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Making Sex Work Safe  >  Chapter 7: Making projects successful 
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Chapter 7: Making projects successful

Making Sex Work Safe

Making Sex Work Safe
Acknowledgements
Foreword
Commercial sex in context
Developing a policy framework
Strategies for education
Enabling strategies
Safe (commercial) sex
Health and safety for mobile populations and drug users
Making projects successful
Further reading
Key information sources and suppliers

 

 

 

Making Sex Work Safe    73  Page 74  75  top of page

  Chapter 7: Making projects successful

 

Making projects successful
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7.1  Assessing needs

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What is the situation?

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Who should be involved?

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What are the sexual health needs?

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What sexual services are practised?

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How is sex work organised?

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What STD services are used?

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Do services and projects already exist?

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What policies do services have?

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What is the legal context?

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7.2  Assessment techniques

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Gathering existing information

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Collecting new information

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7.3  Project planning and design

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Making sense of the problems

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Turning problems into objectives

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Activities

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Measuring change

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Identifying assumptions

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7.4  Monitoring and evaluation

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Is the project working?

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Monitoring

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Start at the beginning

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Types of evaluation

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7.5  Project planning: an exercise

 

 

 

Making Sex Work Safe    74  Page 75  76  top of page

  Chapter 7: Making projects successful

7.1 Assessing needs

What is the situation? 
Needs assessment helps to ensure that a project responds to needs in a relevant and appropriate way. It consists of gathering information (baseline data) before planning the project. How best to carry out a needs assessment depends to a large extent on who is doing the assessment and why. For example, a needs assessment may be required to provide information for a funding application, recommend action for existing local services or a health authority, to establish a new initiative or extend an existing one.

Sometimes existing services are well placed to carry out a needs assessment. For example, existing clinics and NGOs already have knowledge, expertise, and contacts which they can use to gather information. Agencies without existing contacts and experience need to develop local community links before beginning a needs assessment. Sometimes external consultants with experience of setting up sex work projects can be helpful.

 

The methods described in this chapter are useful to all the various people involved and can be used to improve or refine the project's work. But this chapter is not intended as a complete guide to project planning. For further information see: Community Action on HIV: a resource manual for HIV prevention (see further Reading). 

The methods described in this chapter are useful to all the various people involved and can be used to improve or refine the project's work. But this chapter is not intended as a complete guide to project planning. For further information see: Community Action on HIV: a resource manual for HIV prevention (see further Reading). 

  
Sex worker participation 
The participation of sex workers is essential for a needs assessment to be meaningful. Generally, the earlier sex workers become involved, the more useful the result will be. Projects need to be flexible to allow sex workers to participate. For example, sex workers may need training to conduct interviews or participate in planning committees. Times and places of meetings need to be convenient for sex workers. The style of meetings must not be alienating. For example, project management jargon should be minimised and explained. Even very technical discussions can be accessible to observers.

Setting the scope 
It is important to set the scope of a needs assessment so that the information gathered answers key questions. For example:
 

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Who is involved in sex work directly or indirectly, and who should be reached?

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What social and legal contexts, practices, knowledge and beliefs help or hinder safe sex?

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Where does sex work take place and consequently where should activities be focused?

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When is it most convenient for sex workers to be contacted or attend clinics, workshops etc?

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What do sex workers want? 


The answers to these questions will help to identify what type of activities are most appropriate.

The first step in planning a needs assessment is to decide the "big questions", that is, those which underlie the purpose of the needs assessment. Then divide each of the "big questions" into a number of smaller questions. For example, to answer a big question like this: Is a health project necessary in this area?

Ask some smaller ones like these:  
What other services exist and what do they do? 
Are sex workers accessing appropriate health care? 
Are sex workers and clients practising safe sex?



    

 

 

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  Chapter 7: Making projects successful

 

To answer these big questions: 
What type of service would be most effective? 
Who should deliver it? 
Who should be targeted? 
What obstacles are there?


... ask smaller questions: 
How useful would written materials be? 
If they are not likely to be useful, what alternatives might be useful? 
Is there any potential for working with clients or influencers? How might that work? 
Should women, men and transgender sex workers be included or should any project only target one gender? 
Would peer education be appropriate? How might peer educators be recruited and trained? 
Should the project specifically target sex workers or should it target sex workers as part of a broader audience? 
What geographic and demographic factors affect the capacity of the project to reach sex workers?

