Challenges facing sex workers: briefing by Sex Workers Education and Advocacy Taskforce

Joint Committee on HIV and AIDS

23 May 2013
Chairperson: Dr B Goqwana (ANC)
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Meeting Summary

The meeting opened with an acknowledgment that sex work is illegal in South Africa and therefore the profession had no legal status. Despite this, the Committee’s oversight responsibility required that any factors or abuses that perpetuated the spread of HIV/AIDS needed to be examined. Without a doubt, sex work played a role in perpetuating the spread of the disease.

The Sex Workers Education and Advocacy Taskforce (SWEAT), an organization that champions the rights of sex workers, told the Committee that despite their vulnerability, sex workers remained a largely invisible, inadequately served and marginalised population. The main challenges they faced included health risks, violence, and obstacles to gaining access to substantial health care services, legal assistance and social services. A study conducted by the South African National Aids Council (SANAC) and SWEAT had found that there were an estimated 153 000 sex workers in South Africa.  This included males, females and transgender sex workers. The majority of this staggering number was based in Gauteng, where 22% of the sex workers operated. KwaZulu Natal, according to the survey, had 16% of the sex workers operating in the province, with the Western Cape, Eastern Cape, Mpumalanga, the North West and Limpopo all averaging 10%.

Very little data was available about the prevalence of HIV in the sex worker population. Nevertheless, qualitative surveys suggested that the HIV prevalence rate was close to 60%, while 19.8% of new infections of HIV were related to sex work. Despite this percentage, only 5% of sex workers had access to HIV prevention services.  Another survey had found that 57% of sex workers experienced violence or abuse from their clients, and 55 % from police or law enforcement personnel.  

SWEAT’s main responsibility was to address the most urgent issues faced by sex workers. These issues were impediments to health care, stigma and discrimination, and the criminalisation of prostitution.  SWEAT’s approach was based on respect for the choices of sex workers, and its main drive was to provide individualised, realistic support to those in the industry. The programme provided exit strategies, but maintained that this was solely up to the individual. The most important mandate of the SWEAT program was to continue the struggle to decriminalize sex work.

In discussion, a Member pointed out that the issue of sex work placed the Committee under pressure, as the profession was not generally supported by the populace.  There were first-hand accounts of the humiliation and indignities suffered by sex workers at the hands of the police and at clinics, where there were designated lines for HIV and tuberculosis patients.  Members were advised that regional and international trends were towards legalising prostitution.

The Chairperson emphasised that many people who were poor and desperate had no choice but to do whatever it took to survive. He asked the Committee Members to take all the information they had received and make recommendations to departments.  He encouraged SWEAT to return to hear these recommendations.
 

Meeting report

Chairperson’s opening remarks
The Chairperson introduced the delegates from SWEAT to the Committee Members, although various Members were not in attendance. The meeting was intended to be a forum, where the Committee would hear necessary information concerning sex workers in South Africa, and how the issues around this “profession” impacted on the spread of HIV and AIDS.

The Chairperson acknowledged that sex work was in fact illegal and therefore the profession had no legal status. Despite this, he felt it was vital for the HIV and AIDS joint committee to receive this information with a view to ultimately helping to combat the HIV/AIDS pandemic. Moreover, the Committee’s oversight responsibility required that any factors or abuses that perpetuated the spread of HIV/AIDS needed to be examined. Without a doubt, sex work played a role in perpetuating the spread of the disease.  Engaging with SWEAT would therefore have a definite effect in helping to counter the spread of the disease and some of the problems which sex workers faced.

The forum would play a pivotal role in addressing some of the issues faced by sex workers. The Committee had the ability to recommend changes and address situations encountered by sex workers.  If there were certain acts and conditions that were outside of the control of the sex worker, violated their human rights and continued to spread HIV/AIDS, the Committee had a responsibility to listen and make recommendations.

