Fish where the fish are

Online outreach to sex workers through commercial sex sites can be characterised as 'Prevention through Pragmatism'.

The intervention animated


Soa Aids Nederland works together with the Amsterdam Municipal Health Service (GGD) and other Dutch health care services in a comprehensive outreach model to reach sex workers in the Netherlands via the internet.

For advice on how to employ this strategy in other countries, health care professionals can contact

A move away from visibility

Sex workers are at high risk for hiv and STI's. It is increasingly difficult for health care workers to reach sex workers, because worldwide mobile phones and internet facilitate a structural move away from traditional hotspots like brothels to private houses. As a result of this global trend, sex work more and more takes place behind closed doors, out of sight of health care workers and social workers, as well as away from peers that could otherwise offer support. This increased invisibility enhances the risk of hiv and STI transmission among sex workers and their clients.


In response to the expanding use of the internet by sex workers, the Prostitution & Health Centre P&G292 in Amsterdam developed an intervention to contact people that advertise themselves online. Trained medical staff send advertisers within their region a short message per email or SMS to refer them to a local testing facility, followed by reminder a couple of days later.
Soa Aids Nederland was asked to involve and inform other health care workers in the Netherlands to start using the intervention. Since 2012, Soa Aids Nederland coordinates the geographical division to make sure that people are not spammed with health messages from different health care workers.


The intervention proved successful in its 2012 pilot project. Ten health organizations and two webmasters together reached 200.000 people with health information. Around 500 people received individual consultation, including in-clinic testing.

The impact of the intervention is measured in terms of delayed as well as direct response. A sex worker might not immediately respond to a message, but her health awareness will be raised by reading the message.
Also, she might return to the message when she has a concern about her sexual health at a later moment.


Based on our experience we strongly encourage health care professionals in other countries to join us in this pragmatic approach.
As we say: Fish where the fish are.
The engagement with commercial websites where sex is advertised is an example of a non-moralistic mode of operation that is indispensable to reach the most at risk population of sex workers.

The acceptability of the messages is enhanced by building a trusting work-relationship with the webmaster of the chosen website. Every person can claim to be a nurse online. It is therefore important that the webmaster can confirm the trustworthiness of the messages, in case of complaints from the advertisers.