The process continues until a question emerges that can be answered. For example, to answer: Would peer education be appropriate?

Ask: Are sex workers suspicious of authorities? 
Is there much rivalry among sex workers? 
Is there a single "underground" culture or are there more than one? 
What is the mix of ethnic and language groups?

Then... 

Look at how peer education works in similar situations. 

Discuss the possibilities for peer education with potential peer educators, influencers (especially sex business managers) and other sex workers.

 
 

A project planning meeting in the Philippines. Planning and evaluation should be accessible to everyone involved.
A project planning meeting in the Philippines. Planning and evaluation should be accessible to everyone involved.

A research project was asking things like: “How many abortions have you had?” “What religion are your parents?” “At what age did you first have sex?” There was nothing which explored what magazines and newspapers sex workers read, where they got their information about HIV/AIDS/STDs or what other languages they spoke. It was a confused mix of pseudo-scientific, quasi-anthropological enquiry rather than a solid base of information which leads to action.
Consultant. France


Who should be involved? 
The needs assessment needs to involve a range of people.

Sex workers 
 

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Where do most sex workers come from? 

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What movement is there of women and men in and out of sex work?

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Are there any networks or associations of sex workers or relevant sexual minority groups, such as gay men or transsexuals. If so, what do those organisations do?

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Are there possibilities for collaboration between the project and sex worker groups or other

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agencies?

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What ethnic, religious, language or caste groups do sex workers belong to?

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Do male sex workers identify as gay, bisexual or heterosexual? What links do they have to gay communities?

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Do sex workers take drugs? If so, which ones and what is their impact?



    

 

 

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  Chapter 7: Making projects successful

 

Clients 
 

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How can clients be grouped? For example, local single men, local married men, migrant labourers, truck drivers, tourists, military men, men who identify as gay? Do groups vary in each sex work location?

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What languages do clients speak?

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Have clients been targeted by general health education campaigns? What is their understanding of sexual health?


Influencers 
 

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What tasks are performed by people who do not directly provide sexual services, e. g. finding or greeting clients, providing premises, cleaning, serving drinks or food, protecting sex workers from violence etc?

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What are the priorities and interests of these people?

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What are the similarities and differences between their priorities and those of the sex workers?

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How do influencers relate to sex workers, clients and to each other? Is there any rivalry or violence? Are there associations of sex business owners or other ways to address them collectively?

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What languages do influencers speak?


There are a range of people who have an important influence on how the sex industry is conducted. Only the most informal sex work does not involve "influencers". Some business managers are helpful while others are not. Some local business people and even police are helpful, while some obstruct the objectives of health projects.

People who perform different tasks in the sex industry can be grouped in various ways. Groupings should not be used to prejudge them according to stereotypes or moral values. Some examples are:
 
Private influencers 
 

bulletsex workers' families
bulletlovers (of women and men)
bulletother "street people", including people with whom sex workers share accommodation, drug dealers, performers, members of sexual subcultures, friends, neighbours etc.


Business influencers 
 

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landlords, bar and cafe managers and others who allow their premises to be used for commercial sex

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managers of brothels, bars, escort agencies and other formal sex businesses where sex workers work

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taxi drivers, nightclub staff, advertisers and others who are paid to facilitate meetings between clients and sex workers.


Professional influencers 
 

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police and other law enforcement agencies 

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doctors, health and social workers, counsellors, outreach workers

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politicians and other policy makers.

 

"We used a number of methods to evaluate our project:

Formative evaluation 
At the beginning of the project we used focus groups, individual interviews and observation to learn more about the commercial sex workers in Calabar and design the specifics of our intervention.

Process evaluation 
Project records provided us with information about educational sessions in the hotels and clinic, chairladies and proprietor's meetings held, condoms given away free and sold and clinic attendance.

Outcome evaluation 
At the beginning of the project we used a questionnaire to collect data on STDs/AIDS knowledge, sexual practices and condom use.

We used serology (blood tests) to determine the prevalence of HIV and other STDs and noted changes over time. Registration and attendance at the clinic provided us with a means to measure awareness of the existence of the clinic and understanding of the need to treat STDs and other ailments at the clinic. For example, at the start of the project 60 per cent of the women took antibiotics as a prophylaxis for STDs. Now, most of them rely on the clinic to treat their health problems.