SWEAT Presentation on Sex workers and HIV in South Africa
Maria Stacey, Deputy Director of SWEAT, addressed the committee on sex work and HIV prevention. Sex work was any agreement made between two or more persons in which the objective was exclusively limited to the sexual act. It involved preliminary negotiations for a price, which distinguished it from marriage contracts, sexual patronage and agreements concluded between lovers which could include presents in kind or money..

Sex work was illegal in South Africa.  Despite their vulnerability, sex workers remained a largely invisible, inadequately served and marginalised population. The main challenges sex workers faced included health risks, violence, and obstacles to gaining access to substantial health care services, legal assistance and social services. At the beginning of this year, a study conducted by the South African National Aids Council (SANAC) and SWEAT had found that there were an estimated 153 000 sex workers in South Africa.  This included males, females and transgender sex workers. The majority of this staggering number was based in Gauteng, where 22% of the sex workers operated. KwaZulu Natal, according to the survey, had 16% of the sex workers operating in the province, with the Western Cape, Eastern Cape, Mpumalanga, the North West and Limpopo all averaging 10% of the 153 000 figure.

Very little data was available about the prevalence of HIV in the sex worker population. Nevertheless, qualitative surveys suggested that the HIV prevalence rate was close to 60%, while 19.8% of new infections of HIV were related to sex work. Despite this percentage, only 5% of sex workers had access to HIV prevention services.

Given this important information, there was a vital need for a programme like SWEAT. The programme addressed sex workers’ health through individual and group interventions. This entailed counselling, referrals to other sister organizations and, most importantly, always fostering a dialogue between members of the organization and the sex workers.

The main responsibility the programme was to address the most urgent issues faced by sex workers. These issues were impediments to health care, stigma and discrimination, and the criminalisation of prostitution.  SWEAT’s approach was based on respect for the choices of sex workers. SWEAT’s main drive was to provide individualised, realistic support to those in the industry. The programme provided exit strategies, but maintained that this was solely up to the individual. The most important mandate of the SWEAT program was to continue the struggle to decriminalize sex work.

SWEAT also had a National Sex Worker program that expanded on its mandates and responsibilities. The program was funded by the Global Civil Society Grant and the South African AIDS Council. This programme provided peer education, outreach programmes, risk reduction workshops, and a national helpline.

The National Sex Worker Program in 2012 was granted funds by the Global Civil Society Grant to conduct a survey covering the demographics of “risk behaviour” by sex workers. In addition, the survey had looked at the availability or access to services by sex workers, and their knowledge of HIV/AIDS.

The survey had found through interviews with 1 136 sex workers, that 55% of sex workers picked up their clients on the street, 49% in a bar or shebeen, 27% in a brothel, 13% at truck-stops, and 12% worked from home. The survey was not entirely accurate, however, as those that took part in the survey picked up clients from more than one place. The fact that a majority of sex workers used the streets meant that a great majority of sex workers did not have the relative safety and support of bars or brothels, and were likely to be vulnerable to violence and abuse from clients and outside factors.

The survey also found that 57% of sex workers experienced violence or abuse from their clients, 55 % from police or law enforcement personnel, and 29% from a “significant other.”  Here again, the survey was not entirely accurate, as those that took part in the survey experienced violence from more than one person.

In terms of risk behaviour, 95% of those surveyed stated that they used a condom with their clients. When asked whether they used a condom with someone who was not their client, 81% said that they did in fact use a condom. In terms of knowing their HIV status in the last 12 months, 83% stated that they were regularly tested for HIV.  In the last year, 46% said that they had experienced a sexually transmitted infection.

Mrs Stacey emphasised that the impact of this study had had a resounding impact on sex workers in South Africa. There had been an increase in condom use and a greater understanding of HIV prevention methods. According to the National Sex Worker Programme, peer education was an essential component to access a “hard-to-reach” population, and to negotiate the complexity of sex work. Moreover the programme had found that addressing gender-based violence specifically increased the success of HIV prevention programmes by 25%.

