Combating Sexual and Gender-Based Violence Against Female Sex Workers in Sub-Saharan Africa

Over its 13-year trajectory, North Star has built and leveraged coalitions of community actors to engage them in efforts to strengthen the provision of comprehensive sexual and reproductive health (SRH) services for FSWs. In 2016, North Star developed a unique and practical multi-sectoral approach to combat violence against FSWs, by setting up Crisis Response Teams (CRTs). These teams include FSWs themselves, along with representatives of local organizations whose roles in the community are relevant to the challenges faced by FSWs but have previously gone untapped – for example, health and social welfare officials, members of rights groups, police, pastors, border control officials, and other influential community members. In addition to their ongoing support, CRTs are called into action when an FSW faces an incident such as physical assault, threatening verbal attack, rape, family bereavement or arrest. North Star’s CRT model provides essential health services for marginalized (and often criminalized) at-risk, underserved segments of the population through a peer-to-peer model. The innovation employs a unique and proprietary EMR platform to follow and manage data for a highly mobile and historically hard-to-track population. The CRT model leverages North Star’s existing network of Roadside Wellness Centres (RWCs), now located along busy transit corridors in twenty countries across sub-Saharan Africa. These North Star “Blue Boxes” – repurposed shipping containers painted blue and equipped as clinics – can be found at border posts, ports, transport company parking lots and other “hotspots” where truckers frequently stop and sex work is common. North Star’s Blue Box clinics offer a standardized package of health and related services tailored to truckers, FSWs, and the communities they interact with. This includes HIV testing, treatment, care, and support; STI testing and treatment; family planning and contraceptives; primary healthcare services; and referrals for more complex care needs (e.g., safe abortion services).TTS2 funding will support the validation of the two most promising of the eight models - a fee for service model, and a model that leverages National Health Insurance Funds (NHIFs) (discussed further in subsequent section) - at four clinic sites (Mlolongo and Salgaa, Kenya; Tunduma, Tanzania; and Cato Ridge, South Africa). These models were assessed on their alignment with North Star’s mission, revenue potential, implementation timeframe, alignment with team’s capacity, and ability to scale. Through TTS2 funding, North Star aims to provide 10,000 FSWs with SRH services by scaling to eight Blue Box clinics and training 24 peer educators in Kenya, Uganda, Tanzania, South Africa, and Zimbabwe. North Star expects this to result in 300 HIV-positive FSWs being initiated on ART, with a 95% retention rate. If successful in achieving TTS2 milestones, potential follow-on TTS3 funding (contingent upon IP4MNCH no-cost extension or renewal) is projected to increase these figures to 20,000 FSWs with SRH services by scaling to 19 Blue Box clinics; training of 57 peer educators; 1,500 HIV-positive FSWs being initiated on ART; and 30% of HIV-negative FSWs initiating PrEP. Supplemental COVID-19 funding is supporting North Star to equip Blue Box health workers with the capacity to screen high-risk travelers for COVID-19 and minimize transmission among clientele. This includes enhancing prevention and control through the procurement of emergency supplies and delivery of COVID-19 health education, including education by peer educators via the CRT model.