Beginning to Build the Picture: What do we know about Sex Workers

and HIV in South Africa?

Maria StaceyMaria StaceyJoint Committee on HIV/AIDS Joint Committee on HIV/AIDS

24 May 201324 May 2013

Sex work: a definition

“…any agreement between two or more persons in which the objective is exclusively limited to the sexual act and ends with that, and which involves preliminary negotiations for a price. Hence there is a distinction from marriage contracts, sexual patronage and agreements concluded between lovers that could include presents in kind or money, but its value has no connection with the price of the sexual act and the agreement does not depend exclusively on sexual services.”

( Regional UNAIDS workshop on sex work in West and Central Africa in 2000)

Background

• Sex work is illegal in South Africa

• Despite their vulnerability, sex workers remain a largely invisible, inadequately

served and marginalised population.

• Sex workers face:

health risks

violence

obstacles to gaining access to:

• health care

• legal recourse

• social services

How many sex workers are there?

• National Sex Work Population Size Estimation Study

• Commissioned by SANAC• Conducted by SWEAT

Intermediate estimate=153 000 sex workers

(female, male and transgender)

How many sex workers are there?

How many sex workers are there

Province Estimate

Gauteng 32 409

Mpumalanga 15 382

Limpopo 14 457

North-West 15 163

Free State 10 950

KZN 24 504

Eastern Cape 14 615

Northern Cape 5 436

Western Cape 17 112

Sex Workers and HIV in South Africa

• Poor data, under-researched area• HIV prevalence rate 59.6%• 19.8% of new infections sex work related (5.5%

sex workers, the remainder clients and clients partners)

• 5% of sex workers have access to HIV prevention services

SWEAT’s approach• Peer-driven outreach and development• Address sex workers health through individual

and group interventions: information, counselling, referrals, dialogue

• Address contextual and structural impediments to health care: stigma, discrimination, criminalisation

• Respect sex workers choices to remain in the industry or transition out of industry. Provide individualised, realistic support to those wanting to exit.

SWEAT’s approach• Cape Town office as “innovation laboratory”.

New interventions introduced and evaluated.• Expertise shared with stakeholders through

sensitisation and training.• Strategic partnerships e.g. Women’s Legal

Centre; TB/HIV Care from 2011• Hosts Sisonke, ASWA• SWEAT believes adult consensual sex work

should be decriminalised as it is both a human rights and a public health issue

National Sex Worker Programme

• SWEAT SR for GF Round 9: Civil Society Grant• April 2011-March 2016• SWEAT coordinates the programme, sub-

grants to 8 organisations in 6 provinces• Targets initially modest, to be increased

substantially for Phase 2 (October 2013) to 56 sites

Location of SSRs

GEORGE: George

Municipality

BEAUFORT WEST: PSH

RUSTENBURG:LLAC

EAST LONDON:

ELHTA

DURBAN: LIFELINE

JHB: WrHI

MUSINA: CPC

CAPE TOWN: SWEAT

BARBERTON: PSASA

Components of Global Fund National Sex Work Programme

Peer EducationOutreach

Risk Reduction/Life Skills WorkshopsHCT

+National Helpline

+Stakeholder training and sensitisation

National Sex Work Survey (2012)

Objectives• Evaluate national programme• Survey sex workers: demographics, sexual and risk

behaviour, access to services, HIV knowledge • Baseline for future evaluations• Assess information for UNGASS indicators (previously no data available for SA UNGASS report)

National Sex Work Survey (2012)

Findings

• 1136 sex workers interviewed at 7 sites

• 91% Female, 5% Male, 4% Transgender

• 63% over 25; 34% aged 18-25; 3% under 18

Findings: Sex work locations“Where do you pick up clients?

Findings: Violence“Have you experienced violence in the past 12

months? If so, by who?”

Findings: Sexual health and behaviour

Question

Yes No Don't know Refuse to answer

Count % Count % Count % Count %

Did you use a condom last time you had sex with a client? 1077 95% 54 5% 3 <1% 2 <1%

Did you use a condom last time you had sex with someone who wasn’t a client? 922 81% 200 18% 4 <1% 10 1%

Have you had an HIV test in the past 12 months? 1003 88% 123 11% 6 1% 4 <1%

Question

Yes No Don't know Refuse to answer

Count % Count % Count % Count %

Do you know your HIV status?

1041 92% 86 8% 0 <1% 9 1%

Have you had symptoms of an STI in the past 12 months?

523 46% 602 53% 6 1% 5 <1%

Have you experienced physical violence in the past 12 months?

611 54% 519 46% 1 <1% 5 <1%

Findings: Sexual health and behaviour

Findings: Impact

• Sex Workers who had been exposed to the SWEAT National Sex Work Programme had:

• Higher condom use• Better knowledge of HIV preventions

Lessons learnt from National Sex WorkProgramme

1. Sex Worker peer educators essential component to access a “hard-to-reach” population, and to negotiate the complexity of sex work

2. HIV prevention as a vehicle to address holistic personal development. Conversely, sex worker personal development achieves multiple outcomes which address HIV risk

3. Specifically, addressing gender-based violence increases success of HIV prevention programmes by 25%

Lessons learnt from National Sex WorkProgramme

4. Risk reduction workshops (“Creative Space” workshops) are an important dimension: to deepen engagement, provide safe space, opportunity for mutual support

5. Empowerment of sex workers, strengthening of sex worker community, framing sex work as work – esssential structural activities

6. Even when organisations are constrained from addressing the legal status of sex work, human rights defence and access to justice are essential components

(Sex Workers report police harassment, abuse, violence and arrest as their primary concern)

Thank you

Maria StaceySWEAT

Email: maria.stacey@sweat.org.zaPhone: 021 448 7875

Helpline 0800 60 60 60PCM 071 357 7632