Qualitative information collected through observation and focus group discussion demonstrated the enthusiasm of the target population for the programme. Feedback from the larger community, observations pertaining to the behaviour and response of the target group to the programme and overt official support and recognition of the programme represent significant ways of evaluating programme acceptability and effectiveness."


The evaluation framework of a project in Calabar. Nigeria.



    

 

 

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  Chapter 7: Making projects successful

 


This poster was developed by project staff 
working  in bars and hotels in Calabar, Nigeria

  
Wider community 
 

bullet

religious or cultural leaders 

bullet

local community groups.


What are the sexual health needs?
 

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What is the relative importance of different STD and HIV transmission routes, such as male-to-male sexual contact, male-to-female sexual contact, mother to child or drug injecting using shared needles or syringes?

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What is known about patterns of HIV and STD infection among female and male sex workers, and among other groups (e. g. truck drivers and transport workers, military men, drug injectors, and those attending STD clinics and antenatal clinics)?

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What information is available about STDs, reproductive health and HIV for different population groups?


What sexual services are practised? 
 

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What kinds of sex are practised by sex workers and their clients, whether women, men or transgender people?

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Do sex practices vary according to type of contact or transaction site (e. g. between bar, brothel and street based sex work) and/or geographical region (different parts of a city or country)? 

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Do sex practices (and safe sex) vary with different types of clients and partners?

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How much does the process vary between different services? 

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Are people familiar with condoms?

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What are people's attitudes to condom use? 

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Where are condoms available and at what cost (and how does the cost of condoms compare with the cost of sex)?

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Are lubricants available and are they used?

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In which situations are condoms more or less likely to be used and why?

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Are other contraceptives used?

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What, if any, myths or misinformation exist?


How is sex work organised? 

Arrangement 
 

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contact sites (e. g. bars, clubs, brothels, neighbourhoods. hotels, street, through newspaper advertisements)

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transaction sites (e. g. brothels, hotels, rooms near bars, sex workers' apartments/private rooms, car parks)

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level of control by influencers

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sex workers' freedom of movement

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existing community organisations (e. g. formal or informal networks of sex workers, sex workers' or gay organisations) and any services they provide (e. g. child care, legal assistance, support groups, credit union)?



    

 

 

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  Chapter 7: Making projects successful

 

Location 
 

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Where does sex work occur? 

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Where are those who influence the sex industry located? 

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Where do most clients come from? 

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Where are law enforcement agencies located (e. g. police)? 

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Where are condom distribution points, and health and welfare services?


Working conditions 
 

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What is the balance of power between sex workers and clients and between sex workers and business owners and managers?

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Does the balance of power vary according to contact/transaction site, age of sex workers, economic level of the establishment and/or the client?

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To what extent can sex workers choose or turn down clients who are abusive, drunk, or refuse to use condoms?

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Is there access to running water, clean linen, and adequate safe sex supplies (condoms, lubricant)?

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Can sex workers communicate freely with each other?

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What other health and safety issues affect sex workers. e. g. compulsory alcohol consumption, incidence of hepatitis, tuberculosis or dermatological conditions or violence?


What STD services are used? 
 

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What STD services are available?

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Are services good quality? 

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Are services welcoming to female/male/transgender sex workers? Have staff been appropriately trained to deal with marginalised people?

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What symptoms do sex workers recognise as suggesting an STD?

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What level of pain or discomfort is considered normal (e. g. itching, abdominal pain, backache)?

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Do sex workers examine clients for signs of infection (e. g. penile discharge, lesions, warts)?

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Do sex workers use any medications other than those prescribed by doctors?

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What do sex workers do if they feel ill or uncomfortable? Who or where do they go first for advice (e.g. clinic or private doctor, family member, friend, business associate or manager, traditional healer, informal drug vendor, pharmacy)?

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Are there specialised STD or AIDS clinics or are STD services provided in other settings such as hospitals or family planning clinics?

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Are services available at a convenient time and place? 

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Do people feel stigmatised by using services? 

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Does the cost of services affect whether people use them?



