Making the NSP SWEAT
Sex workers face significant barriers to accessing health services, experience a disproportionate burden of disease, and are subject to daily human rights abuses. Since the launch of the second NSP, it appears that there is a new political commitment to improving their lives, and to providing better access to HIV and sexually transmitted infection prevention, care, treatment and support.
The National Sex Worker Symposium, held in 2012 was a mark of progress in programming for sex workers. The symposium engaged researchers, practitioners, policy makers and sex workers themselves in discussions on best practice and innovations related to sex worker healthcare and support. Following shortly after this, SANAC brought together a small technical working group made up of practitioners and experts to develop and finalise the National Sex Work Plan. The Plan, now finalised, includes realistic health indicators for this population group.
SANAC funded a rapid sex worker population size estimate, and at all levels of government, people are grappling with how access to health care for sex workers can be improved. Technical support and guidance are being sought from organisations such as SWEAT and members of the Sex Work Sector. The expertise being provided is significant and support for these activities is essential to enable the Sector and member organisations to respond.
Poor coordination between sex worker projects remains a problem: several are not aligned to a common monitoring or evaluation framework and assessing their progress is therefore challenging. This means that service delivery standards may vary significantly from project to project, and that the good work being achieved may be going unrecognised. Better project coordination is still needed at SANAC and work related to the sex work sector needs to be better supported at both the provincial and local level.
Another major impediment to providing effective programmes for sex workers is the continued criminalisation of sex work. Evidence shows that criminalising sex workers undermines efforts to address their health needs. While SANAC can’t achieve decriminalisation on its own, it has a responsibility as Government’s advisor on HIV, to make recommendations for legal reform. Despite efforts to address this issue, and agreement in the Civil Society Sectors, SANAC Plenary has failed to make a clear recommendation to government about the need to decriminalise sex work. The Human Rights Technical Task Team has held discussions about the issue, but there is still resistance from some quarters to the clear evidence that continued criminalisation impairs sex workers’ access to justice and health, and contradicts South Africa’s efforts to address HIV.
Structural barriers that make it difficult for sex workers to access healthcare also need to be addressed. Interventions that facilitate sex worker empowerment, self-organisation and human rights protections all have the potential to reduce stigma, increase the demand for services, and inspire sex workers to participate more in their own care. The newly convened Social and Structural Drivers Technical Task Team will focus on these complex issues.
The previous National Strategic Plan on HIV, STIs and TB failed in its efforts to improve the lives of those in key vulnerable groups. We are hopeful that the implementation of the current NSP will focus not just on the easy gains, but also on the harder issues that may require more courageous transformation – like legal reform and sex worker empowerment.