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1 rated sexy smart safe Women Sexy, Smart & Safe

2 User Instructions These cards were designed to facilitate small group dialog and education on sexually transmitted infections (STIs) and HIV and AIDS. They were designed as part of a larger package of materials for women engaging in higher-risk behaviors. Use these cards with the Handbook and related materials. These cards can be used in one setting or the content can be broken into sections and used across multiple sessions. Tips for Using the Cards 1. Position the card so everyone in the group can see the picture. 2. Point to the pictures on the front, not the text on the back. 3. Ask participants to tell you about the pictures. 4. Use the text on the back to guide your discussions. 5. Try to involve the whole group and generate discussion. 6. Before starting each small group session, use an icebreaker from the Handbook to help the group feel open and comfortable sharing with one another. This publication is made possible by the generous support of the American people through the United States Agency for International Development (USAID) and the U.S. President s Emergency Plan for AIDS Relief (PEPFAR) under the terms of Agreement No. GPO-A The contents are the responsibility of the C-Change project, managed by FHI 360, and do not necessarily reflect the views of USAID or the United States Government.

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4 Triple S Women Sexy, Smart, and Safe What do you think is happening in this picture? What do you think they are proud of? What concerns might they have? How do the women in the photo support each other? Explain Women who participate in these group activities are rated SSS they are Sexy, Smart, and Safe. Triple S women are ambitious. They work to support their families and themselves in jobs like yours. Triple S women are empowered and control their own destiny. They are sexy, smart, and safe Who would you describe as a Triple S woman? How are you rated Triple S? Discussion Points We have many important priorities in our lives, including our children and relationships. Triple S women need to also consider safety, the law, physical and mental health, money, and our families. As Triple S women, we have the power to control future. STIs and HIV are a big concern because our risk goes up with unprotected sex or sex with multiple people. STIs affect our physical, sexual, and mental health and impact our loved ones How does your health impact you: (A) As a person? (B) As a partner? (C) As a parent? Note to Facilitator: Encourage the group to answer the questions that are raised. Correct any misinformation

5 2 rated sexy smart safe

6 Wise Up! Let s Talk about STIs What do you think is happening in this picture? Why is the woman giving the other women a condom? Discussion Points Chlamydia, Trichomoniasis (Trich), Syphilis, Gonorrhea, Herpes, Genital Warts, and HIV are common but serious STIs. STIs are infections that pass from one person to another. STIs pass from vaginal, anal, or oral sexual contact. We have the power to make smart decisions because we are sexy, smart, and safe. We can prevent STIs by using a condom or female condom every time we have sex. STIs are not spread through kissing, saliva, or sharing clothes, etc. STIs can be spread from man-to-woman, woman-to-man, man-to-man, and woman-to-woman What questions do you think the woman in the picture may have about how she could get an STI? If they were your friends, what would you tell her about STIs so that she also could be rated SSS? Note to Facilitator: Encourage the group to answer the questions that are raised. Correct any misinformation

7 3

8 Know the Signs of STIs What do you think is happening in this picture? How can these women help protect each other from STIs? Discussion Points STIs may or may not have symptoms. Some STI signs are: bad smell or unusual discharge; lower stomach pain, sores (on vagina, anus, or penis), bleeding after sex, pain when peeing, or having to pee a lot. Handouts Pass around STI symptom pictures from the Handbook and discuss. Discussion Points Remember! You can t tell if you or others have an STI without a test. Many STIs have no symptoms at all. There is nothing sexy, smart, or safe about having an untreated STI. If not treated, STIs can cause other serious illnesses, such as cancer, AIDS, infertility, and death. Many STIs can be cured if we are smart and catch them early. All STIs can be treated or managed at the clinic. We can take control of STIs by preventing them and getting a PAP smear and STI check once a year or if we suspect an STI. What other concerns or questions do you have about STIs? What new information did you learn today that you will you share with your friends or your partner?

