THE SADC GENDER PROTOCOL SUMMIT 2014 Project TSEPO (Hope) HIV prevention interventions with sex workers, to reduce the rate of infection amongst sex workers and their clients. Lesotho, 2014 Nkomile Mpooa “When a man is denied the right to live the life he believes in, he has no choice but to become an outlaw.” Nelson Mandela. 50/50 BY 2015: DEMANDING A STRONG POST 2015 AGENDA

SYNOPSIS HIV was declared a national disaster in This result into increased loss of family incomes, increased vulnerability, and increased number of orphans among others. 23% of the population already infected with HI virus (DHS 2009). One of the most important ways to reduce the spread of this deadly virus is to work with the vulnerable groups such as sex workers where HIV is most likely to be transmitted. Commercial sex workers are among some of the most at risk population groups in Lesotho. Yet despite their high rates of infection, currently very few HIV programmes in Lesotho target this high risk group. Comprehensive HIV prevention and testing programmes are needed to reach out to this population group, to reduce the high rates of infection, both within this group and in the population at large.

OBJECTIVES Increased knowledge of HIV & AIDS and forms of prevention. Change in attitudes and values of sex workers and clients to HIV prevention and the use of condoms Improved access to reproductive health services – condoms, STI check-ups, HIV testing Behaviour change amongst sex workers resulting in consistent condom use, and reduced exposure to high risk situations. Establishing Voluntary Loans and savings (VSL) amongst sex workers to lessen their dependency to sex work. 50/50 BY 2015: DEMANDING A STRONG POST 2015 AGENDA

BACKGROUND Historically and contemporarily, sex work in Lesotho tends to be driven by poverty. The exchange of sex for money or favours has been an aspect of survival for many women in Lesotho since the late nineteenth century. High levels of unemployment, low income and inadequate educational attainment comprise the major structural factors that contribute to poverty; these fore mentioned factors drive women to external or internal migrancy to seek income-generating activities, sometimes resulting in sex work. sex work in the country, both the more commercialized aspects involving anonymous partners with cash exchanges for instant sex, and more transactional relationships involving forms of social and sexual exchange, remain a survival strategy adopted by women and girls to sustain themselves and their dependents.(Bokwena 2008) 50/50 BY 2015: DEMANDING A STRONG POST 2015 AGENDA

BACKGROUND 50/50 BY 2015: DEMANDING A STRONG POST 2015 AGENDA A certain proportion of women engage in sex work as an extra form of income, while majority are in need of the income in order to stay out of poverty. CARE Lesotho launched a project Ts’epo in 2010 an integrated project utilising tried & tested strategies to reach out to this high risk population group. CARE Lesotho in collaboration with Ministry of Health invested in developing staff capacity, materials and relationships with sex workers in Maseru and Maputsoe in the Leribe district. CARE used the lessons learned from our partnership with different donors, as well as CARE’s experience of effective and empowering sex worker programmes in South Asia.

KEY ACTIVITIES Peer Education Manual has been developed under Project Ts’epo and 225 SW from Maseru were trained in peer education, 70 were selected as Peer Educators. A series of follow up training were conducted for 38 SW from Maseru and Maputsoe, of whom 27 remain active. Educational Campaign – CARE conducted public education campaigns targeting the sex worker community, to complement the awareness created through the peer education programme. Health Promotion Days this is approach of encouraging all sex workers to take a set of tests to check their health including – sexual and reproductive health status including HIV. 50/50 BY 2015: DEMANDING A STRONG POST 2015 AGENDA

KEY ACTIVITIES Red Umbrella Campaign – This activity is used to tackle violence, stigma and discrimination issues around sex work. This was also done to celebrate the International Day of No Violence against Sex Workers on December 17th as an excellent strategy to address violence against sex workers. Provision of condoms, information and referral linkages – This was done to ensure that condoms are available at the bars, streets and places where sex workers are likely to hang around & HIV information leaflets relevant and appropriate to sex workers are available. This also included HIV and STI testing as well as referral for relevant follow up services thereafter. Initiate Support Group among sex workers – sex workers are assured of a confidential environment where they can share the challenges they face living with HIV & offer support to each other. 50/50 BY 2015: DEMANDING A STRONG POST 2015 AGENDA

RESOURCE ALLOCATIONS 50/50 BY 2015: DEMANDING A STRONG POST 2015 AGENDA Amount local currency (specify) Amount in Rand Gender specific allocation Gender in mainstream projects (please specify) Amount contributed in cash or in kind by partner organisations (please specify) M R M R TOTAL

BENEFICIARIES 50/50 BY 2015: DEMANDING A STRONG POST 2015 AGENDA CATEGORYWOMENMENTOTAL% WOMEN Direct beneficiaries e.g. number of parliamentarians trained 400 Indirect beneficiaries (e.g. through other networks) Online beneficiaries (e.g. website access, mailing lists, scholarly articles) 25 Total 425

CHALLENGES Sex workers have been concerned about a unit within the police department, whose members have been physically violent against sex workers. Most sex workers show interest when talking about Sexual and Reproductive Health issues but rarely seek medical assistance because of reported discrimination by nurses and other health staff. There is less demand and also a challenge around accessing the female condoms which could be more useful to the SWs, regardless of the information given to the sex workers on how to use them however CARE has been scouting for female condoms. It is difficult for peer educators to hold education sessions because sex workers do not have the confidence in them and the fact that they are carried out during working hours. 50/50 BY 2015: DEMANDING A STRONG POST 2015 AGENDA

