#People: The story of Fortunate Sithole

Fortunate Sithole. Photo by Joyrene Kramer

At 41 years old, Fortunate Sithole is not ready to die.

It is said that life happens when we make other plans. Often in ways we could never conceive. Fortunate never imagined herself shrunk in bed in the Boland town of Franschhoek, unable to walk as she waits for ‘her day’. Fortunate is very ill; some say she has mere days left to live. ‘But, I have not written my novel yet,’ she counters. ‘What about the story I have to tell?’ Her eyes are big and shiny, her cheek bones pointed over a pearly grin.

In addition to severe HPV (human papillomavirus) sores across her lower body, Fortunate was diagnosed with cervical cancer at the Franschhoek Clinic in 2016. She started chemotherapy at Tygerberg Hospital, 60 kilometres away in Cape Town’s northern suburbs, traveling to the facility in province-funded HealthNET vans.

The Western Cape has ninety HealthNET vehicles for transporting non-emergency patients between home and medical centres.

‘Now the doctors say they cannot do anything else for me, no more chemotherapy,’ Fortunate explains. ‘But what do they know, the doctors? They have brains like me, they are not God. Only God knows, and he is with me.’ Her voice rises in challenge: ‘I will surprise them all!’

‘Oh, yes you will,’ smiles Tiana Leonard, a social worker at Franschhoek Hospice.

Fortunate pauses, then adds: ‘We could go to Groote Schuur, for a second opinion?’ But Tiana shakes her head.

Fortunate is propped against three pillows; by her side a curtain is tied back, letting in slivers of sun. Next to her is a tidy stack of tissues, sanitary pads, surgical gloves and an array of boxes with pills – provided by the clinic. She takes two oral MST morphine tablets a day. Near her right hand is a blue leather-bound notebook; a recent gift from the hospice organisation, for her to write her memories in.

Fortunate Sithole. Photographer: Joyrene Kramer

Fortunate’s story starts in Zimbabwe, in a slum skirting the capital city of Harare. Here as an adolescent, she sold ice lollies to appease her mother. At thirteen years old she first ran away from home, sleeping on a bench in a city park. Two marriages later, and with a three-year information technology degree, she moved to Johannesburg to start a new life. But Hillbrow’s streets beckoned, and lured by quick cash – up to R2000 an hour – she turned to sex work, sending vast sums of money home to her sister Alice and two kids. For about 10 years she did sex work in Hillbrow, paying her children’s rent in The Avenues, a desirable Harare suburb. Four years ago, now with three children, Fortunate moved to Franschhoek for another clean start. She moved into a neat RDP house in Mooiwater, a township in the crook of the Hawequas Mountains, finding work as a waitress.

Here Fortunate is today, confined to bed with a wheelchair propped outside her bedroom; her voice deep and bright with resistance to her deemed fate.

She recounts her life, hands carving the air. Her fingers are bony like twigs, her nails immaculately groomed, short and painted with black lacquer.

‘I had a very good and bad childhood,’ she says. ‘So, a lot happened which lead to this, it’s all intertwined.’ Her hands sweep toward her lower body, which is covered under a yellow throw.

‘Harare, it is a beautiful place, but growing up I just thought I don’t want to be here. I don’t belong here, you know because of the poverty,’ she says.

Fortunate was born on June 1, 1978, the youngest of eight children, with only her father employed.

‘I did not have a good relationship with my mum,’ she says. ‘My mother started training us at a very tender age to sell stuff, like ice lollies. In Zimbabwe we used to call them “Freeze Its”. We were each given our own cooler box full of Freeze Its. And then you had to sell them, you had to sell them all. I didn’t like that, I hated it with a passion. My mother would bribe us: if you sell these and they’re finished, then you can get meat, maybe some chicken.’