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10 Take Control of HIV and AIDS What do you think is happening in the picture? What are the woman s concerns about HIV as it relates to her relationship? How can this couple address these concerns together? Discussion Points HIV is the virus that causes AIDS. HIV is passed through unprotected sex, sharing needles, or from mother-to-baby. It takes up to three months from HIV infection until someone tests positive. You are more likely to get HIV if you have high numbers of sexual partners or do not always using a condom. Triple S women prevent HIV by always using a condom, even with regular clients and boyfriends. Douching and bunging can put us at greater risk for STIs and HIV because it irritates the vagina. Some people with HIV have no symptoms but they can still pass the virus to others and it still affects their bodies. There is no cure for HIV or AIDS but there is treatment available called ART. ART is free but must be taken for life once started under the care of a medical professional. What questions do you have about HIV and AIDS? Note to Facilitator: Encourage the group to answer the questions that are raised. Correct any misinformation

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12 Going to the Clinic What do you think is happening in this picture? What are this woman s hopes and fears related to going to the clinic? Who is the seated woman in the circle and what is her role? Discussion Points It is sexy, smart, and safe to go to the clinic at least once a year or anytime we think we have an STI. It can be scary to find out your status, but most Triple S women feel better knowing because they then can control their future. Taking a friend with you to the clinic can make it easier to go. The more regularly you test, the easier it becomes. Untreated STIs are NOT sexy, smart, or safe. Garlic and bush remedies are not effective in treating STIs. Medicine that is effective is available at the clinic for free. Remember! Many STIs can be cured and all can be treated. HIV is not a death sentence. All medicine should be taken as prescribed by a doctor. You can also get reproductive health services, including birth control, and medicine at the clinic. Most health workers do their jobs with care. If you encounter a health worker who is unprofessional, report what happened to the clinic manager. Handouts Hand out a list of clinics that have been recommended by SSS women as places they feel comfortable going to. Use The STI Discussion Cube to facilitate a discussion around STIs and clinic visits.

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14 Protecting Myself from STIs and HIV What do you think is happening in this photo? What strategies is this Triple S woman using to protect herself? What can this woman do if the man does not respect her position on condom use? Handouts Pass around STI symptom pictures from the Handbook and discuss. Discussion Points There are SSS strategies we can use to protect ourselves from STIs/HIV. We can take responsibility for our own actions and look out for our friends. We are in control when we use condoms for all sex even with boyfriends and regular clients. No condom, No sex, should be our policy! EVEN if he will pay more or thinks bareback sex means love. We are smarter than our clients. They cannot trick us. We have our own strategies: o Use our own condoms o Put the condom on ourselves and check it regularly o Use a female condom o Keep the lights dim so we can see what s going on o Unite with our friends and have a No Condom, No Sex policy By using condoms always at the beginning of a new relationship, it makes it easier to do with boyfriends later. We show our love to our partner by always using a condom with him. No amount of money is worth our lives. What other Triple S strategies can we use with boyfriends and clients?

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16 Smart is Sexy What do you think is happening in this photo? What do you know about the female condom? Handout Hand out condom use instruction sheets (male and female) from the Handbook. Pass around a male and female condom and lubricant. Ask for volunteers to demonstrate. Correct any misinformation and repeat the demos as needed. Discussion Points Only one condom per sexual encounter is needed. Using two condoms will not make sex safer. We should use a new condom every time to stay safe. Triple S women use condoms during oral sex to protect themselves from STIs. Try flavored condoms as an alternative. Lubricants make sex more pleasurable and prevent tearing. Water-based lubricants like Summer Eve, KY, and Mac are safe. Oil-based lubricants and Vaseline can damage condoms. Female condoms allow us to be safe and in control when negotiating a male condom is difficult. Carrying extra condoms allows us to be prepared and to help a friend who may also need one. Remember! Not only do condoms protect us against STIs and HIV, they also prevent unplanned pregnancy. What makes it difficult to use a male or female condom correctly for all sex (including with your partner)? What Triple S strategies can we use to make this easier?