    

 

 

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  Chapter 7: Making projects successful

 

“ln order to improve an existing service, a project explored the values and aspirations of female sex workers in different sectors of the sex industry in Rio de Janeiro. The project chose five areas, representing different types of formal and informal sex work, and conducted focus group discussions with psychologists facilitating and taking notes. The discussions covered safer sex practices, violence, drug use, family relations and civil rights and other topics introduced by the sex workers. The discussions revealed very different attitudes between the groups and highlighted the need for varied interventions and activities.” 
Programa Integrado Marginalidade, Brazil

  
Do services and projects already exist? 
 

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What relevant health promotion or social welfare programmes already exist, either at local or national level, such as targeted education (e. g. to men who have sex with men), condom promotion or self-help groups?

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Are there already any sex work projects, either specifically for sex workers or including significant numbers of sex workers as part of a larger target group, for example health projects or charitable work?

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What activities are these projects promoting? 

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What problems or constraints have been identified and how have they been resolved (e. g. police confiscating condoms, high rates of migration among sex workers and/or clients, unwillingness of sex workers to participate, high rates of condom breakage, unreliable distribution of condoms or other necessary materials)?


What policies do services have?
 

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Are sex workers required to undergo regular examinations for HIV or other STDs? If so, how often and in what circumstances?

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What are the consequences (legal, job-related) of having (or not having) HIV and STD tests?

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What are the consequences (legal, job-related) of testing positive for HIV or another STD?

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Do the same regulations apply to both women and men who sell sexual services?

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How do sex workers and clinical staff feel about local STD policy?

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Do services already incorporate health education?


What is the legal context? 
 

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What laws affect the sex industry, either directly or indirectly? (See Chapter 2.)

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Do the same laws and regulations apply to women, men and transgender people? If not, what are the differences?

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Are sex work businesses and activities, such as brothels, known street areas, massage parlours and commercial sex bars and clubs, legal or illegal? If they are illegal, how do they operate - through tolerance, corruption, weak laws or inadequate resources to enforce the law?

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What penalties exist (e. g. fines, jail, deportation) and against whom are they used?

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Do sex workers avoid STD services because they are associated with police or other authorities?

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Are laws against rape and physical assault enforced when sex workers are the victims?

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How do police and other law enforcement agencies respond when sex workers report crimes in which they are the victims?



    

 

 

Making Sex Work Safe    80  Page 81  82  top of page

  Chapter 7: Making projects successful

7.2 Assessment techniques

Focus groups can be an ideal way to gather information upon which to base plants to diversify or refine a service.

Focus groups can be an ideal way to gather information upon which to base plants to diversify or refine a service.

  
Gathering existing information 
Information about sex work and the HIV/STD situation, and the social, economic, cultural, religious and legal contexts in which sex work occurs, may be collected from:
 

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articles about the sex industry in local newspapers and magazines 

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novels and short stories by local writers that contain sex workers as characters and which describe the context and/or practices of commercial sex

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memoirs and other first person accounts by sex workers and/or clients

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epidemiological and sociological studies, information about relevant behaviours and practices (e.g. in HIV/STDs, gender and sexuality) 

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international publications and resource centres listed at the end of this book.


Collecting new information 
The first section in this chapter suggested key questions which might be used to investigate the local sex industry. Informal methods of gathering information about stigmatised and intimate behaviours, such as observation and key informant interviews, (with those who are knowledgeable "insiders") are usually more effective than formal surveys. It is extremely useful to train sex workers themselves as interviewers and observers. 

Mapping 
It can be very helpful to produce a "map" of the local sex industry. based on existing maps of the area in which work is being planned. to identify the key issues for the project to address.

Sex workers often know a great deal about sex work in the area and can be important sources of information for mapping. A map could show:
 

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where sex workers and clients meet each other

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where sex workers and clients have sex 

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where agencies that provide services to sex workers, clients are located

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where important events such as police activity and festivals take place (and when)

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location of condom distribution points, health and welfare services.


As with any documentation of commercial sexual activities it is essential to prevent any misuse of such a map. The map should be treated as confidential.



    

 

 

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  Chapter 7: Making projects successful

 

Estimating population size 
It is useful to have some idea, however approximate, of the size of the target group. This helps in identifying activities and locations for your work and in setting targets. Preliminary estimates are often too low, as they are likely to be based on the more visible forms and locations of the sex industry, and may not take into account either the amount of clandestine sex work (e. g. male or transgender sex workers) or the impact of migration. However, estimates can be revised as the project develops. 

