Want to combat HIV? Look after

Want to combat HIV? Look after South Africa’s sex workers

Sex workers are at high risk of HIV infection, and the epidemic will continue unless drastic action is taken soon.

Want to combat HIV? Look after

Scientists are forging ahead with innovative solutions to the HIV/AIDS crisis, but their work will be in vain unless changes are made to laws and policies that violate human rights and deny access to health services.

As groundbreaking biomedical developments were presented this week in Cape Town at the first ever HIV Research for Prevention Conference (HIV R4P), HIV advocates said the solutions were urgently needed by sex workers who are at risk of HIV infection within a hostile legal and social environment.

Sex workers rights need to be addressed to fight HIV.
Sex workers rights need to be addressed to fight HIV.

A discussion focused on a special issue of The Lancet, an international medical journal titled HIV Among Sex Workers, which includes an article by a leading South African researcher, Linda-Gail Bekker of The Desmond Tutu HIV Centre.

The issue follows two earlier special series on HIV Among People Who Inject Drugs and Men who have Sex with Men.

These people are what is known as key population groups in HIV prevention — they are at high risk of HIV infection and the struggle against HIV epidemics can only be successful if key populations are effectively reached by services.

Ironically, they are the people whose needs for HIV prevention and treatment are often not met — because of police harassment, violence, stigmatisation and gender inequities.

Speaking at the conference, Bekker said sex workers must be part of the design of a new system involving Biomedical research solutions.

“It has to be done within a human rights framework. The human rights element must be first and foremost,” she said.

The journal emphasises the disproportionately high burden of HIV among sex workers in all regions – estimated at 11.8% globally, and especially high in southern Africa where HIV prevalence is 30%.

Sex work in many countries, including South Africa, is illegal and the persecution of sex workers helps perpetuate the epidemic, one reason why HIV advocates are lobbying for authorities to decriminalise sex work.

According to Lancet, the number of new HIV infections could be greatly reduced if efforts to prevent the epidemic spreading were not hindered by actions such as police confiscating sex workers’ condoms, or needles used by sex workers who inject drugs – a group that is especially vulnerable.

According to Bekker’s article, a model simulation suggests that condom promotion and distribution programmes in South Africa have already reduced HIV incidence in sex workers and their clients by more than 70%.

Oral pre-exposure prophylaxis together with test and treat programmes could further reduce HIV incidence in South African sex workers and their clients by up to 40% over 10 years.

Another study featured in Lancet showed that in Mombasa, Kenya, HIV prevalence among sex workers is 47%. They lack access to HIV services because there is currently no strategy to mitigate risk factors such as stigma, discrimination, violence and criminalisation. Despite coverage of more than 80% among the general population, only between 20% and 30% of HIV positive sex workers were receiving antiretroviral therapy in 2011.

Research suggests that if these barriers were removed it would avert 34% of infections in Mombasa over the next decade.

In the journal, Bekker states that effective HIV prevention packages exist for sex workers but they are not being utilised.

Sex workers use condoms more than any other affected population, but that the cost and police confiscation of condoms are a barrier to consistent condom use.

Screening and testing for STIs could reduce HIV but this is not happening enough in South Africa.

Apart from lack of access to services, barriers to testing unique to female sex workers include fear of authorities and concerns about confidentiality.

She said that in South Africa, police violence and harassment are something that advocates would need to grapple with.

“Ultimately we need to take on the law but first we need to work on changing the attitudes of law enforcement, she said.

She added that currently the only local group to have confronted the police in the past is the Sex Workers Education and Advocacy Task Force (SWEAT) which continues to lobby for change.

However, the movement to change attitudes and policy towards key populations groups by the authorities and communities is gathering momentum with other organisations such the TB/HIV Care Association (THCA) in Cape Town doing much to help such populations.

Rudolph Basson, a key populations project co-coordinator at THCA said:

“One of the major themes that came out of the R4P conference was excitement around a number of really amazing new biomedical technologies that have been proven effective, such as oral PrEP, or that are currently in development, such as microbicide gels.

”But there was also a strong message that these technologies will never have a real impact on the HIV/AIDs pandemic if they are not accessed by those populations who are most at risk for HIV infection,” he said.

“These biomedical technologies are tools we can use to bring us closer to an AIDS-free generation, but at the end of the day it’s about what actually happens in communities.”