Of all the high-risk groups, sex workers are a particularly mobile sub-population with the potential to impact HIV transmission rates within and beyond the Caribbean region.  From Spanish-speaking female migrant sex workers in the Eastern Caribbean, to local commercial sex workers in Haiti, to the over 100,000 Dominican female sex workers that live in the DR and migrate throughout the region, sex workers’ unmet HIV education and health service needs vary. Through targeted outreach campaigns and in-depth research CARISMA has found that there is no one size fits all HIV-prevention strategy.  While the key to reducing HIV transmission rates among sex workers is to increase consistent condom use and access, the methods used to achieve these goals must be culturally sensitive and locally anchored.

To this end, CARISMA partners employ a wide range of behaviour change communication (BCC) materials, one-on-one counsellors, and local (often ex-sex worker) peer educators to reach these target populations. In addition to awareness-raising mobile 'edutainment' condom-selling units, radio spots and street theatre, CARISMA partners have piloted the expansion of condom sales into non-traditional 'hot spot' outlets such as beauty salons, rum shops and discotheques.  Participatory Ethnographic Evaluation and Research (PEER) in Haiti has been used to inform the design of social marketing strategies. Through PEER, PSI Haiti has reached a deeper understanding of the barriers to consistent condom use among sex workers such as the varying degrees of trust in sexual partnerships, differentiation in brothel status, and the motivations that underlie positive health behaviours.

The results of CARISMA’s sex worker initiative have been overwhelmingly positive. In the Dominican Republic, PSI/DR found that consistent condom use among sex workers increased by nearly 30% in just two years (from 58% in 2006 to 84% in 2008). Furthermore, their studies show that as a result of condom outlet expansion, 72% of sex workers now have access to condoms within 100 metres of their established work sites. Similarly, PSI/Haiti recorded an increase in sex worker condom use from 83% to 98% between 2006 and 2008. Finally, in the Eastern Caribbean, PSI/EC reached over 5,200 Spanish-speaking migrant sex workers (surpassing their goal of 4,400) with behaviour change communication and one-on-one counselling activities.

In Phase II of the CARISMA project, partners will build on existing achievements and broaden outreach efforts to include anti-stigma and anti-discrimination campaigns. In addition, participating country programmes will be expanding the testing and treatment of sexually transmitted infections for sex workers.