In any country, there are usually both female and male sex workers. In some countries, there are also transgender sex workers. There are usually more female than male, but very rarely are there no male sex workers. Male and transgender sex workers tend to work in the same way as females but in different locations. Adult and adolescent sex workers may be working separately and have different needs (young people are more likely to provide sexual services informally or occasionally - street youth may trade sex for food or a place to sleep, for example).

Counting sex workers and clients is an important feature of needs assessment, although the result is unlikely to be exact and does not need to be. Some forms of sex work are easily observable while others are not. To estimate the size of a commercial sex market which includes closed clubs, bars and private homes, researchers must have access to basic information which can only be provided by "insiders". There is a case for beginning pilot services while gathering information on which to base a long-term strategy.

Estimating the number of clients can be dealt with similarly. A survey of sex workers and interviews with a random sample of each category of sex worker could help determine how many clients there are on a typical night, types of clients and how many visits clients make per week or per month.

Surveys and interviews with sex workers could also show how many clients are casual (new to them), how many are seen regularly. how many are frequent clients (even if new to them personally) and how many are rare clients. Again, this approach might be more successful once some level of service has been started and contact with sex workers established.

7.3 Project planning and design

Making sense of the problems 
Every project needs a clear vision of how to solve the main problems identified in the needs assessment. It can be useful to write each problem on a card. Take each card and ask, "What causes this problem?" Write the answer on a second card, and place it underneath the first. Go through the problems in this way until they have each been linked to a cause.

 
 

Consultants from donor and technical support agencies can participate in projecting planning and developing evaluation systems rather than imposing their systems and methods



    

 

 

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Turning problems into objectives 
The next step is to imagine an ideal situation which would solve all the problems you have identified.

Summarise this situation. For example. "Sex workers and others are able to work in safe, health promoting conditions." This becomes the overall goal or aim of your project. However, your project probably won't achieve this alone, so it is important to state clearly how your project will contribute to this overall goal. The steps towards achieving your goal are your objectives.

For example, your needs assessment might identify a pressing need to provide sexual health services for sex workers. Objectives need to be specific, measurable, achievable, relevant and time-limited (SMART). The objective to provide health services would state how many clinics would provide what services to what standard, how many peer educators or outreach workers would promote the service and the number of workshops or training sessions that would be held - all within a specified time period.

Activities 
To achieve each objective requires about three or four key activities. These state what the project staff will actually do. Each activity needs to have a defined set of targets or results such as how many clinics will be established, what equipment secured, what materials purchased or produced, how many staff recruited and trained etc.

Measuring change 
Indicators need to be established for each activity to enable you to see where it is being carried out as planned and helping to achieve the objective. Indicators enable you to see if you are reaching your targets. Indicators are very useful for assessing the performance of the project and are essential in monitoring and evaluation (see next section).

Indicators should be worded in terms of quantity (numbers of people, infections, services, materials etc.), quality (to what standard) and time (by what date). Consider how this information will be collected and documented and ensure that project staff have the skills and resources to do this.

Identifying assumptions 
It is important to identify any assumptions that you are making. For example, you may be assuming that the level of police activity remains low, but what would happen to your project if it suddenly increased? If this is a real possibility you may need to include a relevant activity.

 
 



“When I first went to those meetings people might as well have been talking Chinese. I was terrified that they were going to ask me for an opinion and I would be exposed. I thought: “God what am I doing here? Now I know that when they say ‘monitoring and evaluation’ they just mean keeping track of what you are doing and making sure it’s working. Now I manage the project, do all the statistics and write the reports.” 
Project manager, Britain

 

7.4 Monitoring and evaluation

Is the project working? 
There are many reasons to monitor and evaluate projects. Monitoring and evaluation takes place throughout the project and enables regular reports to be produced. Special purpose evaluations, or reviews. take place less regularly. Some are conducted internally and some involve external evaluators. Evaluation methods vary considerably and can include complex scientific measures as well as simple information gathering and analysis.

Monitoring and evaluation aim to answer key questions about two aspects of the project - the process and the impact. Key questions are:
 

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Are project activities being carried out as planned? How could they be improved?

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Is the project achieving what it set out to do, and making a real and positive difference in people's lives? How could this be strengthened further?



