Posted on plusnews.org
JOHANNESBURG, 16 July 2009 (PlusNews) - Southern Africa's sex workers, denied access to HIV prevention and treatment services, are paying a high price to make a living when even government-issued condoms are not always free, according to a new report.
Published by the Open Society Institute (OSI), Rights not Rescue, documents the experiences of male, female and transgender sex workers in South Africa, Namibia and Botswana.
Their research shows that sex workers have to overcome additional barriers to access HIV prevention and treatment, like stigma, hidden costs and a lack of condoms distributed at their places of work.
In South Africa there are serious gaps in the workplace provision of male and female condoms; sex workers reported that supplies were irregular, rationed or accessed at a cost – including government-issued condoms that should be free of charge.
Lubricants were never provided, so sex workers - especially those engaging in anal sex - resorted to using oil-based lubricants such as Vaseline, which could compromise condom integrity.
In Botswana they have difficulty obtaining condoms from local clinics due to the negative attitudes of health workers, who often limit the availability of condoms and accompany distribution with fatalistic and moralizing lectures on sex work and HIV.
The report found that stigmatizing notions of sex workers as "AIDS carriers" persisted in many communities, and had been fuelled by government officials, the courts and legislation.
More worryingly, not enough prostitutes interviewed in the study were coming forward to be tested. None of them knew their HIV status and many feared not only the emotional fallout of a positive result but also the professional consequences, such as a loss of customers or possible criminal charges. In 2008 South Africa and Botswana introduced legislation to criminalize HIV exposure in the context of sexual assault.
In the case of female sex workers, ignorance of their status also adversely affected their children. "There are ladies we know working under the bridge [who] are HIV-positive," said Sunny, a Namibian sex worker. "They don't get antiretrovirals because of the stigma of testing HIV-positive, and because of the fees you need to pay [for services]."
"Their babies get sick and die with no medicine," she told researchers. "There is no money for a funeral so when babies die, all they can do is put them in the river."
The report recommends that the sex industry in all three countries be decriminalized, and that civil society and donors work to strengthen sex worker-led initiatives and targeted interventions to increase HIV awareness and access to prevention and treatment services.
According to Vicci Tallis, of the Open Society Initiative for Southern Africa, the next phase of the project should include activism to strengthening sex worker-led networks across the region.