Ms Duduzile Dlamini, a project coordinator for SWEAT and a member of Sisonke (the Sex Worker Movement of South Africa) is also a sex worker and advocates for the decriminalization of sex work in South Africa. She told the Committee that Sisonke believed that prostitution is work, and sex workers were faced with occupational risks that were exacerbated by criminalization, human rights violations and discrimination. These issues ultimately left sex workers vulnerable to HIV/AIDS.

Mobilization was vital. The main challenges sex workers faced included police brutality, discrimination from health care providers and from other service providers and communities.  She had witnessed and experienced at first-hand, violence and discrimination from police who, according to her, confiscated condoms and vital medications like ARVS when making arrests. There was also a prevalence of police abuse, where sex workers were forced to have sex with police members without condoms, and any money found on the worker was confiscated.

Another major challenge faced by sex workers was discrimination. It was incredibly difficult for a sex worker to go to a clinic and inform the care providers that they were sex workers. Many experienced humiliation and ridicule by health care personnel, including doctors and nurses. Discrimination in communities was also extremely prevalent, many workers facing being ostracised by community members and even facing violence when their houses were demolished. 

To address these issues, Sisonke used mobilization. The main aim was to get sex workers together to talk about their problems and find adequate solutions. Sisonke emphasised and encouraged sex workers to empower themselves and to fight for their rights. The movement helped sex workers to jointly organise and address their issues.  Mobilisation created a sense of community, where sex workers could feel safe and supported.

Sisonke vehemently believed that the criminalization of sex work was creating huge risks for sex workers. This was now becoming a human rights issue, as criminalization hampered the right of a sex worker to live as a normal member of society. This legislation had resulted in the disenfranchisement and abuse of sex workers by society at large. Ultimately, sex workers felt they had no legal recourse when abused or mismanaged. Furthermore, this abuse came from the very people who were charged to protect society -- the police officials.

Without condoms or access to medications, the risk of HIV infection becomes greater. Eventually, sex workers are forced not to use condoms and brave the possibility of infection or the spread of the disease. Most sex workers wanted to protect themselves and have a business that was legitimate, with minimal risks to safety. One of the greatest problems faced was that sex workers -- because their work was illegal -- had no form of legal recourse when they were infringed upon. Ms Dlamini told the Committee that she had been raped six times but could not report these crimes for fear that she would be humiliated and chastised further.

Sex work was the work they had chosen to do when there were no other real options.  What sex workers required was protection from the violations inflicted on them as a result of the criminalising legislation.  The Committee should address the inequality and oppression faced by sex workers, particularly in the law enforcement and health sector. Criminalisation of prostitution opened many avenues to potential abuse and human rights violations, and this needed to be addressed.

Ms Dlamini emphasised that the Constitution stated that every human being had a right to dignity, and the right to choose their own occupation. Many people felt they had the right to judge sex workers, and that could not be controlled.   However, Sisonke believed that the government had a responsibility to address the abuses perpetrated on sex workers as a result of the sex work being illegal.

Ms Sally-Jean Shackleton, Director of SWEAT, looked holistically at sex work in South Africa and how this work impacted on HIV/AIDS.

She gave a clear explanation of how criminalisation of sex work had a negative effect on sex workers, and how this contributed to the spread of HIV. A hostile environment, which included social exclusion, the risk of arrest and no access to legal resources, was one of the major factors that perpetuated the marginalisation of sex workers. Violence and rights abuses which included police brutality, sexual and physical assault and a lack of protection, were a direct result of the criminalising legislation. These factors, coupled with an unresponsive health care system, without a doubt led to a disproportionately high risk of HIV infection.

The National Sex Worker Programme had found that 60% of female sex workers were HIV positive. Moreover female sex workers were four times more likely to be HIV infected, compared to women (15-49 years).  An estimated 20% of all new HIV infections occurred among sex workers.