    

 

 

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  Chapter 7: Making projects successful

 

7.4  Monitoring and evaluation 
Evaluation is an integral part of a project. The evaluation process needs to be developed before a project is implemented so that activities can be monitored throughout the period. It is a mistake to conduct a project and "do the evaluation" later.

Sometimes evaluation is seen by project staff as a burdensome, intrusive or even threatening task. This is particularly so if the evaluation is seen as serving external needs. Evaluation developed with the participation of staff, volunteers and service users and seen by them to respond to their needs, is likely to be more effective and less difficult to implement.

Health professionals and policy makers recognise that health education, especially HIV prevention, can be hard to evaluate. The impact of the project can be difficult to measure in isolation from other factors. For example, it is difficult to know if condom use has increased as a result of a targeted intervention directed at sex workers, or as part of a general education campaign which has reached both sex workers and clients. Likewise, it is difficult to measure the extent to which peer education has reached those who would not otherwise have had access to health information.

Evaluation of a state-enforced policy of condom use in brothels (in Thailand) revealed a great success. Condom use had risen at a satisfactory rate. However, the evaluation also revealed the worrying information that the STD rate had not declined as expected. Programme planners needed to discover why this was so and refine future work accordingly.

Evaluation should: 
 

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show whether the projects' objectives are being achieved, or what progress is being made, and whether any changes are needed

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show whether resources are being used in the most effective way and how they could be better used

bullet

involve a broad range of stakeholders to provide a picture of the project from their various perspectives. This is sometimes called "participatory evaluation",


 

In Ecuador a primary health care clinic was planned to be located in a brothel complex. A needs assessment found that sex workers wanted health care for their children as well as themselves and that they would not take their children to the brothel area. An alternative site for the clinic was found in a nearby market.

  

Monitoring 
Monitoring means regularly gathering information about the project's activities from the start to find out whether work is being carried out as planned and whether there are any reasons to change the goal. objectives or activities. Information can be collected from, for example, service users, clients, health care workers and other participants. Monitoring looks at the "reach" of the project (what percentage of its potential target group it is reaching) and includes quantitative information, such as the number of new contacts made, the number of condoms distributed or requested, and number of clinic visits or referrals made.

It is important that monitoring is an integrated, ongoing activity. Minutes of meetings, staff journals, newsletters and field notes should be routinely collected for analysis. Recording systems, such as forms and checklists, should be clear and well designed, and staff should be trained in their use.



    

 

 

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Near Jaipur in Northern India sex workers pointed out during a needs assessment that their basic needs such as safe drinking water, general health care and education of their children were not being met and these were their first priority.


Near Jaipur in Northern India sex workers pointed out during a needs assessment that their basic needs such as safe drinking water, general health care and education of their children were not being met and these were their first priority. Some reacted to the question of AIDS with: "We are already dying for want of safe drinking water. What difference will it make if we die of AIDS?"

In response, three pilot developmental activities were carried out: a bore well for safe drinking water; monthly clinics; and primary education for the children. These activities served as a bridge between the project, Gram Bharati Samiti (GBS) and the target community. GBS report that the activities created a good feeling among the sex workers about GBS and "a good image for the project among the villagers. With these critical needs addressed, the sex workers were more able to consider STDs and how to protect themselves."


Start at the beginning 
Effective monitoring and evaluation begins by setting measurable objectives at the outset. Progress can be monitored by asking questions. 

The measures used for monitoring progress are called indicators and these help to keep track of what the project is doing (and not doing) and where it is going.

Smaller questions can indicate the answers to the bigger ones. A common big question, is: "Has the project reduced the transmission of HIV and STDs to and from sex workers?"

It is usually neither possible nor appropriate to answer this by asking how many sex workers have AN or an STD, partly because baseline data does not exist. However, using smaller questions provides indicators which can help to answer the big question.

For example: 
 

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Have more of the sexual contacts been protected as a result of the project?

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Have there been any changes in frequency of minor STDs or unplanned pregnancies? Have requests for condoms and lubricants increased?

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Have sex workers changed their patterns of seeking health services for the better?

bullet

Have visits to an STD clinic or private doctors increased? 

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Has the project received an increase in requests for referral to doctors and clinics?

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Have any of the barriers identified in the situation assessment been addressed e. g. has training been provided for local service providers? 

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Has the project reached enough workers?

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How many sex workers are in the target group? (This may have been reviewed since a previous needs assessment.)

