Implementing for Results : Program Analysis of the HIV/STI Interventions for Sex Workers in Benin

HIV response has entered a new era shaped by evidence that the combination of interventions impacts the trajectory of the epidemic. Even proven interventions, however, can be ineffective if not to scale, appropriately implemented, and with the right combination. Benin is among the pioneering countri...

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Main Authors:	Semini, Iris, Batona, Georges, Lafrance, Christian, Kessou, Léon, Gbedji, Eugène, Anani, Hubert, Alary, Michel
Format:	Journal Article
Language:	en_US
Published:	Taylor and Francis 2013
Subjects:	HIV sex workers program efficiency service delivery
Online Access:	http://hdl.handle.net/10986/15352

id	okr-10986-15352
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spelling	okr-10986-153522021-04-23T14:03:22Z Implementing for Results : Program Analysis of the HIV/STI Interventions for Sex Workers in Benin Semini, Iris Batona, Georges Lafrance, Christian Kessou, Léon Gbedji, Eugène Anani, Hubert Alary, Michel HIV sex workers program efficiency service delivery HIV response has entered a new era shaped by evidence that the combination of interventions impacts the trajectory of the epidemic. Even proven interventions, however, can be ineffective if not to scale, appropriately implemented, and with the right combination. Benin is among the pioneering countries that prioritized HIV prevention for sex workers and clients early on. Effective implementation up to 2006 resulted in consistent condom use among sex workers increasing from 39% to 86.2% and a decline in prevalence of gonorrhea from 5.4% to 1.6%. This study responds to the growing concern that, although proven interventions for female sex workers (FSWs) were expanded in Benin since 2008, indicators of coverage and behaviors are far from satisfactory. The quest to better understand implementation and how to render service delivery efficient and effective resonates with increased emphasis in the international arena on return for investments. Quantitative and qualitative methods were utilized to collect data. The output measured is the number of sex workers seeking Sexually Transmitted Infection (STI) care at user-friendly STI Clinics (SCs). Data were collected for 2010–2011 in nine regions of Benin. While recognizing that commitment to scale up is commendable, the study revealed deficiencies in program design and implementation that undermine outcomes. The selected mix of interventions is not optimal. Allocation of funds is not proportionate to the needs of FSW across regions. Only 5 of 41 SCs were fully functional at time of study. Free distribution of condoms covers only 10% of needs of FSWs. Funding and financing gaps resulted in extended interruptions of services. Successful HIV prevention in Benin will depend on the effective and efficient implementation of well-funded programs in sex work setting. Resources should be aligned to local sex work typology and presence in communities. A national framework defining an appropriate mix of interventions, management structure, referral mechanisms, and operational standards is required to guide rigorous implementation. Health services, in particular functional and user-friendly SCs coupled with mechanisms that link community-based work and health facilities should be strengthened to ensure STI care/anti-retroviral treatment expansion. Without leadership of sex workers, any attempt to end HIV will be unsuccessful. 2013-08-26T20:27:12Z 2013-08-26T20:27:12Z 2013-06-09 Journal Article AIDS Care 0954-0121 DOI:10.1080/09540121.2013.784392 http://hdl.handle.net/10986/15352 en_US CC BY-NC-ND 3.0 IGO http://creativecommons.org/licenses/by-nc-nd/3.0/igo/ World Bank Taylor and Francis Publications & Research :: Journal Article Publications & Research Benin
repository_type	Digital Repository
institution_category	Foreign Institution
institution	Digital Repositories
building	World Bank Open Knowledge Repository
collection	World Bank
language	en_US
topic	HIV sex workers program efficiency service delivery
spellingShingle	HIV sex workers program efficiency service delivery Semini, Iris Batona, Georges Lafrance, Christian Kessou, Léon Gbedji, Eugène Anani, Hubert Alary, Michel Implementing for Results : Program Analysis of the HIV/STI Interventions for Sex Workers in Benin
geographic_facet	Benin
description	HIV response has entered a new era shaped by evidence that the combination of interventions impacts the trajectory of the epidemic. Even proven interventions, however, can be ineffective if not to scale, appropriately implemented, and with the right combination. Benin is among the pioneering countries that prioritized HIV prevention for sex workers and clients early on. Effective implementation up to 2006 resulted in consistent condom use among sex workers increasing from 39% to 86.2% and a decline in prevalence of gonorrhea from 5.4% to 1.6%. This study responds to the growing concern that, although proven interventions for female sex workers (FSWs) were expanded in Benin since 2008, indicators of coverage and behaviors are far from satisfactory. The quest to better understand implementation and how to render service delivery efficient and effective resonates with increased emphasis in the international arena on return for investments. Quantitative and qualitative methods were utilized to collect data. The output measured is the number of sex workers seeking Sexually Transmitted Infection (STI) care at user-friendly STI Clinics (SCs). Data were collected for 2010–2011 in nine regions of Benin. While recognizing that commitment to scale up is commendable, the study revealed deficiencies in program design and implementation that undermine outcomes. The selected mix of interventions is not optimal. Allocation of funds is not proportionate to the needs of FSW across regions. Only 5 of 41 SCs were fully functional at time of study. Free distribution of condoms covers only 10% of needs of FSWs. Funding and financing gaps resulted in extended interruptions of services. Successful HIV prevention in Benin will depend on the effective and efficient implementation of well-funded programs in sex work setting. Resources should be aligned to local sex work typology and presence in communities. A national framework defining an appropriate mix of interventions, management structure, referral mechanisms, and operational standards is required to guide rigorous implementation. Health services, in particular functional and user-friendly SCs coupled with mechanisms that link community-based work and health facilities should be strengthened to ensure STI care/anti-retroviral treatment expansion. Without leadership of sex workers, any attempt to end HIV will be unsuccessful.
format	Journal Article
author	Semini, Iris Batona, Georges Lafrance, Christian Kessou, Léon Gbedji, Eugène Anani, Hubert Alary, Michel
author_facet	Semini, Iris Batona, Georges Lafrance, Christian Kessou, Léon Gbedji, Eugène Anani, Hubert Alary, Michel
author_sort	Semini, Iris
title	Implementing for Results : Program Analysis of the HIV/STI Interventions for Sex Workers in Benin
title_short	Implementing for Results : Program Analysis of the HIV/STI Interventions for Sex Workers in Benin
title_full	Implementing for Results : Program Analysis of the HIV/STI Interventions for Sex Workers in Benin
title_fullStr	Implementing for Results : Program Analysis of the HIV/STI Interventions for Sex Workers in Benin
title_full_unstemmed	Implementing for Results : Program Analysis of the HIV/STI Interventions for Sex Workers in Benin
title_sort	implementing for results : program analysis of the hiv/sti interventions for sex workers in benin
publisher	Taylor and Francis
publishDate	2013
url	http://hdl.handle.net/10986/15352
_version_	1764431021292388352

Implementing for Results : Program Analysis of the HIV/STI Interventions for Sex Workers in Benin

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