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18 Talking with your Partner about Condoms What do you think is happening in this picture? How is the way this woman talks with her partner about condoms different than how she talks to clients about condoms? What challenges do you think she faces in using condoms with her partner? What strategies might work to make using condoms easier with her partner? How can she talk to her partner about condoms when he does not know about her work? Discussion Points (Additional Strategies for Negotiating Condom Use with Boyfriends and Husbands) Use condoms from the start of new relationships to make it easier to continue their use. Let him know that by using a condom, you are showing him you love him. Remind him the benefits of using condoms in preventing unplanned pregnancy. Female condoms may be more acceptable than male condoms and can give you greater control. Try both (but not together) and see what works! Regular condom use throughout a relationship is important to prevent STIs and HIV even if we use condoms with clients. Show him the fun you can have with different types of condoms that are available. Even if you have not used condoms in the past with him, you have the right to change your position. Let him know that when you feel protected (from STIs as well as pregnancy), you feel more confident and sexy. Practice Divide participants into pairs. Have half of the group role play a discussion on using condoms with a boyfriend who knows about her work. Have the other half role play a discussion on using condoms with a boyfriend who does NOT know about her work. After participants are done, ask for volunteers to role-play the two scenarios for the larger group. For each role-play: What worked well in terms of her condom negotiation? For each role-play: How could she have been more successful in her condom negotiation.

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20 Talking with your Clients about Condoms What do you think is happening in these pictures? What challenges do women face in using condoms with clients? What strategies could she use to help her make condom use easier with clients? Discussion Points (Additional Strategies for Negotiating Condom Use with Clients) We can share our no condom, no sex policy. Let him know right away we always use condoms even if he will pay more. Triple S women bring their own condoms and have them ready to use. Be firm, but not aggressive, when talking to him about condom use to ensure your safety. Reducing the amount we drink and avoiding drugs will allow us to stay in control. We can be creative putting the condom on and let him know that we can help him get an erection without a problem. We can explain why using condoms is important for him and his loved ones. Even if we have not used condoms in the past with a client, we have the right to change our position. Triple S women back up and support their friends especially younger girls that might be more easily taken advantage of. ASK What are ways we can respond to a client who offers to pay more for bareback sex? What strategies can we use if a client gets aggressive about not using a condom? Practice Have participants divide into pairs. Assign pairs role-play scenarios: 1) client willing to pay more for bareback; 2) drunk and aggressive client; 3) regular client with whom they have not previously used a condom; 4) other scenarios of the participants choice. After participants are done, ask for volunteers to role play their scenario back to the larger group. For each role-play: What worked well in terms of her condom negotiation? For each role-play: How could she have been more successful in her condom negotiation.

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22 Keeping Safe What do you think is happening in this picture? What are the key safety challenges this woman faces in her work? What strategies can she use to stay safe? Discussion Points (Additional Strategies for Keeping Safe when Working) We can keep to a buddy system. If on the street, we can protect our corner and each other and always let someone know where we are. By establishing codes, we can let others know we need help secretly. When in doubt or if you do not feel comfortable SHOUT! If in an establishment, we can avoid leaving with a client. If we have to go with a client, text a friend the license plate and let him know that we pick the place. Avoid overnights we run the risk of losing our money and having a fight. If someone doesn t pay up we should walk away. It s not worth our life! Establish a rapport with club owners and security guards and let them know our whereabouts for greater protection. We should always warn our friends and other girls about aggressive men. Reducing alcohol use and avoiding drugs will help us to stay in control and we will be less likely to be taken advantage of. How can alcohol and drug use impact your personal safety when working? Who has a story that they will share about a dangerous situation they encountered while working and how they handled it? What are some Triple S strategies for dealing with a client who has (a) had too much to drink or is on drugs (b), who is aggressive and (c) is violent?

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24 We also have Rights What do you think is happening in this picture? How is her friend supporting her? How can she mobilize her friends to also stand up for their rights? Discussion Points Triple S women know their rights so that they can stand up for themselves and their friends. They also share their knowledge with their friends. Sex workers do not have professional rights because solicitation is illegal. Everyone, has individual rights, however, to which they are entitled. What are our rights as individuals as they relate to health care, legal access, and social services? Where can we go for health, legal, and support services?

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26 Triple S Women Unite What do you think is happening in this picture? What benefits do these women receive by protecting and supporting each other? Discussion Points Women rated SSS sexy, smart, safe should stick together to mobilize and support other women to take care of themselves. If we look out for other women where we work, they will be there to support us as well. Based on what you have learned during the sessions, what actions can you take to engage your friends for their personal protection? How does being a Triple S woman sexy, smart, and safe make you feel? Handout Hand out Word of Mouth campaign wrist bands and discuss the key oral messages associated with each wrist band and instructions for sharing them with friends (see the Handbook for instructions).

