Sex workers- a key population


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Presentation by Andrew Scheibe, at the National Sex Work Symposium, in the session 'Recommendations for South Africa' (Boksburg, 22 August 2012).

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Sex workers- a key population

  1. 1. Sex Workers – a Key Population Andrew Scheibe, MBChB Sex worker symposium Boksburg, 22 August 2012
  2. 2. Overview• Background• Methods• Outcomes• Limitations• Recommendations• Key Points
  3. 3. Key Populations• Refers to people most likely to be exposed to HIV or to transmit it• Their engagement is critical to a successful HIV response• Includes people living with HIVSource: South African National Strategic Plan on HIV, STIs and TB (2012 – 2016)
  4. 4. BackgroundAim• Provide evidence-informed recommendations to improve HIV interventions targeting key populations in South AfricaObjectives• Gaps – knowledge, policy, programming• Stakeholder consultation & consensus building• Recommendations for National Strategic Plan– Men who have sex with men (MSM)– Sex workers– People who inject drugs and other drug users– Migrants and mobile populations– Detained persons and prisoners
  5. 5. Methodology for key population gap analysis Stakeholders identified Stakeholder engagement Electronic contact (165)December Telephonic interviews (12) 2010 Face-to-face interviews (6) Literature review Peer reviewed articles, grey literature, guidelines, progress reports (>170 documents) Key informant feedback Electronic feedback of template (150 sent out, 21% response rate) Workshop participation Stakeholder consultation June Regional workshops Pretoria workshop (n=60) 2011 Cape Town workshop (n=41) National workshop SA AIDS conference workshop (n=72)September 2011 Consolidation of recommendations
  6. 6. OutcomesSeptember 2011Policy brief developedCirculated at NSP summitOctober 2011Key Populations, KeySolutions report publishedDecember 2011NSP launchedIncluding Key Populations
  7. 7. Limitations- Obtaining diverse participation in process- Limited data on key populations- Poor response to electronic requests for information
  8. 8. Sex worker vulnerabilitiesVulnerabilities Current situation in South Africa Lack of specialised services Scanty and ineffective public and donor fundingRestrictedaccess to Condom available in primary health clinics, but limited in sex work settingshealth services Syndromic treatment of symptoms within general STI services limited Limited access to health information and family planning counselling.Restricted Laws against gender-based violence seldom enforced, police do not act on sexaccess to legal worker complaintsprotectionUnsafe work Unsafe venuesconditions Obtaining clients and negotiation often occurs in alcohol settingsStigma Difficulties in negotiating safe sex Judgmental health care workers Despite the threat of fines or imprisonment, women enter sex work in response toEconomic the demand for paid sex and pressures of providing for dependents, as they havevulnerabilities few alternatives Source: Richter, 2010
  9. 9. Findings: HIV epidemiologyLocation Date Prevalence Sample MethodsKZN 1996/7 50% 145 Cross-sectional survey, truck stops. (Ramjee, Abdool Karim, & Strum, 1998) KZN 1996/9 56% 472 Screened for HIV-positive cohort study. (Connolly et al., 2002)Joburg 1998 45% 247 Outreach recruitment (Rees et al. 2000)Carletonville 1998 69% 121 Cross-sectional surveys (Williams et al., 2003)Joburg 1996/7 46% 295 Cross-sectional survey among female sex workers. (K. L. Dunkle et al., 2005)CT, DBN, 2001 17 – 66% 249 Cross-sectional survey, results stratified byJoburg race (Leggett, 2008)Durban 2004 60% 775 HIV prevention trial (van Loggerenberg et al., 2008)CT, DBN, 2005 34% 67 A rapid assessmentJoburg (Parry, Dewing, et al., 2009)Joburg 2010 26% 343 Sex workers attending health services at brothels (Sibanyoni, Gay, Venter, Klaas, & Motlokoa, 2011)
  10. 10. Recommendations (1)Address knowledge gaps• Conduct more research on sex work and sex worker needsDecriminalisation & protection of sex workers• Decriminalisation of sex work and removal of criminal laws and municipal by-laws• Protection of sex workers under existing labour & occupational health and safety lawCapacity building• Capacity building of sex workers is required for them to exercise their rightsIncreased representation• Increase sex worker presentation and participation in the HIV response
  11. 11. Recommendations (2)Sensitisation training• Sensitisation training programmes for key stakeholders (HCW, police, customs officials, journalists, judiciary, and teachers)Improved access to comprehensive package of health services• Access to sexual and reproductive health services, including: – HCT and ART – STI and TB screening and treatment – Family planning and termination of pregnancy services – Medical male circumcision – PAP smears and – Access to mental health and substance abuse services
  12. 12. Recommendations (3)Sex worker specific health services• Where sex work prevalent – specialised clinics & mobile services providing: – Peer educators to provide condoms (particularly female condoms) and lubrication – IEC materials and linkages to services for sex workers, their clients – General public education and anti-stigma campaigns• Where infrequent - integration of sex work- friendly services
  13. 13. Key Points• Sex workers are a Key Population• Documented vulnerability to HIV due to various factors, not due to sex work per se• High HIV prevalence indicates that services to date NOT effective• Essential to include sex workers as a focus for national HIV prevention efforts• Key Population, Key Solution was a part of this journey
  14. 14. Resources• Key Populations, Key Solutions – policy• Key Populations, Key Solutions – 1/2011_-_key_population_report.pdf
  15. 15. AcknowledgementsBen Brown Marlise Richter Helen Rees Roeleen Booi Tabiso Chaka-RamelaZoe Duby Monika Dos Santos Francois Venter Geraldine PienaarLinda-Gail Bekker Sally Shackleton Danga Mughogho John Mkandawire Kholi ButheleziHeston Philips Cynthia Totten Zwoitwajo Nevhutalo Mikey Meji He-Jin KimOlga Lyan Karen Kraan Brian Tkachuk Liesl Theron David Bayever Pascal ManiniNono Simelela Miriam Sabin Sibongile Shoba Robert HamblinCatherine Sozi Bret Miner Carlos Toledo Eleanour Gouws Alex Semba Ashika MaharajGerrit Maritz Anindya Chatterjee Elizabeth Weich Marina Rifkin Allanise CloeteDavid Makapela Luisa Frescura Bronwyn Myers Charles ParryDabea Gaboutloeloe Nelly Mary Apiyo Oscar Radebe Jill Hendersen Andreas PluddermanSikhulilie Ngqase Tim Barnett Mwaka Kevin Rebe Sarah FisherJo Veary Petal Petersen Brian Kanyemba Glenn de Swardt Robert MacDonaldSasha Gear Tara Carney Lavinia Brown Stacey-Leigh Manoek Amanda BrinkmanFranz Trautman James McIntyre Elise Batist Miriam ChipimoJohn-Peter Kools Helen Struthers Nienke van Schaik Elsa Oliveira Paul BoyceDavid Burrows Aretha Louw Deon Benetatos Alex Hamblin Oratile MosekiAncella Voets Nonandi Diko Mmapaseka Letsike Greer Schoeman Dawie Nel Naomi Webster Gerard Lombard