Law nails HIV sex worker scheme

Sex workers, long ignored by the government and harassed by police, will finally get access to HIV treatment and prevention - but decriminalisation has not been dealt with by government and this could hobble the initiative.

Deputy President Cyril Ramaphosa released a detailed plan on Friday to ensure sex workers achieve better healthcare.

About 70% of sex workers in Johannesburg are HIV-positive.

Ramaphosa said sex workers will now receive antiretrovirals as soon as they test positive. Unlike other South Africans they will not have to wait until their CD4 count - the measure of immunity - drops to 500 to qualify.

Truvada, an antiretroviral pill that prevents HIV, will be given to sex workers who are not HIV-positive.

Within a year of becoming sex workers, individuals need to be engaged by peer educators - former and current sex workers who have been trained in healthcare - to ensure they don't become infected, said Fareed Abdullah, CEO of the SA National Aids Council.

About $13-million (about R200-million) has been allocated to the plan by The Global Fund for HIV, Tuberculosis and Malaria.

On Friday Deputy Minister of Health Joe Phaahla said between "6% and 20% of all HIV infections in the country can be linked to sex work".

This makes it imperative to improve HIV treatment of sex workers to bring down the rate of new infections.

If HIV-positive people are on correct treatment, they are not infectious.

"The plan is very big news and an opportunity to access treatment," said Kelly Kgobane, a sex worker. "We do not have to fear going to the clinic."

Ramaphosa admitted nurses treat workers "harshly".

He said: "Sex work is work. It is recognised by the constitution."

Sex workers and advocates praised the plan as a turning point in the recognition of sex workers as humans who deserve to do their jobs with dignity and safety.

Ramaphosa said: "We are moving ahead in terms of arresting new HIV infections.

"This effort we have embarked on will not be successful if sex workers are disempowered, ignored, neglected, forgotten, disregarded or stigmatised."

Sex workers often have condoms confiscated by police or are locked up for the weekend where they are unable to access antiretrovirals that need to be taken daily.

Deputy Minister of Social Development Hendrietta Bogopane conceded that sex workers were harassed, arrested and abused by policemen.

The plan concedes that criminal sanction affects the provision of health services to sex workers.

"While services for sex workers are available in some areas, there is limited reach and treatment is a challenge given that sex work is criminalised."

At the launch of the plan not one speaker from government mentioned decriminalisation.

Sex worker Nosipho Vidima, who works for advocacy group Sweat, said: "The health plan without decriminalisation is limited in effectiveness."

Even Ramaphosa said government worked against itself.

"It is not uncommon to come across one department acting in pursuit of law enforcement confiscating condoms that were distributed by another department."

Up to 45% of infections of sex workers and clients could be averted if sex work was decriminalised.

The Law Reform Commission - which investigated whether the law that makes prostitution illegal has to be changed - held hearings on decriminalisation in 2001 and accepted written submissions in 2012. "The process, taking 15 years, has been too long," said Sally Shackelton, director of Sweat.

"The Department of Justice said it is still considering the commission's report on adult prostitution," said Marlise Richter, researcher at the University of Cape Town's department of public health.

The Department of Justice was notably absent at the launch of the plan. Deputy Minister John Jeffery who was expected to attend was ill.

"We sex workers are disappointed. He could have shed light on decriminalisation," said Vidima.

Richter said: "Sex workers and rights advocates were elated at the launch on Friday. "The high-level government support for the plan was evident from the deputy president. While delegates did not refer to decriminalisation, it is clearly and unambiguously included in the plan." But she said it would not reach its targets of having 90% of positive sex workers on antiretrovirals and 95% encounters protected by condoms without law reforms.

Richter said: "While the plan is ambitious and far-reaching, it is doubtful if it will truly be able to reach its own stated targets if the criminal law in any form still applies to sex work. "If the criminal law applies to sex work even when it is in the formal, legalised or partially criminalised framework, the state sends a symbolic and practical message that sex workers and their clients are not worthy of protection or dignity. 

"It diverts important resources away from supporting sex workers and providing the necessary services," she said.