In 2010, while almost one in five new HIV infections could be attributed to the sex work industry, less than 5% of sex workers were reached with HIV prevention. Thankfully, four years later, we can say that this is no longer the case. Things have moved very rapidly in the sex work sector. In the past year, the Global Fund-supported national sex work programme, now branded the Red Umbrella Programme, has scaled up rapidly and dramatically.
The programme has gone from eight sites around South Africa to 70 sites in all nine provinces; and from 50 peer educators to 560. Before last year there were eight implementing partners; now there are 19.
These 70 sites were selected to take services to sex workers where they were most needed, and to avoid duplication with other sex worker projects, most notably those funded by PEPFAR.
At these 70 sites, sex worker peer educators, led by a site coordinator (most of whom are also sex workers) implement combination prevention programmes for sex workers. They engage with sex workers wherever they work: streets, brothels, truck stops, shebeens and sex workers’ homes. They distribute condoms and lubricant, provide health and human rights support, and refer for HIV testing and other health, social and legal services. Local service providers are also offered sensitisation training to increase their ‘sex work friendliness’.
Sex Workers Education and Advocacy Taskforce (SWEAT) provincial managers have taken the work into provinces and districts, engaging with Provincial Strategic Plans, and working towards strengthening sex worker inclusion in provincial, district and local AIDS Councils. They also provide support and capacity-building for the 19 implementing partners to ensure programme quality and consistency. –
Maria Stacey, Deputy Director and National Programme Manager, SWEAT
Reaching out to sex workers in Hillbrow
MaPinky is one of the 42 peer educators who work in the outreach programme. She came to become a peer educator through a Sisonke Sex Worker’s Movement ‘creative space’ workshop. She does the work because “if you are facing this, it’s only you who know these things.” MaPinky is only too aware of the issues that sex workers face. “It is hard to do sex work without alcohol or drugs. Sex workers also get raped. You are sex workers mos (you are only a sex worker, after all).”
She counsels sex workers on safe sex, distributes condoms and tells them about the services that the WHRI clinics offer. “Before I came I didn’t know how to speak to people. But then I became friendly and gained trust. Sex workers don’t want to speak, because then people will start judging. Once you think you are better than them, they won’t listen,” she says.
MaPinky says that HIV is the main issue facing sex workers and many male clients offer more money for sex without a condom. HIV is linked to the very high rates of sexually transmitted infections among sex workers and recurrent infections. She also observes that many sex workers default on their HIV treatment as they don’t have time to get their ARVs from the clinics. Through her work, she wants to see sex workers being able to do their work safely.
“We want to do it in a respectful way—in the right place, with the right person.” The sex worker outreach programme is making Hillbrow a safer place for sex workers. They have negotiated with the local police and this has resulted in reduced harassment and violence against sex workers in the area. This is thanks to peer educators like MaPinky, who is giving sex workers in the area a safer work environment and an outlet for their frustrations.
The WHRI sex worker outreach programme is a partner of the Red Umbrella programme and is co-funded by PEPFAR and the Global Fund.