Fortunate recalls her mother beating her with electrical cables. ‘She accused me of having sex, because I had a problem down there, you know, a fungal infection. But I was still a virgin, I didn’t know anything yet. I mean, I was just a child. So, when I was 13 I ran away from home, it was the first time I ran away; I slept in a park in town. I don’t know how many times I ran away from her, I don’t know.’

At 16, she ran away from home again. This time she moved in with a man. ‘I lost my virginity to him; I saw that he had warts, which I contracted from him. I didn’t know what was going on, I was just a girl. I moved in with him, as I didn’t have anywhere else to go. I married him and stayed with him until I had my son, my first born, when I was 18. I had two miscarriages before then. The miscarriages were due to me trying to commit suicide. See he was very abusive, he was also beating me. So I took poison. I would take two packets of malaria tablets. Also, there’s this poison that’s pretty common in Zimbabwe that you put on plants to kill lice. After my son was born, my husband left me, he was no longer working. He passed away a few years later.’

Aged 21, Fortunate met her second husband, the father of her second child; a good man who supported her studies in IT. ‘But four years later, he passed away too. That was when all hell broke loose.’

In 2004, at Harare’s New Start Centre, Fortunate tested positive for HIV. She started taking anti-retrovirals; and a year later boarded a bus to Johannesburg.

Here, job-hunting endeavours lead to Hillbrow. ‘The sex work, it was good money, I mean about R1500 to R2000 an hour,’ she says. ‘I could afford a good life for my kids back home; they were staying in town in an apartment in The Avenues with my sister. Rent there was like the equivalent of R6500 a month. So I could pay that apartment and manage to buy food, I could send them to school. Everything was sorted. I did that for years and years, traveling between Harare and Hillbrow, probably 10 years.’

Fortunate’s family never knew she did sex work. She gestures toward her nether regions again. ‘In that time, these things were escalating. I had operations; I tried to get them healed, but nothing was working. I did safe sex, I would put on two condoms. I hated it, it was so sore. I used to pray: “Lord, help me, I want out.” Then one day, I did get out. I started working as a maid, around Germiston and Boksburg, around the eastern parts of Joburg. But the money wasn’t good. You can imagine working for R150 a day, and you’re not even working five days a week. It was really bad for the kids, because I could not afford that lavish lifestyle anymore. But at this point I decided to put my own life first.’

A friend advised her to move to Franschhoek. ‘I had a friend who didn’t like what I was doing in Joburg. So I told her that I was working as a maid, and she said: “Come this side, to Franschhoek. There are restaurants here with lots of money; you are strong and can work hard, you could take good care of yourself here.” So that’s when we came here.’

Fortunate Sithole recounts her life story, which starts in Harare, Zimbabwe. Photographer: Joyrene Kramer

At present, Fortunate’s three children, aged 23, 17 and eight, are at home in Franschhoek with her, while her sister Alice and brother Anton are visiting from Harare to help her.

‘Alice came earlier this year,’ she says. ‘Initially I was still okay though, I could walk and so on. But it actually got worse. When my sister came, that’s when I started deteriorating.’

The Franschhoek valley is known as a bastion of local and foreign capital, with lush farms curling up vineyard-cloaked foothills. The town’s quaint centre is home to some of the country’s top restaurants, with bougainvillaea spilling over white-washed walls. This postcard pretty facade belies a fraught underbelly: townships with absent fathers, grandmothers raising youngsters, unemployed youth and drug scourges, notably ‘tik’. Franschhoek Hospice has their hands full caring for the area’s sick and dying.

Nursing service manager, Sister Susan Swanepoel, says they provide free care to 160 palliative patients, of who sixteen are terminal, and about fifty are children – mostly living with TB or HIV, or malnourished. Their staff of two nursing sisters, a social worker, and nine community health workers, between them, try to visit each patient once a day.

Driving through Mooiwater, social worker Tiana Leonard’s white hospice van is widely recognised. Next to the road a man waves at her, and she screeches to a halt to speak with him.

