Maria Stacey Joint Committee on HIV/AIDS 24 May 2013 Beginning to Build the Picture: What do we know about Sex Workers and HIV in South Africa? Maria Stacey Joint Committee on HIV/AIDS 24 May 2013

Sex work: a definition “…any agreement between two or more persons in which the objective is exclusively limited to the sexual act and ends with that, and which involves preliminary negotiations for a price. Hence there is a distinction from marriage contracts, sexual patronage and agreements concluded between lovers that could include presents in kind or money, but its value has no connection with the price of the sexual act and the agreement does not depend exclusively on sexual services.” ( Regional UNAIDS workshop on sex work in West and Central Africa in 2000)

Background Sex work is illegal in South Africa Despite their vulnerability, sex workers remain a largely invisible, inadequately served and marginalised population. Sex workers face:  health risks  violence  obstacles to gaining access to: health care legal recourse social services

How many sex workers are there? National Sex Work Population Size Estimation Study Commissioned by SANAC Conducted by SWEAT Intermediate estimate= sex workers (female, male and transgender)

How many sex workers are there?

How many sex workers are there ProvinceEstimate Gauteng Mpumalanga Limpopo North-West Free State KZN Eastern Cape Northern Cape5 436 Western Cape17 112

Sex Workers and HIV in South Africa Poor data, under-researched area HIV prevalence rate 59.6% 19.8% of new infections sex work related (5.5% sex workers, the remainder clients and clients partners) 5% of sex workers have access to HIV prevention services

SWEAT’s approach Peer-driven outreach and development Address sex workers health through individual and group interventions: information, counselling, referrals, dialogue Address contextual and structural impediments to health care: stigma, discrimination, criminalisation Respect sex workers choices to remain in the industry or transition out of industry. Provide individualised, realistic support to those wanting to exit.

SWEAT’s approach Cape Town office as “innovation laboratory”. New interventions introduced and evaluated. Expertise shared with stakeholders through sensitisation and training. Strategic partnerships e.g. Women’s Legal Centre; TB/HIV Care from 2011 Hosts Sisonke, ASWA SWEAT believes adult consensual sex work should be decriminalised as it is both a human rights and a public health issue

National Sex Worker Programme SWEAT SR for GF Round 9: Civil Society Grant April 2011-March 2016 SWEAT coordinates the programme, sub- grants to 8 organisations in 6 provinces Targets initially modest, to be increased substantially for Phase 2 (October 2013) to 56 sites

Location of SSRs GEORGE: George Municipality BEAUFORT WEST: PSH RUSTENBURG :LLAC EAST LONDON: ELHTA DURBAN: LIFELINE JHB: WrHI MUSINA: CPC CAPE TOWN: SWEAT BARBERTON: PSASA

Components of Global Fund National Sex Work Programme Peer Education Outreach Risk Reduction/Life Skills Workshops HCT + National Helpline + Stakeholder training and sensitisation

National Sex Work Survey (2012) Objectives Evaluate national programme Survey sex workers: demographics, sexual and risk behaviour, access to services, HIV knowledge Baseline for future evaluations Assess information for UNGASS indicators (previously no data available for SA UNGASS report)

National Sex Work Survey (2012) Findings 1136 sex workers interviewed at 7 sites 91% Female, 5% Male, 4% Transgender 63% over 25; 34% aged 18-25; 3% under 18

Findings: Sex work locations “Where do you pick up clients?

Findings: Violence “Have you experienced violence in the past 12 months? If so, by who?”

Findings: Sexual health and behaviour

Findings: Impact Sex Workers who had been exposed to the SWEAT National Sex Work Programme had: Higher condom use Better knowledge of HIV preventions

Lessons learnt from National Sex Work Programme 1.Sex Worker peer educators essential component to access a “hard-to-reach” population, and to negotiate the complexity of sex work 2.HIV prevention as a vehicle to address holistic personal development. Conversely, sex worker personal development achieves multiple outcomes which address HIV risk 3.Specifically, addressing gender-based violence increases success of HIV prevention programmes by 25%

Lessons learnt from National Sex Work Programme 4.Risk reduction workshops (“Creative Space” workshops) are an important dimension: to deepen engagement, provide safe space, opportunity for mutual support 5.Empowerment of sex workers, strengthening of sex worker community, framing sex work as work – esssential structural activities 6.Even when organisations are constrained from addressing the legal status of sex work, human rights defence and access to justice are essential components (Sex Workers report police harassment, abuse, violence and arrest as their primary concern)

Thank you Maria Stacey SWEAT Phone: Helpline PCM