Panos | 1 Oct 2008

By Kristin Palitza

Without the decriminalisation of sex work it will be almost impossible to reduce sex workers’ risk of HIV infection, experts say. Because sex work is regarded as a crime in South Africa, sex workers are particularly vulnerable to violence and largely unable to negotiate condom use with their clients. As a result, it is difficult for them to practise safe sex.

“Human rights and health issues are integrally linked. The continued criminalisation of sex workers has contributed to their stigma, isolation and violation of human rights,” says Vivienne Lalu, training coordinator of the Sex Worker Education and Advocacy Taskforce (SWEAT). “Rather than investing large amounts of resources in criminalising sex workers by policing and prosecuting them, the state would achieve more if it concentrated on the health needs of sex workers.”

A number of South African NGOs, including SWEAT, lobby for and advocate the decriminalisation of sex work, demanding the removal of laws that make adult commercial sex work and aspects of the sex work industry a crime. In 2002, SWEAT submitted a request to the South African Legal Reform Commission to change the Sexual Offences Act of 1957, which criminalises sex work in the country. But so far, the law has not been reformed.

“We don’t have any comprehensive research data on the link between criminalisation of sex work and HIV infection, but through anecdotal evidence we know for a fact that criminalisation leads to both increased violence and less access to health information and care which in turn increases the risk of infection with the virus,” explains Lauren Jankelowitz, technical advisor for the sex worker project at the Reproductive Health and Research Unit (RHRU), University of the Witwatersrand in Johannesburg.

The fact that most sex workers are women, that their work is illegal and that they are shunned by their communities exposes them to exploitation. “They are often forced to work in isolated and remote areas, which makes them vulnerable to violence and abuse, but also makes it very difficult for intervention projects to locate them to do prevention work,” says Lalu.

Violence takes many forms and comes from various quarters. Police harass sex workers, sometimes forcing them to offer free services in exchange for not being arrested. “Police officers often confiscate condoms as proof that the women or men are sex workers. As a result, sex workers are wary of carrying condoms on them or at least enough to last for the night,” says Lalu.

What makes matters worse is that pimps and managers threaten and coerce sex workers to do things they don’t want to do, and clients force them to perform sex acts other than those originally agreed to. “The illegal nature of sex work in South Africa makes it extremely difficult for sex workers to negotiate condom use with their clients. In some instances insisting on condoms has resulted in increased levels of violence against them,” further explains Lalu.

The criminalisation of the industry and the stigmatisation of sex workers also mean that few sex workers are able or willing to report incidents of violence to the police or to access health and support services.

Due to the nature of the work, sex workers need to be especially well informed about HIV prevention and need to be extremely proactive in taking precautions against contracting the virus. The lack of HIV prevention and health promotion services directed at sex workers means however that they find it difficult to get hold of condoms and safer sex and health information which they cannot obtain from traditional sources because of stigmatisation and fear of being arrested.

“Until sex workers have full and unhindered access to protection, health and legal services, they will not be in a position to insist on safer sex practices and will remain at risk of contracting HIV,” notes SWEAT researcher Helen Alexander in a 2001 research paper on “The impact of violence on HIV prevention and health promotion -The case of South Africa”.

As a result, levels of HIV-infection among sex workers in Southern Africa are high, with almost seven out of ten carrying the virus, according to the Council for Scientific and Industrial Research (CSIR). Although sex workers know the ‘facts’ about HIV and AIDS, condom use remains extremely rare, notes CSIR researcher Zodwa Mzaidume.

“Women say they lack the economic power to insist on condoms if paying clients refuse to use them. They also lack the psychological confidence to insist on condom use in a strongly male-dominated culture,” Mzaidume explains. If a sex worker refused to use a condom, the client would simply find a more willing woman next door.

Because criminalisation forces sex work underground, sex workers have found it difficult to organise themselves in any significant way to fight for their rights. Although in 2003, South African sex workers formed the Sisonke movement, a national body aimed at lobbying for their rights, their success in improving their working conditions has been limited. “Since sex workers are regarded as criminals and highly stigmatised, it is very difficult for them to run the organisation publicly, have a spokesperson, for example,” explains Lalu.

SWEAT supports the development of the Sisonke movement with logistical assistance and by running safer sex and life skills workshops as well as skills training programmes for its members. The organisation also provides sex workers with information about HIV, sexual health and free condoms. But before Sisonke can succeed, the laws around sex work in South Africa have to be changed, says Lalu.

Apart from demanding the decriminalisation of the industry, NGOs would like to see better health care provision for sex workers. “We need to take more clinic services into brothels and areas where they are working. There is also a need to educate doctors and nurses about the specific needs of sex workers when it comes to reproductive and sexual health,” says Jankelowitz.

There is also a call for more roadside clinics in remote areas of the country that are open throughout the night to provide health services for sex workers and their clients, such as voluntary counselling and testing (VCT) as well as treatment of sexually transmitted infections (STIs), according to Xolani Tshandu, project coordinator at the Planned Parenthood Association of South Africa (PPASA): “At the moment, we only have ten such clinics countrywide, but we need many, many more.”

South Africa also needs more skills training and exit programmes for sex workers to help those who want to leave the industry to do so. Says Jankelowitz: “We need long-term solutions, rather than short-term interventions. But it all starts and ends with decriminalisation. There is no other way to go.” /2010 Features