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Diagonal Interventions to Fast Forward Enhanced Reproductive health (DIFFER)


According to the World Health Organization, reproductive and sexual ill health accounts for 20% of the global burden of ill health for women, and 14% for men. These rates are often highest in marginalised populations with limited access to health services, increased exposure to infection, general poor health, and the effectives of living in poverty.

Although proven solutions for improving Sexual and Reproductive Health (SRH) exist, their implementation has been fragmented, with limited population impact, and little access for populations most at risk, such as sex workers. Integration of SRH services is key to achieving universal access to reproductive health. However, with weakened health systems and an HIV pandemic, the way forward is uncertain. The essential package of services and models for delivering them at high coverage in resource-limited settings are unclear.


The Diagonal Interventions to Fast Forward Enhanced Reproductive health (DIFFER) project was a “diagonal” strategy, incorporating both “horizontal” health systems strengthening and more targeted “vertical” approaches. Horizontal programmes can reach large numbers of women, while vertical programmes target high-risk populations, difficult to reach through a horizontal approach. The aim was improved SRH services through identifying best practices in delivering a combined package of interventions for general population women and female sex workers.

CHP and MatCH (Maternal, Adolescent and Child Health Division) provided formative information on SRH policy, especially of services for high-risk populations, by conducting a policy analysis of existing SRH services and undertake a situational analysis of existing SRH services. In addition, the Wits group was responsible for taking research to policy through activities and workshops involving local and national health authorities to develop, implement and evaluate a strategy to bridge the gap between research and health policy and service delivery guidelines.


This research involved both north-south and south-south collaboration, and for the first time brought the rich experience and successes of innovative, scaled-up sex worker-led interventions from the DMSC Sonagachi, Ashodaya and Avahan projects for adaptation to the African setting. The partners were the International Centre for Reproductive Health, University Ghent, Belgium; Ashodaya Samithi, India; International Centre for Reproductive Health, Kenya and Mozambique; the Centre for Health Policy and MatCH at the University of the Witwatersrand, South Africa; the Centre for International Health and Development, University College London, United Kingdom.

Capacity Building

This challenging project offered significant capacity building opportunities to CHP staff, particularly in the adaptation of sex-worker interventions for the African context which have been so successful in India.



Chersich MF, Bosire W, Kong'ola N, Temmerman M, Luchters S. Effects of hazardous and harmful alcohol use on HIV incidence and sexual behaviour: A cohort study of Kenyan female sex workers. (2014) Global Health;

Richter M, Chersich MF, Vearey J, Sartorius B, Temmerman M, Luchters S. (2014) Migration status, work conditions and health utilization of female sex workers in three South African cities. J Immigr Minor Health;16 (1):7-17.

Richter ML, Scorgie F, Chersich MF, Luchters S. (2014) 'There are a lot of new people in town: but they are here for soccer, not for business' a qualitative inquiry into the impact of the 2010 soccer world cup on sex work in South Africa. Global Health;10 (1):45.

Dhana A, Luchters S, Moore L, Lafort Y, Roy A, Scorgie F, Chersich M. (2014) Systematic review of facility-based sexual and reproductive health services for female sex workers in Africa. Global Health;10:46.

Moore L, Chersich MF, Steen R, Reza-Paul S, Dhana A, Vuylsteke B, Lafort Y, Scorgie F. (2014) Community empowerment and involvement of female sex workers in targeted sexual and reproductive health interventions in Africa: a systematic review. Global Health;10:47.


Scorgie F, Nakato D, Harper E, Richter M, Maseko S, Nare P, Smit J, Chersich M.‘We are despised in the hospitals’: sex workers’ experiences of accessing health care in four African countries. Culture, Health & Sexuality 2013.http://dx.doi.org/10.1080/13691058.2012.763187

Scorgie F, Vasey K, Harper E, Richter M, Nare P, Maseko S, Chersich MF. (2013) Human rights abuses and collective resilience among sex workers in four African countries: a qualitative study. Global Health; 9 (1):33.

Luchters S, Richter ML, Bosire W, Nelson G, Kingola N, Zhang XD, Temmerman M, Chersich MF. (2013) The Contribution of Emotional Partners to Sexual Risk Taking and Violence among Female Sex Workers in Mombasa, Kenya: A Cohort Study. PLoS One;8 (8):e68855.

Richter ML, Chersich M, Temmerman M, Luchters S. (2013) Characteristics, sexual behaviour and risk factors of female, male and transgender sex workers in South Africa. S Afr Med J;103 (4):246-51.


Scorgie F, Chersich MF, Ntaganira I, Gerbase A, Lule F, Lo YR. Socio-demographic characteristics and behavioral risk factors of female sex workers in sub-saharan Africa: a systematic review. AIDS Behavior. 2012 16(4):920-33.

Steen R, Chersich MF, Gerbase A, Neilsen G, Wendland A, Ndowa F, Akl EA, Lo Y-R, De Vlas SJ. Periodic presumptive treatment of curable sexually transmitted infections among sex workers: a systematic review. AIDS. 2012 26(4): 437-445.

Steen R, Chersich MF, De Vlas SJ. Periodic presumptive treatment of curable sexually transmitted infections among sex workers: recent experience with implementation. Current Opinion Infectious Diseases. 2012 25(1)100-106.


R Steen, M Chersich, A Gerbase, G Neilsen, A Wendland, F Ndowa, EA Akl, YR Lo, SJ de Vlas Periodic presumptive treatment of curable STIs among sex workers: a systematic review. AIDS. 2011 Nov 16.

W Delva, M Richter, P De Koker, M Chersich, M Temmerman. Sex Work during the 2010 FIFA World Cup: Results from a Three-Wave Cross-sectional Survey.PLoS ONE 2011 (in press)

Scorgie F, Chersich MF, Ntaganira I, Gerbase A, Lule F, Lo YR Socio-Demographic Characteristics and Behavioral Risk Factors of Female Sex Workers in Sub-Saharan Africa: A Systematic Review. AIDS Behav. 2011 Jul 13. [Epub ahead of print]

Veldhuijzen NJ, Ingabire C, Luchters S, Bosire W, Braunstein S, Chersich M, van de Wijgert, J Anal intercourse among female sex workers in East Africa is associated with other high-risk behaviours for HIV. Sex Health. 2011 Jun; 8(2):251-4.


Richter ML, Chersich MF, Scorgie F, Luchters S, Temmerman M, Steen R Sex work and the 2010 FIFA World Cup: time for public health imperatives to prevail.Global Health. 2010 Feb 11; 6(1):1

Luchters SM, Vanden Broeck D, Chersich MF, Nel A, Delva W, Mandaliya K, Depuydt CE, Claeys P, Bogers JP, Temmerman M Association of HIV infection with distribution and viral load of HPV types in Kenya: a survey with 820 female sex workers. BMC Infect Dis. 2010 Jan 26;10:18.