27 rated sexy smart safe Women Sexy, Smart & Safe

28 User Instructions These cards were designed to facilitate small group dialog and education on sexually transmitted infections (STIs) and HIV and AIDS. They were designed as part of a larger package of materials for women engaging in higher-risk behaviors. Use these cards with the Handbook and related materials. These cards can be used in one setting or the content can be broken into sections and used across multiple sessions. Tips for Using the Cards 1. Position the card so everyone in the group can see the picture. 2. Point to the pictures on the front, not the text on the back. 3. Ask participants to tell you about the pictures. 4. Use the text on the back to guide your discussions. 5. Try to involve the whole group and generate discussion. 6. Before starting each small group session, use an icebreaker from the Handbook to help the group feel open and comfortable sharing with one another. This publication is made possible by the generous support of the American people through the United States Agency for International Development (USAID) and the U.S. President s Emergency Plan for AIDS Relief (PEPFAR) under the terms of Agreement No. GPO-A The contents are the responsibility of the C-Change project, managed by FHI 360, and do not necessarily reflect the views of USAID or the United States Government.

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30 Triple S Women Sexy, Smart, and Safe What do you think is happening in this picture? What do you think they are proud of? What concerns might they have? How do the women in the photo support each other? Explain Women who participate in these group activities are rated SSS they are Sexy, Smart, and Safe. Triple S women are ambitious. They work to support their families and themselves in jobs like yours. Triple S women are empowered and control their own destiny. They are sexy, smart, and safe Who would you describe as a Triple S woman? How are you rated Triple S? Discussion Points We have many important priorities in our lives, including our children and relationships. Triple S women need to also consider safety, the law, physical and mental health, money, and our families. As Triple S women, we have the power to control future. STIs and HIV are a big concern because our risk goes up with unprotected sex or sex with multiple people. STIs affect our physical, sexual, and mental health and impact our loved ones How does your health impact you: (A) As a person? (B) As a partner? (C) As a parent? Note to Facilitator: Encourage the group to answer the questions that are raised. Correct any misinformation

31 2 rated sexy smart safe

32 Wise Up! Let s Talk about STIs What do you think is happening in this picture? Why is the woman giving the other women a condom? Discussion Points Chlamydia, Trichomoniasis (Trich), Syphilis, Gonorrhea, Herpes, Genital Warts, and HIV are common but serious STIs. STIs are infections that pass from one person to another. STIs pass from vaginal, anal, or oral sexual contact. We have the power to make smart decisions because we are sexy, smart, and safe. We can prevent STIs by using a condom or female condom every time we have sex. STIs are not spread through kissing, saliva, or sharing clothes, etc. STIs can be spread from man-to-woman, woman-to-man, man-to-man, and woman-to-woman What questions do you think the woman in the picture may have about how she could get an STI? If they were your friends, what would you tell her about STIs so that she also could be rated SSS? Note to Facilitator: Encourage the group to answer the questions that are raised. Correct any misinformation

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34 Know the Signs of STIs What do you think is happening in this picture? How can these women help protect each other from STIs? Discussion Points STIs may or may not have symptoms. Some STI signs are: bad smell or unusual discharge; lower stomach pain, sores (on vagina, anus, or penis), bleeding after sex, pain when peeing, or having to pee a lot. Handouts Pass around STI symptom pictures from the Handbook and discuss. Discussion Points Remember! You can t tell if you or others have an STI without a test. Many STIs have no symptoms at all. There is nothing sexy, smart, or safe about having an untreated STI. If not treated, STIs can cause other serious illnesses, such as cancer, AIDS, infertility, and death. Many STIs can be cured if we are smart and catch them early. All STIs can be treated or managed at the clinic. We can take control of STIs by preventing them and getting a PAP smear and STI check once a year or if we suspect an STI. What other concerns or questions do you have about STIs? What new information did you learn today that you will you share with your friends or your partner?

