Sex work and HIV incidence in South Africa: what do we know?
SEX WORK AND HIV INCIDENCE INSOUTH AFRICA: WHAT DO WEKNOW? Mr Tshepo Molapo Sex workers symposium 22-24 September 2012 Birchwood, Johannesburg
WHAT WILL BE PRESENTED? Introduction Background New HIV infections and sex work in South Africa How does incidence TRANSLATE when it come to HIV prevalence among sex workers in South Africa Implications for programmes
INTRODUCTION Globally, sex workers (SW), have been shown to be at disproportionate risk for HIV infection. Sex workers (Female) are a population who are at heightened risk of HIV infection secondary to biological, behavioural, and structural risk factors. Multiple and concurrent partners, casual encounters Because they are often marginalized by society and greatly affected by discrimination and stigma, these groups have become some of the most at-risk populations for HIV infection. SWs form part of “key populations”.
BACKGROUND High levels of prejudice and moral loading has been shown to create barriers to accessing prevention, treatment, care and support – increasing vulnerability to HIV. Insufficient consensus around HIV incidence and prevalence in this key population have led to uncertainty around the perception of risk of HIV acquisition
WHAT ARE THE ESTIMATES WHEN IT COMESTO HIV INCIDENCE AND SEX WORK IN SOUTHAFRICA? As part of the Know you epidemic/Know your response (KYE/KYR), SACEMA was tasked with running a model for South Africa in 2009.
THE MODES OF TRANSMISSION(MOT) MODELThe MoT model is static, and provides a short-term projection based on current HIV prevalence levels and behaviours. The adult population is segmented into six closed subpopulations, namely Injecting drug users (IDU’s) and their partners Sex workers (SW’s), the clients of SW’s and the clients’ partners Men who have sex with men (MSM) and their females partners Individuals engaging in casual heterosexual sex (CHS) and their partners Individuals engaging in low-risk heterosexual sex Individuals at no risk
MODEL INPUTS (SOURCES)Estimates from national South African surveys were used where possible. The three main surveys that provided data for model inputs are: The National HIV and Syphilis Prevalence Survey: by the National Department of Health and involves the surveillance of women attending antenatal clinics. The Demographic and Health Survey (DHS): conducted in 1998 and 2003. The National HIV Prevalence, Incidence, Behaviour and Communication Survey: by the Human Sciences Research Council (HSRC); the Medical Research Council (MRC); the Centre for AIDS Development, Research and Evaluation (CADRE) and the South African National Institute for Communicable Diseases (NICD). Estimates from smaller studies in South Africa and studies in other regions, as found in published literature, were also used as model inputs. Such estimates were particularly useful for describing the characteristics of the smaller, high-risk groups such as SW’s or MSM.
MODEL OUTPUT: NEW HIV INFECTIONS ESTIMATED DATA 19.8% of all new HIV infections in South Africa are related sex work (SACEMA) Percent of new HIV infections, group only (5.5 %) Percent of new infections, group and their partners/clients (19.8 %)
HOW DOES THIS TRANSLATE IN TERMS OF DISEASE BURDEN – HIV PREVALENCE AS A START Meta-analyses of aggregate country data comparing HIV prevalence among female sex workers and women of reproductive age in low-income and middle-income countries, 2007–11. (Lancet Infect Dis 2012;12: 538– 49) Method: Systematic review of 434 articles and surveillance reports representing 99 878 female sex workers in 50 middle income countries.
STUDY FINDINGSHIV 95% CI HIV % HIVprevalence prevalence infectionsamong among amongfemale sex female femaleworkers population sex workers59·6% 56.2–63.1 25.32% 5.7%
IMPLICATIONS FOR PROGRAMMES Results indicate the urgency of establishing a national programme for sex workers that includes HIV prevention interventions Further studies of South Africa’s high risk populations, including sex workers and their clients, to obtain estimates of the sizes of these groups and HIV incidence and prevalence among them. “In South Africa, the HIV epidemic is truly generalized with HIV transmitted mainly heterosexually, and high levels of infection by no means restricted to the high-risk groups”.
ACKNOWLEDGEMENTS The SACEMA team• Reshma Kassanjee and Alex Welte• Tyrone Lapidos• Eleanor Gouws (UNAIDS) Dr John Mkandawire (WRHI)