WE HAVE FINALLY WOKEN UP TO THE NEED TO REACH SEX WORKERS COMPREHENSIVELY

K Mangold, C Nogoduka, N Mungoni, F Abdullah

24 July 2014|International AIDS Conference

South Africa Launches the National Sex Worker HIV Treatment and Prevention Programme

• South African Constitution– Including non-Discrimination on

the basis of sexual orientation

• Sex work is criminalised

The South African constitution enshrines the right of all people in South Africa to be free from

discrimination on any basis

The ongoing criminalisation of sex work undermines several constitutional rights; it increases the overlapping vulnerabilities of sex workers including violence,

abuse by law enforcement officials, harassment, HIV acquisition and lack of access to health and justice services.

In spite of this, sex workers still experience high levels of human rights violations in South Africa

Sex Workers experience a disproportionate burden of HIV in South Africa…

The HIV prevalence of sex workers in South Africa is estimated at around 60%

Modelling estimate that sex workers, their sexual partners and clients account for 6

to 11 per cent of new HIV infections in South AfricaAn estimated 153 000 sex workers live in South Africa

…In spite of the high risk, national programmes have been slow to address Sex Workers in HIV prevention & treatment

efforts

The current NSP 2012-2016 identifies sex workers as a key population and priority group for

intervention

‘For the first time, the NSP raises the importance of providing HIV treatment and prevention to key populations. This

is in fact seen as one of the highest priority interventions and the NSP

makes it very clear that key populations need a comprehensive response

including treatment, prevention, access to justice, dealing with violence and

substance abuse as well as strengthening implementing

organisations

‘

SANAC Development of the National Strategic Plan for HIV prevention, care & treatment for sex

workers

Principles

Sex workers are equal citizens Sex workers’ rights and dignity must be respectedSex workers are not victims by virtue of being sex

workersSex work is a livelihood option

Sex worker ownership: “nothing about, us without us”

Evidence-informed responseInterventions should not do harm

Collective sex worker engagement, mobilisation and empowerment essential for success

This plan was translated into action by following these steps:

Peer Education

Skills development and income generation

Challenge legal barriers

Educate clients of sex

workersImprove access to

health services

Deal with human rights

abuse & violence

Funded by:Global FundNDoHSANACPEPFAR

Implementers:GF money flows through SANAC CCM and NACOSA to 18 local NGOSPEPFAR will build on existing programmes of 3-4 NGOSNDoH funds HTA programmes in provincesSANAC will fund the management and coordination of the programme as well as fund raise for further scale-up

It took one year from strategy development to the programme being rolled out at a national

scale

This is the logic model upon which the national programme is structured

Key aim: Improved Sex Worker Services & Enabling Environment

Treatment & Clinical

Services -- WHRI

Surveillance – UCSF

Evaluation and Research –

HDA, HSRC

Capacity Development -

ICAP, SA PARTNERS,

UCSF

Combination Prevention –

HDA, Reaction, TB/HIV Care Association,

WHRI

PEPFAR has a growing portfolio of programmes in South Africa for Sex Workers

In 2011, PEPFAR funded programmes provided HCT to 1755 sex workers. In 2012 this rose to

2393 and in 2013 this number was reported to be 8442

National Sex Worker Programme Scale UpHIV prevention and treatment programmes in

South Africa for Sex Workers

COMPONENT INFORMATION

IMPLEMENTATION AREA Nationally in South Africa, 9 provinces, 60+ sites based on mapping exercise

SUB-RECIPIENTS 18 Sub-recipients, one lead Sub-recipient providing programme support and training

IMPLEMENTERS560 Peer Educators56 Site Co-ordinators (10 Peer Educators overseen by a Site Coordinator)

MODEL

Peer Educators , existing or previous sex workers working part time to reach out to sex workers providing HIV prevention education, condom distribution, HIV counselling and testing or referrals for testing, referrals to a range of SRHR and TB services, legal and human rights support when needed, risk reduction workshops

BUDGET USD 11,021,868 over 2.5 years

Nationally 16 308 sex workers have been reached so far with outreach work and 2665 have been

tested for HIV

EC FS GP KZN LP MP NC NW WC0

1000

2000

3000

4000

5000

6000

7000

8000

Sex workers reached through peer outreach

Sex workers who had HCT

Figure 1: Provincial breakdown of sex workers reached

The inclusion of key populations as a focus in the National Strategic Plan for HIV, STIs and TB gives solid grounding and support to the success of a sex worker programme that is national, multi-sectoral, comprehensive and coordinated

Even in a country where sex work is criminalised, a national unified response is still possible

The existence and acceptance of a number of local projects run by NGOs in different parts of the country enabled a coordinated scale up to occur in a short period of time. Sex worker organisations must play a leading role from the beginning

Informed discussion among key HIV policymakers is critical to legitimise the need for sex workerspecific HIV programmes

Lessons Learnt

Kerry Mangold et alSally Shackleton and Maria Stacey (SWEAT)Kholi Buthelezi (SISONKE)Marieta de Vos and Maureen van Wyk (NACOSA)Helen Savva (CDC Pretoria)Dr Jana (SONAGAJI)

Acknowledgements

South Africa has realised that in order to turn the tide of the epidemic, a co-ordinated public health

approach – lead at a national level – is particularly strategic in a context where sex work is illegal and

mobility is high

THANK YOUEmail: fabdullah@sanac.org.za