• Utilize sex working peers in outreach activities, support groups, “ladies nights” and/or other SAP activities. Encourage sex workers to talk with, learn from and support one another. • Discuss the negative impact of sex workers undercutting each others’ prices as a means of discouraging this behavior and promoting supportive relationships. • When possible, offer the use of a mirror, toilet, shower, telephone and washer and dryer. • Support participants to report rapes, assaults and other violence, providing escorts to medical services and police when possible and appropriate. • Understand local laws pertaining to sex work and prostitution. • Support participants in reporting abusive law enforcement. • Collect street sex work-appropriate clothing donations as well as umbrellas. • When possible, provide foods that are rich in vitamin C (such as tomato soup, citrus and cranberry juices) to prevent bladder infections, bleeding gums and easy bruising. • If possible, provide workshops and training to help sex workers develop good street skills and self-defense as well as relaxation, meditation and creative visualization. • Support sex workers interested in leaving the sex industry, as well as those who wish to continue to work in it.
T r a n s g e n d e r Perso n s Transgender persons – including all individuals who in one way or another do not conform to traditional gender norms associated with their biological sex – are especially vulnerable to harassment, stigma and discrimination at all levels of social engagement. Transgender people are commonly rejected by their families and are routinely denied employment and other opportunities for social resources. This marginalization, along with high incidence of violence toward transgender persons, has serious impacts on mental health, self esteem and stability, often leading to increased rates of poverty, drug use, illicit hormone injection, sex work and HIV. Discrimination against transgender people extends to traditional social and healthcare services. As a result of repeated insensitivity, transgender people may be reluctant to access these services. SAPs must work to ensure that transgender participants feel safe to access services without fear and with the knowledge that they will be respected and that their needs will be understood by all staff. Training is required to ensure that staff are educated about the diverse experiences of the transgender communities, including the complex intersection of issues on the biological, psychological and social levels. Staff must respect the personal choices of all participants; however privacy and sensitivity may be especially important when working with transgender participants. Transgender persons are often at higher risk for HIV and HCV transmission on multiple levels. Hormone replacement therapy (HRT) requires routine injections of estrogen or testosterone administered intramuscularly, and can be very costly and is rarely covered by public insurance. This has led to an underground market and the common practice of self-administered hormone injection, which can be risky. In addition to complications related to the unknown quality and purity of hormones not directly obtained from a pharmacy, there can also be significant and serious side effects related to HRT that are best managed under professional supervision. SAPs should consider the following measures to assist transgender participants engaging in prescribed or underground self-administered HRT: • Stock 3 cc syringes for intramuscular injection. • Educate participants about safer muscle injection, HCV and HIV prevention and other risks associated with improper injection. • Provide comprehensive information about side effects and potential drug interactions with estrogen-based (for male-to-female transgender (MTF) participants) and testosterone-based (for female-to-male transgender (FTM) participants) HRT. Health effects should be addressed at the physiologic and psychological level. • Work with participants to manage side effects of HRT. • If possible, develop relationships with doctors, physicians’ assistants and nurses willing to assist with Shot -70-