CHALLENGES SWs are known to be sex workers but individually they want to remain anonymous. This makes it difficult for programming and advocacy for non violence or any other services that SWs may need. Some of them are believed in their homes to be doing a different job and therefore would not want to be known. Due to the work that the SWs are doing, during the HIV meetings there are always new members which makes slow progress in the HIV prevention trainings since all members have to be at least on the same level of understanding. The meetings that are held are usually at night where we can have access to more SWs. This is also a challenge as some will leave just in the middle of the training to be with the client. 50/50 BY 2015: DEMANDING A STRONG POST 2015 AGENDA

CHALLENGES There are a number of organisations working with SW around Maseru. These organisations provide huge incentives which CARE cannot afford. Bearing in mind that the ladies are out in the night for money, this becomes a challenge because the SWs are then reluctant to work with CARE for lesser incentives. Even though there has been some collaborations with some of these organisations, a lot of work still needs to be done to encourage SWs to do the HIV prevention activities for lesser incentives. 50/50 BY 2015: DEMANDING A STRONG POST 2015 AGENDA

MONITORING AND EVALUATION We used quantitative and Qualitative methods to measure impact. Bio weekly night visits were done with sex workers.(spot check) 50/50 BY 2015: DEMANDING A STRONG POST 2015 AGENDA

MONITORING AND EVALUATION Peer educators report on monthly basis. Statistics is obtained from clinics that sex workers are referred to. One on One monitoring is done with sex workers and project officers 50/50 BY 2015: DEMANDING A STRONG POST 2015 AGENDA

RESULTS Women’s empowerment Series of sex workers were trained on different issues among them were Human rights and Sexual Reproductive health Rights. As part of Improving livelihood opportunities and alternative sources of income to reduce sex worker’s dependency and need to engage in risky sex, Peer Educators formed a Voluntary Saving and Loans (VLS) group called Work. 50/50 BY 2015: DEMANDING A STRONG POST 2015 AGENDA

RESULTS Capacity Building Ten SWs had exchange visits to SWEAT in Bloemfontein to learn for SA SWs on advocacy and Human rights issues 50/50 BY 2015: DEMANDING A STRONG POST 2015 AGENDA

RESULTS Change in attitude. Different stakeholders could now engage at a personal level with sex workers without grouping them. Sex workers after training indicated that they are now confident to negotiate condom use between them and their clients. 50/50 BY 2015: DEMANDING A STRONG POST 2015 AGENDA

LESSON LEARNED AND INNOVATION Peer Education - in his book “changing the course of HIV”, Professor Dickinson has showed that peer educators are often the link between workers, HIV and AIDS prevention programs and services. With the peer education manual that was developed to equip the sex workers with not only the knowledge but also the skills to assist in HIV prevention. Duration of project – A project of this nature, that deals with behavioural change require a longer implementation timeframe in order for the full impact of the project activities to register. This is due to the need of mobilisation, training, confidence building and practice of the knowledge that requires a lot of time. IEC Materials – HIV prevention issues for the high risk groups require careful planning and design of IEC materials to promote behavioural change. With the limited budget not a lot of IEC materials were developed specifically for the sex workers. There has been a lot of IEC material related to HIV prevention, however, specific information is needed for this specific group. 50/50 BY 2015: DEMANDING A STRONG POST 2015 AGENDA

Cont. Scope of the project – There has been a narrow focus on providing HIV and AIDS related information and services and not the related activities such as factors that result in them being in the high risk category. Dealing with the high risk groups, demand that a number of issues that are linked to HIV prevention for example, violence in the case of CSW be addressed in collaboration with prevention initiatives. Communication of the project objectives to all stakeholders - This could lead to less support from the relevant stakeholders which could hinder implementation of some HIV prevention activities.

LEARNING AND SHARING WITH OTHER COUNCILS CARE held a series of meeting with LPPA, WLSA and FIDA on women’s rights to develop a longer term approach to holistically addressing key issues of sex workers resulting in increased safety, security, mutual support and dignity for women engaged in sex work. Value clarification trainings were also done targeting service providers including Nurses and police. 50/50 BY 2015: DEMANDING A STRONG POST 2015 AGENDA

SUSTAINABILITY AND REPLICATION The project can be replicated in other areas of Lesotho and through the region; the methodology of implementation was well documented. In fact BSS is currently run by JHU in collaboration with PSI funded by USAID on most vulnerable groups in the country that is MSM and Sex workers which will in future influence programs that target these groups. Criminalizing sex work has negative consequences for health and rights of sex workers and clients. Certain sexual behaviour can lead to reinforced HIV and AIDS related stigma, spread misinformation about HIV, and disincentives voluntary HIV testing treatment and Care. 50/50 BY 2015: DEMANDING A STRONG POST 2015 AGENDA

KEY PRIORITIES FOR 2014 Training of 100 FSW on SRH Peer educator recruitment and (refresher) training. Biweekly FSW network meetings Condom use counselling and distribution Adherence buddy system for HIV positive FSW Service referrals Exchange visits with SWEAT in South Africa Advocacy training and campaigns to address legal reform Establishment of more VSL groups 50/50 BY 2015: DEMANDING A STRONG POST 2015 AGENDA

Girls in action

The End LET US ALL PROTECT SEX WORKERS SOME ARE THERE BY CHOICE SOME ARE THERE BY CIRCUMSTANCES