Sex workers in Gauteng

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Presentation by Dr Liz Floyd, at the National Sex Work Symposium in Boksburg, on 22 August 2012

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Sex workers in Gauteng

  1. 1. DEPARTMENT OF HEALTHSEX WORK IN GAUTENG PROVINCE Models for implementation MODELS AND RESULTS 22nd August 2012
  2. 2. 1. Situation Analysis of Sex Work1. Poverty and survival of young women 1. Low education, no ID, unemployment 2. Some are abused or abandoned 3. “Lifeskills” and vulnerability e.g. OVC2. Informal settlements at mines: 40% of pregnant women HIV positive by 20021. Profile of sex work : 1. All CBDs, mines, men’s hostels (? farms) 2. Very widespread: bars, shebines, clubs 3. Shacks/ flats/ hotels/ rooms/ houses/ bush/ trucks2. Social norms which accept transactional sex3. HIV rates over 50% 2
  3. 3. 2. CSW InterventionsA. Social prevention and protection for young women1. Vulnerable poor young women and OVC : parenting2. Increase education, lifeskills, training, income for young women3. Reduce violence, substance abuse, exploitation4. Delay sex, reduce partners, increase safety for girls5. Improve social norms for transactional sexB. Peer education with social support1. Peer education on best practice model (PSG): high outputs2. Recruit, train, support and manage CSW educators3. Provide social support and services4. Organization of CSW e.g. hotels, hostels and safety5. Support for children and link to families 3
  4. 4. CSW Interventions cont ….C. Increased utilization of primary health care services: 1. FP, TOP, ANC/PMTCT/MCH (SRH), HCT, STI, TB, ART 2. Access: Hours, queues, transport, attitudes, skills 3. ? Mobile clinics : criteria ? 4. Residential care for very ill CSW (dumped)D. Increased access to social services: 1. Children, child care and ECD, ID, grants 2. Abuse, substance abuse, shelters, street kids 4
  5. 5. 3. CSW logical framework for resultsPlan M&E Indicator SourceGoal Impact Reduced new HIV in youth (15-24), adults Surveys of HIVStrategic Out-come 1. Increased social norms e.g. Behaviouralobjective transactional sex surveys 2.Increased knowledge of 1.Household prevention 2.BSS for CSW 3.Increased regular condom use 3.BSS for YOS 4.Reduced social risks (defined) 5.Increased knowledge of HIV status 6.Reduced substance abuse 7.? Reduced STIs, ? Youth pregnancy (tbc)Services Output Numbers CSW reached © with services : Service reports 1.Peer education Verified 2.Health and Social ServicesManage- Process Quality and coverage Audit of servicesment Guidelines, training, M&E system Registerssystems Management of CSW projects ReportsResources Inputs Budget. Number of educators Financial, HR Supplies of condoms and materials Delivery notes 5
  6. 6. 4. What Research shows us:1. Evaluation of peer education model (PSG)• Changes sexual behaviours : high condom use• Reduced STIs : no direct link to HIV (even for PPT)• Not proven to reduce new HIV : ? Reasons2. Evaluation of Mothusimpilo (CSW mines) by Horizons• HIV spread to 40% of young women and men in mining town• Narrow focus on CSW = low impact on general HIV rates• Local risk analysis : informal settlements = social risks3. KYE report : refer to presentations4. Meta-analysis of HIV prevention by CIET : A cascade = ‘combination prevention’ = social, behavioural and medical combined. 6
  7. 7. Research continued4. Behavioural surveys (BSS) of CSW in Joburg Central• 94% condom use @ last sex: 2003, 2004, 2007, 2013• Low condom use for partners, low drug use (<5%)• Risks reduced through organization: hotels, brothels5. BSS of unemployed youth (YOS) 2007, 2013• A combination of high social risks: alcohol, drugs, sex partners, condom use, pregnancies.• In informal settlements and townships.• Social analysis: has spread to YIS, increased unemployment from 20086. High HIV rates in sex workers : 60% plus 7
  8. 8. Lessons from implementation1. Combined prevention for CSW = Peer education + social support + health + social services1. Aim for high coverage : ‘numbers reached’ © 1. Widespread CSW & transactional sex : decentralize 2. High output, low cost peer education model : PSG 3. Ensure minimum standards : quality & management 4. Ensure high condom supply : male, female2. Measure outcomes with behavioural surveys every 3 years : Use BSS by FHI to compare across time and groups 8
  9. 9. Lessons ….4. Access to primary health care services : 1. Including ‘SRH’ : FP, TOP, ANC/PMTCT/MCH, STI etc 2. HIV and TB, other services5. Access to social services : Children, rehab, shelter, IDs, grants etc6. Training for income : Labour Dept, EPWP, CWP7. Address social vulnerability = social protection (DSD). 1. Lifeskills training. Social norms . 2. Vulnerable girls eg OVC. Poverty relief 3. Reduce abuse : physical, emotional, sexual, substance, trafficking etc. 4. Provide exit services = support, train, income 9
  10. 10. MODELS THAT WORK1. CSW peer education ‘best practice’ model = PSG standards. For dense CSW populations. 1. Recruit, train, support and manage CSW educators 2. Map area, weekly plan with review, records 3. High outputs with quality education and condoms 4. Social support and organization2. Increased utilization of primary health care 1. Primary health care including ‘SRH’ services 2. Times, queues, attitudes, skills, ? Distance 3. Mobile services for high risk wards & rural areas 4. ? Criteria for dedicated CSW clinic services eg days, brothels 10
  11. 11. Models …3. Increased access to social support and services 1. Social support systems for CSW projects : defined 2. Social services : children, violence, rehab, IDs, grants etc. 3. Multi purpose centres (MPCs), ECD4. Ward model = adaptation of peer education model 1. Very high reach for risk areas & groups : informal settlements, YOS, bars, OVC 2. Referrals for poverty, social and health services with follow up 3. Coordinated community worker and local services in wards – schools, clinics, children’s services, NGOs etc5. CBO community mobilization model 1. Train leaders to educate and support members 2. Social action to reduce social risks eg alcohol, violence, OVC 3. Inclusion of vulnerable groups (‘mainstreaming’) 11
  12. 12. CSW models Thank you 12

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