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36 Take Control of HIV and AIDS What do you think is happening in the picture? What are the woman s concerns about HIV as it relates to her relationship? How can this couple address these concerns together? Discussion Points HIV is the virus that causes AIDS. HIV is passed through unprotected sex, sharing needles, or from mother-to-baby. It takes up to three months from HIV infection until someone tests positive. You are more likely to get HIV if you have high numbers of sexual partners or do not always using a condom. Triple S women prevent HIV by always using a condom, even with regular clients and boyfriends. Douching and bunging can put us at greater risk for STIs and HIV because it irritates the vagina. Some people with HIV have no symptoms but they can still pass the virus to others and it still affects their bodies. There is no cure for HIV or AIDS but there is treatment available called ART. ART is free but must be taken for life once started under the care of a medical professional. What questions do you have about HIV and AIDS? Note to Facilitator: Encourage the group to answer the questions that are raised. Correct any misinformation

37 rated sexy smart safe 5

38 Going to the Clinic What do you think is happening in this picture? What are this woman s hopes and fears related to going to the clinic? Who is the seated woman in the circle and what is her role? Discussion Points It is sexy, smart, and safe to go to the clinic at least once a year or anytime we think we have an STI. It can be scary to find out your status, but most Triple S women feel better knowing because they then can control their future. Taking a friend with you to the clinic can make it easier to go. The more regularly you test, the easier it becomes. Untreated STIs are NOT sexy, smart, or safe. Garlic and bush remedies are not effective in treating STIs. Medicine that is effective is available at the clinic for free. Remember! Many STIs can be cured and all can be treated. HIV is not a death sentence. All medicine should be taken as prescribed by a doctor. You can also get reproductive health services, including birth control, and medicine at the clinic. Most health workers do their jobs with care. If you encounter a health worker who is unprofessional, report what happened to the clinic manager. Handouts Hand out a list of clinics that have been recommended by SSS women as places they feel comfortable going to. Use The STI Discussion Cube to facilitate a discussion around STIs and clinic visits.

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40 Protecting Myself from STIs and HIV What do you think is happening in this photo? What strategies is this Triple S woman using to protect herself? What can this woman do if the man does not respect her position on condom use? Handouts Pass around STI symptom pictures from the Handbook and discuss. Discussion Points There are SSS strategies we can use to protect ourselves from STIs/HIV. We can take responsibility for our own actions and look out for our friends. We are in control when we use condoms for all sex even with boyfriends and regular clients. No condom, No sex, should be our policy! EVEN if he will pay more or thinks bareback sex means love. We are smarter than our clients. They cannot trick us. We have our own strategies: o Use our own condoms o Put the condom on ourselves and check it regularly o Use a female condom o Keep the lights dim so we can see what s going on o Unite with our friends and have a No Condom, No Sex policy By using condoms always at the beginning of a new relationship, it makes it easier to do with boyfriends later. We show our love to our partner by always using a condom with him. No amount of money is worth our lives. What other Triple S strategies can we use with boyfriends and clients?

41 rated sexy smart safe 7

42 Smart is Sexy What do you think is happening in this photo? What do you know about the female condom? Handout Hand out condom use instruction sheets (male and female) from the Handbook. Pass around a male and female condom and lubricant. Ask for volunteers to demonstrate. Correct any misinformation and repeat the demos as needed. Discussion Points Only one condom per sexual encounter is needed. Using two condoms will not make sex safer. We should use a new condom every time to stay safe. Triple S women use condoms during oral sex to protect themselves from STIs. Try flavored condoms as an alternative. Lubricants make sex more pleasurable and prevent tearing. Water-based lubricants like Summer Eve, KY, and Mac are safe. Oil-based lubricants and Vaseline can damage condoms. Female condoms allow us to be safe and in control when negotiating a male condom is difficult. Carrying extra condoms allows us to be prepared and to help a friend who may also need one. Remember! Not only do condoms protect us against STIs and HIV, they also prevent unplanned pregnancy. What makes it difficult to use a male or female condom correctly for all sex (including with your partner)? What Triple S strategies can we use to make this easier?

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44 Talking with your Partner about Condoms What do you think is happening in this picture? How is the way this woman talks with her partner about condoms different than how she talks to clients about condoms? What challenges do you think she faces in using condoms with her partner? What strategies might work to make using condoms easier with her partner? How can she talk to her partner about condoms when he does not know about her work? Discussion Points (Additional Strategies for Negotiating Condom Use with Boyfriends and Husbands) Use condoms from the start of new relationships to make it easier to continue their use. Let him know that by using a condom, you are showing him you love him. Remind him the benefits of using condoms in preventing unplanned pregnancy. Female condoms may be more acceptable than male condoms and can give you greater control. Try both (but not together) and see what works! Regular condom use throughout a relationship is important to prevent STIs and HIV even if we use condoms with clients. Show him the fun you can have with different types of condoms that are available. Even if you have not used condoms in the past with him, you have the right to change your position. Let him know that when you feel protected (from STIs as well as pregnancy), you feel more confident and sexy. Practice Divide participants into pairs. Have half of the group role play a discussion on using condoms with a boyfriend who knows about her work. Have the other half role play a discussion on using condoms with a boyfriend who does NOT know about her work. After participants are done, ask for volunteers to role-play the two scenarios for the larger group. For each role-play: What worked well in terms of her condom negotiation? For each role-play: How could she have been more successful in her condom negotiation.