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What percentage of the target group has been reached? 

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What are the characteristics of those who have not been contacted? (Perhaps they are at great risk or perhaps they are working safely and do not need advice, support or assisted access to condoms.)


Types of evaluation 

Process evaluation 
Process evaluation focuses on how the project is implemented. It considers aspects such as: 
 

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number of training sessions/publications/events completed

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number of STD examinations performed or referrals to other services

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number of sex workers, clients and influencers contacted 

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number of "one off" contacts compared with the number of repeat contacts

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average amount of time spent with members of the target audience

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percentage of meetings. events and tasks in which sex workers have participated.



    

 

 

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Impact evaluation 
Impact evaluation considers measurable changes over time, for example, beliefs and attitudes, behaviour, practices, and policies. These changes need to be related to the activities of the project and not to another intervention or influence.

Impact evaluation requires the collection of appropriate baseline data relatively early in the project and follow-up data at regular intervals (e. g. every six to 12 months).

Measurable changes might include: 
 

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increased knowledge about sexual health

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more positive attitudes towards sex workers in local services, the press, among police etc.

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increased skill in negotiating safe sex or using condoms

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increased frequency of safe sex (both intercourse with condoms and non-penetrative sex)

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more sex work business managers supporting routine condom use and/or non-penetrative sex

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involvement of sex workers in the programme

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higher percentage of contacts with the project which are initiated by members of the target group.

 


It is important to measure subtle changes 
such as improvements in police attitudes.

 

Distribution of promotional materials such as badges, matches, condom packs and nail files is effective and easily measured.
 

Distribution of promotional materials such as badges, matches, condom packs and nail files is effective and easily measured. Distribution of promotional materials such as badges, matches, condom packs and nail files is effective and easily measured.

Distribution of promotional materials such as badges, 
matches, condom packs and nail files is effective and easily measured.


Qualitative evaluation 
Qualitative evaluation complements quantative information to provide a fuller picture of a project. Qualitative information can be gathered from sources including focus group discussions, diaries, suggestion, complaint books, individual interviews, and records of events, such as stories, pictures and simple questionnaires which allow people to express their views.

Information about improvements in the quality of life of those who use a service can be used in training or written reports to funders and can be shared among staff and service users. Qualitative information is not necessarily converted to statistics but may be presented as summarised text or individual anecdotes.

Refining the project 
Evaluation may identify gaps and problems, and highlight opportunities to address these. For example, an evaluation might show a series of positive results about safe sex in the workplace but no corresponding decline in STD rates. Strategies to address safe sex behaviour with private partners needs to be increased.



    

 

 

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  Chapter 7: Making projects successful

 

Evaluation is often an ongoing process and strategies may need to be changed as information emerges.

Expansion 
Once a project is working reasonably smoothly and effectively, its scope can be expanded. It can expand its target audiences (e. g. to include clients or influencers), its location or geographical reach, or it can introduce more ambitious work.

Expansion should not happen too rapidly or too early because it can stretch resources or take away the original focus.

Replication 
The experiences gained by established projects should be shared with others involved in similar areas of work. For example: 
 

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Project staff, especially sex workers, can train staff in new projects. Basic training skills are required for this.

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Exchange visits and study tours can be arranged. 

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Letters, newsletters and educational materials can be exchanged with other projects. The Internet includes websites and discussion groups for projects to share information. The Network of Sex Work Projects, regional networks of sex work projects and the International Council of AIDS Service Organisations may be able to put projects in touch with each other.

7.5 Project planning: an exercise

On the next page is an example of a needs assessment report. You can use this for an exercise in designing a project.

Guidelines on the exercise 
This exercise will be more useful and enjoyable if carried out in a small group. First, hand out copies of the needs assessment and ask everyone to read it.
 

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Ask people to identify the potential beneficiaries and key stakeholders.

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Ask people to consider how contact could be made with the potential beneficiaries. Ask them to identify issues to be explored with them, and how to do this.

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Ask people to identify specific problems highlighted by the needs assessment. As they do so, write down each problem on a separate card or piece of paper.

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Place all the cards face up on the floor or stick them on a board. 

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Ask people to link the problems in terms of cause and effect, so that cards finish up with the effects at the top and the underlying causes at the bottom.

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Take the effects and turn them from negatives into positive statements (goals or objectives).

