This document outlines models for implementing sex work interventions in Gauteng Province, South Africa. It summarizes the situation analysis of sex work, including high rates of HIV and poverty driving transactional sex. Interventions discussed include peer education, increasing access to primary healthcare and social services, and addressing social vulnerabilities. Research shows that combined prevention through these models can increase condom use and knowledge, though may not directly reduce new HIV infections. Lessons learned emphasize providing widespread coverage of peer education, health services, and addressing social risks through skills training and poverty relief. Models that show effectiveness include a peer education model, increasing primary healthcare utilization, and mobilizing communities to reduce risks.

1. DEPARTMENT OF HEALTH
SEX WORK IN GAUTENG PROVINCE
Models for implementation
MODELS AND RESULTS
22nd August 2012

2. 1. Situation Analysis of Sex Work
1. Poverty and survival of young women
1. Low education, no ID, unemployment
2. Some are abused or abandoned
3. “Lifeskills” and vulnerability e.g. OVC
2. Informal settlements at mines:
40% of pregnant women HIV positive by 2002
1. 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/
trucks
2. Social norms which accept transactional sex
3. HIV rates over 50%
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3. 2. CSW Interventions
A. Social prevention and protection for young women
1. Vulnerable poor young women and OVC : parenting
2. Increase education, lifeskills, training, income for young
women
3. Reduce violence, substance abuse, exploitation
4. Delay sex, reduce partners, increase safety for girls
5. Improve social norms for transactional sex
B. Peer education with social support
1. Peer education on best practice model (PSG): high
outputs
2. Recruit, train, support and manage CSW educators
3. Provide social support and services
4. Organization of CSW e.g. hotels, hostels and safety
5. Support for children and link to families
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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
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5. 3. CSW logical framework for results
Plan M&E Indicator Source
Goal Impact Reduced new HIV in youth (15-24), adults Surveys of HIV
Strategic Out-come 1. Increased social norms e.g. Behavioural
objective 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 Services
Manage- Process Quality and coverage Audit of services
ment Guidelines, training, M&E system Registers
systems Management of CSW projects Reports
Resources Inputs Budget. Number of educators Financial, HR
Supplies of condoms and materials Delivery notes
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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 : ? Reasons
2. 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 risks
3. KYE report : refer to presentations
4. Meta-analysis of HIV prevention by CIET :
A cascade = ‘combination prevention’
= social, behavioural and medical combined. 6

7. Research continued
4. 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, brothels
5. 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 2008
6. High HIV rates in sex workers : 60% plus
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8. Lessons from implementation
1. Combined prevention for CSW =
Peer education + social support + health + social
services
1. 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, female
2. Measure outcomes with behavioural surveys every
3 years :
Use BSS by FHI to compare across time and groups
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9. Lessons ….
4. Access to primary health care services :
1. Including ‘SRH’ : FP, TOP, ANC/PMTCT/MCH, STI
etc
2. HIV and TB, other services
5. Access to social services :
Children, rehab, shelter, IDs, grants etc
6. Training for income : Labour Dept, EPWP, CWP
7. 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
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10. MODELS THAT WORK
1. 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 organization
2. 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
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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), ECD
4. 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 etc
5. 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’)
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12. CSW models
Thank you
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