In October last year the hospice organisation started caring for Fortunate, too. They found her through the Franschhoek Clinic.

‘The thing is, despite all that is happening,’ says Fortunate, ‘I am an aspiring writer and motivational speaker. This is something I’ve been thinking about actually; I have a story to tell, one which I know will help a lot of women out there. I want to tell women to take note, to take care of their bodies. I want to tell mothers to listen to their daughters, especially when they speak of their bodies. That was my hope. Ja, things have not gone according to plan.’

Outside Fortunate’s home in Lavender Road, election posters tied to lamp posts show politicians promising a better tomorrow.

But writing in her notebook, Fortunate is not pondering the future. She is reliving the past, capturing lessons and stand-out memories; fragments of her story, the story of Fortunate Sithole.


Humans in the Age of HIV

We turn the spotlight on people living or working on the margins in South Africa. Referred to some as key populations, these folk – sex workers, trans people, MSMs, injecting drug users, LGBTQIA+ people – are at more risk of HIV and are often forgotten. Read about them here and then go to our website to read the longer stories.

AIDS2018: Humans in the Age of HIV-Where I work now, I actually feel like a woman

By Nomatter Ndebele

Thirty-seven-year-old Zelda Leonie, has been a sex worker since she was 17 years old. She decided to go into sex work when she realized that she could not depend on her mother to provide them with everything, so she turned to sex work. “I was desperate, I wanted things that my mother couldn’t give me, so I decided to make my own money,” said Zelda.

As she reflects, Zelda admits that in the beginning it worked out well for her, she was able to make her money and pay for everything and anything she wanted. After a few years however, the sex work got more intense, and she started to encounter a lot of abuse.

Some clients, would tie her up, beat her and throw her against the walls.  Zelda starts tearing up, as she shares this information. At one point, she looks into the camera and announces “ I can’t do this.” She bursts into tears and quickly moves out of the frame. After a few moments, she decides she is ready to continue.

Now, Zelda speaks about her new life. She has now become a masseuse, after her friend took her off the streets and tried to get her a new job. “Now I just do massages, and if a client wants a happy ending, he has to pay more.” Zelda is reluctant to say she is still a sex worker, she chooses to focus on being a masseuse more than anything else.

Zelda sees this opportunity of having a job, as a step in the right way in relation to changing her life. “Where I work now, I actually feel like a woman, the clients are respectful and they treat me like a woman,” she says smiling.

Her message for other girls who are involved in sex work is a simple one “I just want everyone who is involved in sex work, to know that if you want to get out, you can. Just like I did.”

This article is part of a Spotlight special series on people who form part of so-called key populations.


AIDS2018: Humans in the Age of HIV-Carmen is impossible to miss

By Nomatter Ndebele

Carmen is impossible to miss. She comes sauntering down the road with her luscious  black locks bouncing gently behind her, as she moves closer she casually drops her arms and reveals her toned abdomen, sporting a tattoo that rises to the side of her midriff.

Carmen is a transgender person who does sex work. Yesterday we met her as Clinton.

Pic by Joyrene Kramer

You wouldn’t say this was the same fidgety man we met in the blistering cold yesterday, trying to make his way to the drug dealer to calm his morning nerves. Today, Clinton is no more, and we are greeted by the beautiful Carmen.

Today, her face is softer, she is visibly more gentle and her voice has a softer tone to it. Her face is meticulously done up, highlighted and contoured to absolute perfection. She is a beautiful woman, with piercing  hazel eyes and once they settle on you, she’s got you.

Carmen is about as key population as you can get:  A transgender person who has been taking drugs from the age of 14 and who has been involved in sex work from the age of 18. If all the talk in the HIV world about serving key populations were being implemented, Carmen would have all the support she needs. However, this is not the reality.

Brixton Cemetery next to Vrededorp where we initially met Clinton is a hive of constant activity. While some rest, injecting drug users mill about to find spaces to take their hits. Sex workers look for spaces where they can provide services to their clients. In the evenings the cemetery comes alive with hundreds of destitute night dwellers.