45 rated sexy smart safe 9

46 Talking with your Clients about Condoms What do you think is happening in these pictures? What challenges do women face in using condoms with clients? What strategies could she use to help her make condom use easier with clients? Discussion Points (Additional Strategies for Negotiating Condom Use with Clients) We can share our no condom, no sex policy. Let him know right away we always use condoms even if he will pay more. Triple S women bring their own condoms and have them ready to use. Be firm, but not aggressive, when talking to him about condom use to ensure your safety. Reducing the amount we drink and avoiding drugs will allow us to stay in control. We can be creative putting the condom on and let him know that we can help him get an erection without a problem. We can explain why using condoms is important for him and his loved ones. Even if we have not used condoms in the past with a client, we have the right to change our position. Triple S women back up and support their friends especially younger girls that might be more easily taken advantage of. ASK What are ways we can respond to a client who offers to pay more for bareback sex? What strategies can we use if a client gets aggressive about not using a condom? Practice Have participants divide into pairs. Assign pairs role-play scenarios: 1) client willing to pay more for bareback; 2) drunk and aggressive client; 3) regular client with whom they have not previously used a condom; 4) other scenarios of the participants choice. After participants are done, ask for volunteers to role play their scenario back to the larger group. For each role-play: What worked well in terms of her condom negotiation? For each role-play: How could she have been more successful in her condom negotiation.

47 rated sexy smart safe 10

48 Keeping Safe What do you think is happening in this picture? What are the key safety challenges this woman faces in her work? What strategies can she use to stay safe? Discussion Points (Additional Strategies for Keeping Safe when Working) We can keep to a buddy system. If on the street, we can protect our corner and each other and always let someone know where we are. By establishing codes, we can let others know we need help secretly. When in doubt or if you do not feel comfortable SHOUT! If in an establishment, we can avoid leaving with a client. If we have to go with a client, text a friend the license plate and let him know that we pick the place. Avoid overnights we run the risk of losing our money and having a fight. If someone doesn t pay up we should walk away. It s not worth our life! Establish a rapport with club owners and security guards and let them know our whereabouts for greater protection. We should always warn our friends and other girls about aggressive men. Reducing alcohol use and avoiding drugs will help us to stay in control and we will be less likely to be taken advantage of. How can alcohol and drug use impact your personal safety when working? Who has a story that they will share about a dangerous situation they encountered while working and how they handled it? What are some Triple S strategies for dealing with a client who has (a) had too much to drink or is on drugs (b), who is aggressive and (c) is violent?

49 rated sexy smart safe 11

50 We also have Rights What do you think is happening in this picture? How is her friend supporting her? How can she mobilize her friends to also stand up for their rights? Discussion Points Triple S women know their rights so that they can stand up for themselves and their friends. They also share their knowledge with their friends. Sex workers do not have professional rights because solicitation is illegal. Everyone, has individual rights, however, to which they are entitled. What are our rights as individuals as they relate to health care, legal access, and social services? Where can we go for health, legal, and support services?

51 rated sexy smart safe 12

52 Triple S Women Unite What do you think is happening in this picture? What benefits do these women receive by protecting and supporting each other? Discussion Points Women rated SSS sexy, smart, safe should stick together to mobilize and support other women to take care of themselves. If we look out for other women where we work, they will be there to support us as well. Based on what you have learned during the sessions, what actions can you take to engage your friends for their personal protection? How does being a Triple S woman sexy, smart, and safe make you feel? Handout Hand out Word of Mouth campaign wrist bands and discuss the key oral messages associated with each wrist band and instructions for sharing them with friends (see the Handbook for instructions).

53 rated sexy smart safe

Key Concepts Guide. Rev. March 2015 Page 1 of 13

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