
distributed, rather than documenting sex worker-led organizational progress and social inclusion.
Box1.9 and Table 1.2 describe approaches to monitoring community empowerment.

Box 1.9

Case example: Monitoring community empowerment of sex worker

organizations in India
Monitoring empowerment is challenging because numbers alone do not convey the complex interaction
of factors that define empowerment. In the Avahan India AIDS Initiative, where NGOs worked with
community leaders to establish formally registered CBOs, it was found that simply reporting the number
of community groups or meetings held was inadequate, because these data did not capture the quality of
the capacity-building and the functioning and autonomy of the groups. To address this, special surveys
were developed to capture the various aspects of community empowerment, using an index with multiple
groups of indicators. The surveys were administered over a period of several days by trained facilitators
with leaders and members of each CBO as well as staff of the NGO implementing the programme, using a
small-group discussion format. Initial survey results were immediately reported to the CBO and NGO and
discussed with them, with a detailed analysis following later. It was found that a combination of qualitative
and quantitative indicators and approaches to monitoring and evaluation was needed to document the
complex process of community group formation and the development and sustainability of each collective.

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Table 1.2 Monitoring indicators for sex worker empowerment

Level Empowerment activities Empowerment indicators
Central Strengthen and expand sex- Inclusion of sex worker movement in national
worker-rights networks to policies and programmes
promote sex workers rights at
Amount of funding allocated to sex worker-led
a global level
groups
Prioritize and invest in
Inclusion of sex worker-led groups in policy-
community-led HIV prevention
making on such issues as HIV prevention
approaches
Recognition of sex worker-led organizations at
Include sex workers in policy,
the national level
programming and funding
decisions
State/province/ Recognize sex work as work Inclusion of sex worker movement in state/
district/county district policies and programmes
Incorporate sex worker
participation in formation Number of health-care providers, police and
of local/district/state-level social service agents trained in sex worker
policies and programmes rights and needs
Train health-care providers, Level of sex worker involvement in service
police and social service design and delivery, including health care,
agencies in sex worker rights legal services and social services
and needs
Changes in attitudes and practices of health-
Involve sex workers in care providers, police and social service
planning, implementation and agents towards sex workers
service delivery of health, legal
Changes in degree of discrimination perceived
and social services
by sex workers from health-care providers,
police and social service agents
Municipality/ Raise awareness of sex worker Amount of participation of sex workers in
Sub-municipality rights in communities public life
Forge relationships with sex Degree of social acceptance of sex workers by
worker-led organizations and members of the general community
other community groups
Number of outside organizations that report
contact and partnering with sex worker-led
organizations
Frontline worker Create safe communal spaces Number of safe spaces created
Identify common priorities, Degree of social cohesion among sex worker
needs and goals groups
Establish and sustain sex Number of sex worker-led organizations/
worker-led organizations collectives established
Hold meetings, marches and Number of meetings, marches or rallies held to
rallies for sex worker rights, promote sex worker rights
to the extent the legal context
Percentage of sex workers who report
allows
participation in a sex worker-led group/
Train legal advocates to collective
document and challenge
Number of sex workers trained as legal
human-rights violations
advocates
Documentation of human-rights abuses

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 1 Community Empowerment

1.4 Resources and further reading

1. UNAIDS guidance note on HIV and sex work. Geneva: Joint United Nations Programme on HIV/AIDS, 2012.
http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2009/JC2306_UNAIDS-
guidance-note-HIV-sex-work_en.pdf
2. Prevention and treatment of HIV and other sexually transmitted infections for sex workers in low- and middle-
income countries: recommendations for a public health approach. Geneva: WHO, UNFPA, UNAIDS, NSWP,
2012.
http://apps.who.int/iris/bitstream/10665/77745/1/9789241504744_eng.pdf
3. The Global HIV Epidemics among Sex Workers. Washington, DC: World Bank, 2013.
http://www.worldbank.org/content/dam/Worldbank/document/GlobalHIVEpidemicsAmongSexWorkers.pdf
4. SANGRAMs Collectives: Engaging Communities in India to Demand their Rights. Arlington, VA: AIDSTAR-
One/John Snow, Inc., 2011.
http://www.aidstar-one.com/sites/default/files/AIDSTAR-One_CaseStudy_GenderMARPs_SANGRAM_India.
pdf
5. Recommendation concerning HIV and AIDS and the World of Work, 2010 (No. 200). Geneva: International
Labour Organization, 2010.
http://www.ilo.org/aids/WCMS_142706/lang--en/index.htm
6. Sex Work and the Law in Asia and the Pacific: Laws, HIV and human rights in the context of sex work.
Bangkok: United Nations Development Programme Asia-Pacific Regional Centre, 2012.
http://www.undp.org/content/dam/undp/library/hivaids/English/HIV-2012-SexWorkAndLaw.pdf
7. Community Mobilization of Female Sex Workers: Module 2, A Strategic Approach to Empower Female Sex
Workers in Karnataka. Bangalore, India: Karnataka Health Promotion Trust, 2008.
http://www.khpt.org/Community_Mobilization.pdf
8. Scamell D. Legal help for sex workersfrom sex workers. Open Society Foundations, March 5, 2013.
http://www.opensocietyfoundations.org/voices/legal-help-sex-workers-sex-workers
9. HIV and the Law: Rights, Risk and Health. New York, NY: Global Commission on HIV and the Law, United
Nations Development Programme, 2012.
http://www.hivlawcommission.org/index.php/report
10. The HIV and Sex Work Collection: Innovative responses in Asia and the Pacific. Bangkok: United Nations
Population Fund, Joint United Nations Programme on HIV/AIDS and Asia Pacific Network of Sex Workers [no
date].
http://www.unaids.org/en/media/unaids/contentassets/documents/document/2012/20121212_HIV_SW.pdf
11. Building Partnerships on HIV and Sex Work: Report and Recommendations from the First Asia and the Pacific
Regional Consultation on HIV and Sex Work. Bangkok: Asia Pacific Network of Sex Workers, United Nations
Population Fund, Joint United Nations Programme on HIV/AIDS, 2011.
http://asiapacific.unfpa.org/public/pid/7491
12. The Global Network of Sex Work Projects (NSWP).
www.nswp.org
13. Bar Hostess Empowerment and Support Project (BHESP).
www.bhesp.org
14. Healthy Options Project Skopje (HOPS).
www.hops.org.mk/programs.htm
15. The Yogakarta Principles on the Application of International Human Rights Law in relation to Sexual
Orientation and Gender Identity (2007).
http://www.yogyakartaprinciples.org/
16. The Denver Principles (1983).
http://data.unaids.org/Pub/externaldocument/2007/gipa1983denverprinciples_en.pdf

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