Dangers of sex traders revealed
53.6% of female Sowetan workers have already contracted HIV
IN SOWETO, a client plying the township’s sex worker trade has possibly left his mark on at least two women he had sex with.
Both women have drug-resistant HIV and genetic evidence points to them having contracted the disease from the same source, likely a male client or partner.
A study of a sample of sex workers in Soweto has revealed that this is just one of the many dangers these women face and that intervention programmes meant to protect this vulnerable group from HIV/Aids need to be stepped up.
Earl i e r t hi s month, researchers released a paper that examined the rates of HIV and violence among sex workers in Soweto.
It’s the first of its kind, they say, and likely gives a snapshot of some of the complex issues facing sex work across South Africa.
“So little research has been done among sex workers, just looking at their HIV prevalence,” explains one of the paper’s authors, Rachel Jewkes.
What they found from their sample of female sex workers was an HIV prevalence of 53.6%. This from sex workers based in taverns and hostels.
“Here we have a group of people who are so neglected overall in response to HIV and are so vulnerable,” says the lead author, Jenny Coetzee.
“A lot of what we see is survival sex where people are engaging in sex work to provide for families. It’s a mom putting children through school or a grandmother looking after grandchildren.”
The study, which appeared in the journal Plos One, focused on 508 sex workers across Soweto, aged between 18 and 59 years.
What the researchers found was that as the age of the sex worker increased, so did the likelihood of them having HIV.
A sex worker who was older than 30 years of age had a 4.9 times higher chance of having HIV, compared to younger women in the study.
A sex worker with incomplete secondary schooling almost tripled the likelihood of a woman having the disease, while a migrant from outside Gauteng had nearly a two-anda-half times greater chance of having HIV.
Coetzee says they also dis- covered that condom use was not as high as was previously reported for this population.
To understand this low uptake of condoms, an anthropologist was tasked to find out the reasons.
“It ended up with 80% of sex workers who said they had not consistently used condoms in the past month.
“There are a couple of reasons why. One was that they were having very quick interactions, which meant they did not have time to negotiate condom usage,” says Coetzee.
Sex workers also revealed to the anthropologist that they would often first assess a client and if they thought he was likely to be aggressive they wouldn’t ask to use a condom, as their request may have been interpreted as a form of defiance and resulted in assault.
An a c a d e mic p ap e r, “Cross- sectional study of Female Sex Workers in Soweto, South Africa: Factors Associated with HIV Infection,” also examined incidents of violence and found that more than half the woman had experienced violence from a non-partner.
What is concer ning to the researchers is that, from interviews, they believe that sexual violence was seriously under-reported and that these women have a very limited ability to seek justice given the criminalisation of the profession.
Part of their research, which was not in the Plos One paper, was examining the rates of drug-resistant HIV.
Working with the National Institute for Communicable Diseases, they were able to assess HIV drug-resistant rates.
Preliminary results have revealed that 16% of HIV-infected sex workers had the drug-resistant variant of the disease, but that almost 40% of women who had a high viral load and had never previously taken antiretroviral treatment were also resistant.
This suggested the possible sexual acquisition of HIV drug resistance.
“We found that two women in our study shared a genotype, which meant that somewhere in their history they had a shared sexual partner, whom they had gotten drug resistant HIV from.
“So there is the potential that you have a client out there who is giving it to multiple sex workers,” says Coetzee, who adds that most HIV programmes focus exclusively on sex workers, with limited service offering to clients, and no interventions addressing gender equality among men in the sector.
Both Coetzee and Jewkes believe that such programmes involving sex workers need to be re-looked at.
Coetzee also says they have a number of other papers due to be published shortly that show the scale of mental health issues as an epidemic on its own, and the way in which violence, mental health and HIV intersect as epidemic in this population.
She suggests the need to have inclusive programmes, which build on the existing sex work projects in South Africa, and include comprehensive violence prevention and mental health interventions as priority points in addressing HIV.