In conjunction with the South African Health Department, SWEAT had developed a national response programme to combat the rate of infection amongst sex workers. In 2012, SWEAT had hosted a sex work symposium that drew attention to the HIV problem and for the first time linked sex workers with researchers and policy makers. This had resulted in plans and strategies to actively challenge the HIV infection rate, which should be implemented this year.

One of the major plans this year was the South African National Response programme. This aimed to increase the coverage and access to comprehensive HIV, sexually-transmitted infections (STI) and tuberculosis (TB) services for sex workers, their partners and families. Moreover, the programme aimed to reduce violence and human rights abuses perpetuated on sex workers. Lastly the programme would create and enable health systems for sex workers. The objectives of the programme were to reduce social and structural barriers to HIV, STI and TB prevention, to reduce sexual transmission of HIV among sex workers, to sustain the health and wellness of sex workers, and to collect information and research to enable an effective HIV response.

Ms Shackleton said this programme should see a reduction in human rights violations on sex workers, a focused policy of inclusion for sex workers and an established sex worker coalition and network. The hope was that the program would allow increased access to legal recourse for sex workers and progression towards the decriminalisation of sex work. The ultimate impact would be the reduction of new HIV infections among sex workers and their partners, with the resultant decrease in HIV and TB related deaths among sex workers.

How would the programme create this?   Certain areas with communities, suburbs and metropolitan areas would be identified as “hot spots.” These hot spots would be provided with services that would include medical aid, alcohol and drug support, psychological support, access to legal services and peer-counselling. Peer-led activities were vital in addressing the decriminalisation mandate, coupled with mobilisation activities. The programme hoped to create a partnership between sex workers and the communities they lived in, so there was a sharing of knowledge and an open dialogue.

The programme would also see the inclusion of mobile clinics, where sex workers could gain access to the services they needed, but also to the guidance and information they do not currently have access to.  This program would be overseen by the SA National Aids Council (SANAC) at a national level and by the sex workers themselves at the local level. At this point, the model was still under observation and cost evaluation. Training was under way to ensure that peer counsellors had the relevant training to access situations and provide guidance.

Ms Shackleton concluded the presentation with an invitation to visit the offices of SWEAT, so that Committee Members could see at first-hand how this model or programme would be implemented.

Discussion
The
Chairperson emphasised that the mandate of the Committee was to increase the longevity of South African lives. He acknowledged the fact that the Committee could not legalise prostitution, but based on the information given by SANAC, it could not deny that prostitution played a huge role in perpetuating the spread of HIV.  Any recommendations that could help provide insight to alleviate the spread of the disease was vital.

Mr V Magagula (ANC) asked whether the representatives of SWEAT knew the amount of pressure they were placing on the Committee.  He acknowledged the stigma placed on sex workers but also pointed out that most South Africans do not support sex workers, and asked how the delegates expected the Committee to support something that was not supported by the populace.  

Responding to all three speakers’ statements that the police were infringing on the human rights of sex workers, Mr Magagula articulated a scenario in which a sex worker is denied money from the client, and then accuses the client of rape. What should the police do if this was what happened on a daily basis?  Essentially, why should the police take the sex worker seriously?

Mr Magagula asked if there were male sex workers, and what this occupation entailed.   Was money is the real driving force behind the need for a sex worker to continue in the profession?

Mr D Joseph (DA) thanked SWEAT for sharing the information they had provided, and acknowledged that this engagement with Parliament was important. He asked where the organization received its funding from.   What did regional and international bodies, such as the United Nations and the South African Development Community (SADC), have to say on the subject of legalising prostitution?   He suggested that some form of a referendum should be conducted so that the general public’s opinion could be heard when it came to decriminalising sex work.