Carmen has been a sex worker for 14 years now.  She has gone from working in surreptitious establishments to picking up clients on the side of the road. Within her first year and a half of doing sex work Carmen calculates that she has provided sexual services to over 100 men. Most of these men are married and straight, she explains, all of them trying to live out their fantasies, in such a way that they never intersect with their daily realities.

Carmen has been dating her partner, Justin, for three years now. Justin has a job as a carpenter, he has dark brown hair, that match his eyes, and he too is addicted to heroin.

Pic by Joyrene Kramer

The two had to figure out how they were going to maintain their relationship, while Carmen continued with her sex work. “It was really hard in the beginning, but I guess I have got used to it by now and it doesn’t bother me as much,” says Justin. Out of respect for her partner, Carmen says she no longer “picks up” men on the side of the road and doesn’t wear feminine clothing as often, despite the fact that she can make a lot more money when she is dressed up.

On evenings where Carmen goes to meet clients, Justin waits patiently at home. “I wait for her and I pray that nothing bad happens to her out there, because you never know what could happen”, says Justin.

When Carmen is working her biggest priority is being safe. She never shares needles, not even with Justin and she never takes a client who refuses to use a condom. All of this however, Carmen had to learn on her own. She had to learn for herself that she did not have to have unprotected sex with anyone. It was her own knowledge of HIV that led to her making the firm decision to not share needles with other users. In Carmen’s case it was not even that services failed her, they simply don’t exist.

This article is part of a Spotlight special series on people who form part of so-called key populations.

Sex Work and the new NSP

By Marlise Richter[1], Thuli Khoza[2] and Katlego Rasebitse[3]

Sex Work and the ‘National Strategic Plan on HIV, STIs and TB 2017-2022’ – time to be brave!

No HIV plan or response will be wholly successful if it does not candidly address the context in which sex work takes place, and do so from within a human rights framework.  South Africa’s HIV programmes have taken the lead in acknowledging the need to partner with sex workers and sex work advocacy groups.  Some AIDS plans have even be so wise as to recommend the decriminalisation of sex work – this means that all criminal laws that apply to sex work are removed, and sex work is dealt with as ‘work’.  Modelling research has shown that decriminalisation will reduce HIV transmission by 33%-46% among female sex workers and clients within a decade. In fact, South Africa is one of the first countries to have a sex work-specific plan in the form of the South African National Sex Worker HIV Plan 2016-2019, and it specifically endorses decriminalisation.

There is much to be proud of – but it is not yet enough.

Meme produced by Zia Wasserman

The drafting and consultation process for the NSP 2017-2022 has been a tricky one, with drafts radically changing from one month to the next.  One draft would have a robust human rights chapter, only to be followed by a version where there is none, which will catalyse strong push-back from civil society.

The last version of the NSP we studied was dated 24 February 2017.  It had remedied many of the issues raised by consultations and submissions including a clear commitment towards human rights, and should be applauded.

We would however like to see much more robust sections on the structural factors that impact on sex work, and submit the following key recommendations:

