WE HAVE FINALLY WOKEN UP TO THE NEED TO REACH SEX WORKERS COMPREHENSIVELY K Mangold, C Nogoduka, N Mungoni, F Abdullah 24 July 2014|International AIDS Conference South Africa Launches the National Sex Worker HIV Treatment and Prevention Programme

South African Constitution – Including non-Discrimination on the basis of sexual orientation Sex work is criminalised The South African constitution enshrines the right of all people in South Africa to be free from discrimination on any basis The ongoing criminalisation of sex work undermines several constitutional rights; it increases the overlapping vulnerabilities of sex workers including violence, abuse by law enforcement officials, harassment, HIV acquisition and lack of access to health and justice services.

In spite of this, sex workers still experience high levels of human rights violations in South Africa

Sex Workers experience a disproportionate burden of HIV in South Africa… The HIV prevalence of sex workers in South Africa is estimated at around 60% Modelling estimate that sex workers, their sexual partners and clients account for 6 to 11 per cent of new HIV infections in South Africa An estimated sex workers live in South Africa …In spite of the high risk, national programmes have been slow to address Sex Workers in HIV prevention & treatment efforts

The current NSP identifies sex workers as a key population and priority group for intervention ‘ For the first time, the NSP raises the importance of providing HIV treatment and prevention to key populations. This is in fact seen as one of the highest priority interventions and the NSP makes it very clear that key populations need a comprehensive response including treatment, prevention, access to justice, dealing with violence and substance abuse as well as strengthening implementing organisations ‘

SANAC Development of the National Strategic Plan for HIV prevention, care & treatment for sex workers Principles Sex workers are equal citizens Sex workers’ rights and dignity must be respected Sex workers are not victims by virtue of being sex workers Sex work is a livelihood option Sex worker ownership: “nothing about, us without us” Evidence-informed response Interventions should not do harm Collective sex worker engagement, mobilisation and empowerment essential for success

This plan was translated into action by following these steps:

Peer Education Skills development and income generation Challenge legal barriers Educate clients of sex workers Improve access to health services Deal with human rights abuse & violence Funded by: Global Fund NDoH SANAC PEPFAR Implementers: GF money flows through SANAC CCM and NACOSA to 18 local NGOS PEPFAR will build on existing programmes of 3-4 NGOS NDoH funds HTA programmes in provinces SANAC will fund the management and coordination of the programme as well as fund raise for further scale-up It took one year from strategy development to the programme being rolled out at a national scale

This is the logic model upon which the national programme is structured

Key aim: Improved Sex Worker Services & Enabling Environment Treatment & Clinical Services -- WHRI Surveillance – UCSF Evaluation and Research – HDA, HSRC Capacity Development - ICAP, SA PARTNERS, UCSF Combination Prevention – HDA, Reaction, TB/HIV Care Association, WHRI PEPFAR has a growing portfolio of programmes in South Africa for Sex Workers

In 2011, PEPFAR funded programmes provided HCT to 1755 sex workers. In 2012 this rose to 2393 and in 2013 this number was reported to be 8442

National Sex Worker Programme Scale Up HIV prevention and treatment programmes in South Africa for Sex Workers COMPONENTINFORMATION IMPLEMENTATION AREA Nationally in South Africa, 9 provinces, 60+ sites based on mapping exercise SUB-RECIPIENTS 18 Sub-recipients, one lead Sub-recipient providing programme support and training IMPLEMENTERS 560 Peer Educators 56 Site Co-ordinators (10 Peer Educators overseen by a Site Coordinator) MODEL Peer Educators, existing or previous sex workers working part time to reach out to sex workers providing HIV prevention education, condom distribution, HIV counselling and testing or referrals for testing, referrals to a range of SRHR and TB services, legal and human rights support when needed, risk reduction workshops BUDGETUSD 11,021,868 over 2.5 years

Nationally sex workers have been reached so far with outreach work and 2665 have been tested for HIV Sex workers reached through peer outreach Sex workers who had HCT Figure 1: Provincial breakdown of sex workers reached

The inclusion of key populations as a focus in the National Strategic Plan for HIV, STIs and TB gives solid grounding and support to the success of a sex worker programme that is national, multi-sectoral, comprehensive and coordinated Even in a country where sex work is criminalised, a national unified response is still possible The existence and acceptance of a number of local projects run by NGOs in different parts of the country enabled a coordinated scale up to occur in a short period of time. Sex worker organisations must play a leading role from the beginning Informed discussion among key HIV policymakers is critical to legitimise the need for sex worker specific HIV programmes Lessons Learnt

Kerry Mangold et al Sally Shackleton and Maria Stacey (SWEAT) Kholi Buthelezi (SISONKE) Marieta de Vos and Maureen van Wyk (NACOSA) Helen Savva (CDC Pretoria) Dr Jana (SONAGAJI) Acknowledgements

South Africa has realised that in order to turn the tide of the epidemic, a co-ordinated public health approach – lead at a national level – is particularly strategic in a context where sex work is illegal and mobility is high THANK YOU