Sexual health and rights for sex workers - via SMS

The Women’s Health Intervention using SMS for Preventing Pregnancy (WHISPER) project worked with sex workers to develop and test an SMS service that is effective at addressing sex workers’ sexual and reproductive health and rights (SRHR) needs.

The participatory project asked local sex workers in Mombasa, Kenya who were already working as peer educators to join the team that developed the service. This team then worked with other sex workers to test the service.

The SMS service was designed using cognitive behaviour change communication theory and covered SRHR topics selected by the peer educators. The issues covered were contraception; HIV and sexually transmitted infections; dual protection strategies; gender-based violence, stigma and rights; alcohol and drug use, and service information and access.

Three types of messages were designed. The first was informational and motivational messages of less than 160 characters (the standard length of an SMS message), which could be ‘pushed’ (sent) to participants’ phones on a predetermined schedule.

Role model stories, consisting of narratives about female sex workers negotiating sexual and reproductive health risks told over several messages, were also included. The peer educators provided ideas about character names, language and narrative to ensure their relevance.

On-demand messages were the third type of message included in the service. These messages contained more information about contraceptive methods and available health services in the area and could be accessed at any time by replying to messages with specific codes.

Around 40 female sex workers took part in six workshops to test the messages’ content. Sex workers also participated in interviews to assess technical performance.

Workshop participants said the messages were relevant and spoke to their real experiences. This was particularly the case for the role model stories, with which they strongly identified.

Some participants said the messages taught them new information, particularly in relation to contraceptive options and side effects, coils (IUDs), condoms and HIV.

Messages that gave general pregnancy prevention advice and information about IUDs were particularly useful. Messages on rights, violence, and alcohol use were also seen as helpful, especially when violence hotlines were provided and practical tips given to reduce drinking-related harms.

Most workshop participants said they would share the messages with other sex workers. The majority said they were likely to trust the information provided, a key reason being that sex workers had helped develop it.

Feedback from the workshops was used to finalise the service, which was then released for use over a 12-month trial. WHISPER participants received SMS two to three times a week, and on-demand messages were alternated with role model stories every month. Messages were scheduled for mornings on set days, in line with participant preferences.

This study demonstrates that WHISPER is a workable and acceptable way to support women who sell sex in similar settings as Mombasa to address SRHR issues. Whether this results in high levels of engagement, and ultimately produces better health outcomes, remains to be seen and will be addressed by results from the 12-month trial.