Mr T Makunyane (ANC) argued that the Committee could not pontificate on the issue of whether to legalise the issue of sex work, as the HIV infection rate was still increasing. He challenged the Committee to recognise that the problems sex workers faced had a direct impact on the increasing infection rate.  Sex workers had rights, and from a constitutional viewpoint, their rights needed to be protected. They could not be denied health services or law enforcement. The Committee must include sex workers in HIV discussions.

Ms M Segale-Diswai (ANC) stated that while the Committee had no right to legalise sex work, it could not now claim ignorance on the issues facing sex workers.   She was appalled by that fact that women were not receiving medical attention, based on their occupation, and challenged the Chairperson to take this up with department heads in the Health Department and in the Police Department. 

Ms Segale-Diswai asked how SWEAT helped sex workers who were not educated and could not comprehend the consequences of their actions.   How was it educating non-sex workers about the issues facing sex workers, in order to reduce new infections?

Ms R Motsepe(ANC) asked whether the statistics were accurate, Limpopo, for instance, had no boundaries and therefore this would affect the numbers. Moreover in rural areas, many people did not talk about the topic, so this would also impact on the accuracy of the statistics provided by the SWEAT representatives.

Mrs Motsepe then asked whether SWEAT checked the ages of the members that joined them. Was there a possibility that they allowed children to be sex workers?

Mr M de Villers (DA) inquired whether the organization had a specific plan to educate communities. He challenged the Committee to propose a private bill in support of sex workers, and also commented that it had a responsibility to tackle the departments that were not showing adequate or acceptable treatment towards sex workers.

The Chairperson asked the members of SWEAT to try to answer as much of the members questions as possible given the time period the meeting had. It is important to note that not all questions were answered.

Ms Shackleton said SWEAT received funding from the Western Cape Provincial Health Department, the National Lottery and various international donors.

Regarding the views of regional and international bodies on sex workers, the Commission for Gender Equality had released a paper in May 2013 calling for the decriminalisation of sex work. Moreover the Congress of South African Trade Unions (COSATU) had also sent out a resolution in support of sex work and sex workers themselves. The World Health Organization in December last year had released a policy brief encouraging states to decriminalise sex work in order to address HIV. Lastly the Commonwealth heads of government had also called for the legalisation of prostitution.

Mr R Saayam, from SWEAT, and a sex worker himself, answered the questions posed my Mr Magagula. He said that sex workers did not ask for HIV/AIDS, and regarding the amount of pressure placed on the Committee, sex workers had a greater burden and a greater pressure -- and that was HIV. The requirements to curb the spread of HIV meant that people had to run to a committee who had the authority to make a change. In response to how a male could be a sex worker, he said he could be a sex worker in the same way a woman could. He emphasised that no one had the same life, and that all came from different backgrounds -- some wealthy, some not -- and he personally had to do whatever he could to make money to survive. 

Ms N Sonadi, from SWEAT, addressing a question about sex in public spaces, said that most sex workers did not have sex in a public places and that those who did faced the consequences of public indecency. One needed to acknowledge the circumstances that caused sex workers to use the streets.  She also addressed the scenario where a sex worker who has not been paid claims rape in order to either receive money, or punish the client. She believed that if a client broke an agreement with a sex worker, it was rape.

Ms Noman Goolum, a transgender woman from SWEAT referred to the questions around the Health Department, and shared her story and her feelings around the discrimination she had experienced in clinics by health professionals. She emphasised the humiliation and the indignity she had had to endure to receive treatment and consequently had to move to a place where she was not so recognised in the community. Lastly, she spoke about designated lines in clinics for ARV patients and TB patients. These lines indicated to the general public that these people were HIV positive, and for her this segregation and humiliation was unbearable.

The Chairperson said the testimony of Miss Goolam he emphasised that many people who were poor and desperate had no choice but to do whatever it took to survive. He asked the Committee Members to take all the information they had received and make recommendations to departments.  He encouraged SWEAT to return to hear these recommendations.

The meeting was adjourned.

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