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Do the same with the causes and turn them into activities. 

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Consider what might be the main concerns of each group of stakeholders in relation to a project for sex workers (and others).



    

 

 

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  Chapter 7: Making projects successful

 

Needs assessment report 

LOCATION: Coastal city at one end of a major truck route that goes through three other major cities (and many towns) within the country to the capital of a neighbouring country.

POPULATION: 500,000, of which: men 300,000; women  80,000; children 120,000.

HIV/STD: Prevalence of HIV and STDs thought to be low among the population overall. However, surveys among sex workers and men who have sex with men reveal very high levels of STDs, with a growing problem of HIV.

MAJOR EMPLOYERS: Trucking company employs 1,350 long-distance drivers; military camp with 50,000 men; shipping company with 2,035 male employees; several factories with around 1,000 male employees each; two factories (a textile factory and a cigarette factory) together employing 1,500 women. Large informal employment sector, including street vendors and small business owners (e. g. kiosks, small hotels and boarding houses, unlicensed drinking establishments). Other economic activities: major daily market in the centre of the city used by farmers and other traders. Wednesday is the biggest market day, attracting people from a wide area. 

HOUSING: Most workers are migrants from other parts of the country, or neighbouring countries. Transport workers include men from other countries that the truck route passes through. Few workers in the formal sector live with their families; most live in company dormitories or small hotels that are clustered into three districts in the city.

ORGANISATION OF SEX WORK: 

Female sex workers: About 12,000 women work in bars, both licensed and unlicensed (3-15 per establishment), serving drinks and also, on a more or less regular basis, engaging in sex with male bar attenders in exchange for money (tips). Another 3,500-4,000 live in small apartments or single rooms, sometimes two women sharing, and earn their living through the provision of sexual services. Some of the women who work in the cigarette and textile factories sometimes trade sex for money, contacting clients on the street, near small hotels that rent rooms for short periods of time, or in the harbour area, or in nearby bars. A few women provide services to tourists, contacting clients in tourist hotel bars.

Male sex workers: Approximately 1,500 young men provide sexual services to men, most of whom contact clients in the harbour area or on the beach, and a few of whom contact clients in one of the bars near a five star hotel.

Management: Women who work in the bars are generally controlled by the bar owners, many of whom are women who are former sex workers, although a few are men. The bar owners are worried that all the talk about AIDS will hurt their business. Many are wary of having any health education, materials or condoms on the premises for fear of discouraging customers. In addition, they are afraid that if they had stocks of condoms, the police might use that fact as an excuse to raid the bar.

Contact/transaction site: Most bars have small rooms in the back where the bar workers can take clients for quickie sex. Women also take clients out to their own rooms, often In the same area, for "all-night" transactions.

Turnover: There is an estimated 50 per cent turnover in the sex worker population per year (i.e. 50 per cent of the women leave the area and/or stop doing sex work, to be replaced by a similar number of newcomers or returning migrants). There is also a significant amount of movement within the city, from one establishment to another, and also from one category or level of sex work to another.

Professional career: A few sex workers manage to save up enough money to buy a bar, becoming bar owners who then hire other women to work in their bars.

Legal status: Prostitution is illegal, but the police rarely arrest anyone. Very occasionally, usually before or during a big tourist convention, or just before a big military ship is expected, police round up a lot of women and put them in camps on the edge of town.

STD services: The family planning clinic is willing to provide STD services, but tends to be disapproving of prostitution, so few sex workers go there. The primary health care clinic has hours specifically set aside for STD services, usually in the morning before the factories are open. However, few women go there, partly because of the hours (when they are generally asleep), but also because they don't feel welcome. Running water and electricity are often cut off, making it difficult for health care providers to sterilise syringes, speculums and other medical instruments. Diagnoses are therefore often made on the basis of symptoms. Many women treat themselves with antibiotics, bought from traditional healers and street vendors.

Condom availability: Some condoms are available from pharmacies, but are expensive. Family planning clinics distribute condoms, but are usually unwilling to give them to single women. They will only give married women 10-12 condoms per month, which is not enough for sex workers. In addition, the breakage rate for condoms distributed by the family planning clinics is fairly high, leading to a high distrust of condoms. No water-based lubricants are available, which may be one reason for the high breakage rate.

 

 

 
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