Sex Worker Implementation Tool (SWIT)

Putting World Health Guidelines Into Practice

A significant part of APNSW’s work in 2017 involves training member organisations in the world health guidelines known as “SWIT” – or, the Sex Worker Implementation Tool.

APNSW holds regional trainings, where members from several countries come together in one place to learn. Then APNSW supports those members  to hold their own trainings on SWIT at national level to share this knowledge with their organisations and community.

This page explains in more detail what “SWIT” is all about.

What are world health guidelines?

The World Health Organisation (WHO) is the specialised agency of the United Nations concerned with international public health. WHO plays a leading role in many areas of health policy, and many countries use WHO guidelines as a reference for developing national health policies.

The WHO constitution states that the organisation’s objective is:

the attainment by all peoples of the highest possible level of health.” (Article 1)

WHO works on all aspects of health and recognises that:

  • Health is a state of complete physical, mental and social well-being, not just the absence of disease or infirmity
  • Health is the fundamental right of every human being, everywhere
  • Health is crucial to peace and security
  • Health depends on the cooperation of all individuals and States

What is the SWIT?

The Sex Worker Implementation Tool (SWIT) is the short name for a book of recommendations, published by the World Health Organisation, about how best to implement HIV and STI programmes with sex workers.

Thumbnail of the front cover of the booklet with short title
The SWIT is sometimes called “the pink book” due to its bright cover.

In 2012, WHO worked together with NSWP, UNFPA and UNAIDS to develop a set of guidelines for the prevention and treatment of HIV and STIs for sex workers in low and middle-income countries. The following year, they published the SWIT guide, which outlines how to put the 2012 Guidelines into practice.

front cover of the "2012 guidelines" - pink colour with logos of WHO, UNFPA, UNAIDS, and NSWP. Full title of the book is "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."
The “2012 Guidelines” – also bright pink! – to be implemented using SWIT.

Scientific evidence that has been formally evaluated, plus the experiences of sex workers, form the basis of the SWIT guide and the 2012 Guidelines

Public health officials, HIV/STI program managers, NGOs, community organisations and health workers are the intended users of the SWIT. International funding agencies, health policy-makers and advocates may also be interested in the SWIT.

The SWIT guide is also very useful to sex workers when advocating for rights-based services.

SWIT is part of a series of guides for key populations. There are also implementation tools for men who have sex with men, and for transgender people.

What does the SWIT guide say?

The SWIT guide states:

All sex workers have a fundamental human right to the highest attainable standard of health. Health-care providers have an obligation to provide services to sex workers, regardless of the legal status of sex work and sex workers.”

Human rights of sex workers are central to the SWIT, including the right to health. Human rights are referred to throughout the guide:

Health workers, programme managers and national leaders should ensure that all sex workers have full, adequate and equal access to HIV prevention methods and commodities, and HIV testing services and HIV treatment, guided by the principle of health for all and human rights.” (Page xiv)

The second principle of the SWIT guide is the importance of sex worker community empowerment and community leadership.

The first three chapters describe approaches and principles to building programmes that are led by the sex worker community. These community-led approaches are themselves essential interventions.”

Community empowerment means sex workers coming together to help each other, and working to address the needs of the community in a supportive environment. It means building partnerships with government, civil society and local allies.

Community empowerment also means sex workers taking a lead in identifying their priority issues, and how to address those issues; and participating meaningfully in all aspects of the design, implementation, management and evaluation of programs that affect sex workers.

In order to achieve community empowerment, sex worker organisations and communities need money and resources provided directly to them.

community-empowerment
Graphic illustrating the different aspects of community empowerment outlined in the SWIT guide.

The SWIT guide is based on a series of recommendations in the 2012 Guidelines. These recommendations are divided into two groups:

  • Good practice recommendations – are principles derived from common sense, ethics and human-rights principles.
  • Evidence-based recommendations – are supported by both scientific evidence and the real-life experience of sex workers around the world.

Good practice recommendations

  1. All countries should work toward decriminalization of sex work, and elimination of the unjust application of non-criminal laws and regulations against sex workers
  2. Government should establish anti-discrimination and other rights-respecting laws to protect against discrimination and violence, and other violations of rights faced by sex workers; in order to realize their human rights and reduce their vulnerability to HIV infection and the impact of AIDS. Anti-discrimination laws and regulations should guarantee sex workers right to social, health and financial services.
  3. Health services should be made available, accessible and acceptable to sex workers based on the principles of avoidance of stigma, non-discrimination and the right to health
  4. Violence against sex workers is a risk factor for HIV and must be prevented and addressed in partnership with sex workers and sex worker-led organizations.

Evidence-based recommendations

  1. Offer a package of interventions to enhance community empowerment among sex workers
  2. Promote correct and consistent condom use among sex workers and their clients
  3. Offer periodic screening for asymptomatic STIs to female sex workers
  4. Offer female sex workers, in settings with high prevalence and limited clinical services, periodic presumptive treatment for asymptomatic STIs
  5. Offer voluntary HIV testing and counselling to sex workers
  6. Use the current WHO recommendations on the use of ART for HIV-positive general populations for sex workers (and refer to the latest ones published in 2013, ie. Begin ART below a CD4 count of 500).
  7. Use the current WHO recommendations on harm reduction for sex workers who inject drugs (in particular needle and syringe programme and opioid substitution therapy).
  8. Include sex workers as targets of catch-up hepatitis B immunization strategies in settings where infant immunization has not reached full coverage

Components of SWIT

The SWIT covers six broad topics that provide guidance on implementing the 2012 Guidelines:

  1. Community Empowerment
  2. Addressing violence against sex workers
  3. Community-led services
  4. Condom and lubricant programming
  5. Clinical and support services
  6. Programme management and organisational capacity-building
Graphic from the SWIT book showing six circles corresponding to steps in effective programming: 1) Community Empowerment 2) Addressing Violence against Sex Workers 3) Community-led services 4) Condom and lubricant programming 5) Clinical and support services 6) Programme and organisational capacity building
The key steps in implementing HIV and STI programs with sex workers.

The SWIT guidelines are relevant globally. They provide a solid human rights and evidence base for developing programs with sex workers everywhere.

Although the focus of the guidance is on low- and middle- income countries, they may be applicable to sex workers in high-income countries as well.” (2012 Guidelines, p12.)

Languages and translations.

Global NSWP has produced a “Smart Guide to SWIT”, which is available in:

APNSW has also arranged for the SWIT smart guide to be translated into:

Translation into Mongolian is planned in 2017.

The full SWIT guide is 196 pages long and is available in: