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Zoyla Segura Anna Gorter Esteban Zuniga Roger Torrentes ICAS-Nicaragua Financed by NOVIB

Zoyla Segura Anna Gorter Esteban Zuniga Roger Torrentes ICAS-Nicaragua Financed by NOVIB. A voucher scheme to reach young sex workers (including young glue-sniffing girls), to treat STI’s and to prevent HIV transmission. NICARAGUA. First AIDS case reported: 1987

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Zoyla Segura Anna Gorter Esteban Zuniga Roger Torrentes ICAS-Nicaragua Financed by NOVIB

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  1. Zoyla Segura Anna Gorter Esteban Zuniga Roger Torrentes ICAS-Nicaragua Financed by NOVIB A voucher scheme to reach young sex workers (including young glue-sniffing girls), to treat STI’s and to prevent HIV transmission

  2. NICARAGUA • First AIDS case reported: 1987 • AIDS cases reported: 392 • Prevalence HIV adults: 0.2% • Prevalence sex workers Managua: 1991 0.8% 1997 1.3% 1999 2.0% • Highest among young sex workers

  3. What is a Voucher Program • A program in which health service providers are reimbursed for the number of patients attended • Services best performing are selected • Provision of services can be targeted to special (vulnerable) populations ( • It puts the patient central and gives the power of choice to the consumer

  4. A document which can be exchanged for defined goods or medical services as a token of payment OR “Tied cash As opposed to liquid cash” What is a voucher Example of voucher

  5. The Voucher Program in Managua • Started in 1995 • The vulnerable groups it reaches are: • Female sex workers, including glue-sniffing girls • Glue-sniffing boys • Transvestite sex workers • Clients/partners of these groups (since 1999) • Men who have sex with men (since 2001) • Prevention and treatment of STIs • Prevention development AIDS epidemic

  6. NGO's V O U C H E R V O U C H E R V O U C H E R Voucher V Agency O U C H E R V O U C H V E O R U C H E R Donor/ Government Vulnerable groups Clinics V O U C H E R V Clients & O U C H Partners E R

  7. Methods • City-wide map of sites with prostitution • Interviews with vulnerable groups • Competitive tender/contracting of clinics • Training of all staff in clinics • Voucher distribution biannually (rounds) • Medical attention with “best practice” treatment protocols • Monitoring quality clinics, only best clinics contracted for subsequent rounds

  8. Services Offered • Consultation and follow-up • Tests for syphilis, trichomonas,candida, gardnerella and cervical cancer • Physical examination of condilomata, herpes, chancroid and other STIs • Counseling safe sex, condoms • Single dose of Azithromycine • Additional treatment if necessary • Voluntary counseling and HIV testing Gonorrhoea testing was performed during the first 4 years to measure impact of the program

  9. Prostitution in Managua(1,300,000 inhabitants) • 50-60 sites with prostitution • 1,150 female sex workers • 24% younger than 20 years • of the young SW ¼ is addicted to glue • Turnover sex workers is high with a medium working time of: • Overall 2 years (range 1 week-30 years) • Adult women 3 years • Young sex workers 1 year

  10. Overall results • Between 8 to 10 clinics are contracted (public, private and NGO clinics) • In 7 years (13 rounds ) • > 20,000 vouchers distributed • > 7,000 medical consultations • > 3,000 STI’s detected and treated • Of vouchers distributed to sex workers 40% is used • 2,840 different sex workers attended (690 younger than 20)

  11. Young and glue-sniffing sex workers Young SW’s in nightclub Glue-sniffing SW’s market

  12. Young SW’s have more STIs then adult SW’s

  13. Prevalence in young sex workers decreased

  14. Prevalence in gluesniffers decreased

  15. Conclusions • Young SW, including glue-sniffers can be reached effectively • Girls most in need make more use of their voucher • STI rates reduced considerably • Voucher schemes should be considered as highly effective in attracting young SW’s with high levels of STIs, treat their STI’s and promote safer sexual behavior

  16. More information: www.icas.net bonos@ibw.com.ni agorter@ibw.com.ni

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