  • Strong call for the decriminalisation of sex work with clear indicators. The last NSP draft calls for “steps to be taken towards the decriminalisation of sex work”, which we applaud and support as this form of law reform is absolutely key to protect sex workers and their clients from HIV and other illnesses. However SANAC and the Department of Health should take the lead in pushing for law reform, and these efforts should be measured and monitored in the careful log frames that are included in the drafts.
  • Eliminate the police practice of ‘Condoms as Evidence’: The sub-objective on sensitising law makers and law enforcement agents should include an explicit statement on the elimination of the police practice of using possession of condoms, lubricant, ARVs or any other legal commodity as evidence of sex work and grounds for confiscation or arrest . In shorthand, called the ‘Condoms as Evidence’ practice, some police undermine public health principles by harassing sex workers carrying condoms, or destroying them.  This has to stop.
  • Remove ideology-based funding restrictions: The Department of Health and SANAC should petition US agencies for the removal of the so-called PEPFAR ‘Anti-Prostitution Pledge’ from funding agreements between US donors and SA NGOs and agencies that prohibit funding recipients for advocating for law reform on sex work. This is currently the case, and is causing organisations working with sex workers to remain silent on the human rights abuses experienced by sex workers.  Law reform is urgently needed on sex work to reduce the violence and abuse of sex workers, and the voices of organisations providing services to sex workers need to be heard.
  • Include the Social Impact Bond: Social Impact Bonds should be included under the discussion of innovative funding mechanisms, and be supported.  The SIB is an exciting intervention that we need to watch carefully as it could support the empowerment of sex workers and the reduction of their vulnerability to HIV and other illnesses. SANAC has been collaborating with Social Finance (UK) to explore if some components of the funding for the Sex Worker HIV Programme 2016-2019 could be raised through an outcomes-based financing model that could be an SIB.
  • Include a migration focus: There are strong links between migration and sex work in South Africa and the region, and it is regrettable that this NSP makes almost no provision for migration-aware health services or responses in its text.

We look forward to seeing the final NSP 2017-2022, and we trust that it will be the best one South Africa has ever had.


[1] Sonke Gender Justice

[2] SANAC Sex Work Sector leader

[3] SANAC Sex Work Sector leader


Hoer! Magosha! Prossie! Doxy! – Why has the law on sex work not changed?

By Marlise Richter

Sex work is fully criminalised in South Africa.

This means that anyone who buys sex, who sells sex, or who helps facilitate a sex-work transaction can be prosecuted.

An installation by SWEAT highlighting the delays of the South African Law Reform Commission and the Department of Justice in transforming apartheid-era sex work laws.
An installation by SWEAT highlighting the delays of the South African Law Reform Commission and the Department of Justice in transforming apartheid-era sex work laws.

For years, advocates and sex workers have asked that the law on sex work be changed, and that all criminal elements are removed (the ‘decriminalisation’ of sex work).  Research has shown that this will reduce HIV, will make societies safer, and will respect the human rights of sex workers.

Yet, very little has happened. Why?

People do not like to think or talk about sex work (or prostitution). Except when they are rude or insulting towards other people, or when cracking ‘dirty jokes’ – mostly about women.

Many people associate sex with love, intimacy and perhaps even long-term relationships.  The idea of having sex with a stranger for money, and therefore selling sex as a job, is something that many people feel deeply uncomfortable with. They think selling sex is a ‘sin’, is ‘wrong’ or an insult to women, and want the criminal law to stamp it out. They don’t think about the fact that people have sex for many different reasons, and that adult, consensual sex is a private decision and should be free from state interference.

This prejudiced thinking is a form of sexual moralism – that is, making judgements about another person’s morality based on their sexual behaviour or preferences. Sexual moralism forms the core of homophobia and transphobia, and was the basis for outlawing sex across the colour bar in apartheid South Africa. Fortunately, our laws on sexual orientation and race have changed for the better and reflect our Constitutional values.

It is time that people challenge their own sexual moralism, and that we do the same on sex work!

Did Durban listen to sex workers?

By Ishtar Lakhani

This year marked the 21st International AIDS Conference (AIC) held in Durban – 16 years since this conference was last held on South African soil in 2000. So it was an apt time to ask what has

Richter and Steve Lambert ask plenary speakers at the 2016 AIDS Conference how long it will take before they mention sex work in their speeches
Richter and Steve Lambert ask plenary speakers at the 2016 AIDS Conference how long it will take before they mention sex work in their speeches

changed for sex workers in the last 16 years? The answer is, very little.

In those 16 years: the apartheid-era law that criminalises sex work remains unchanged; sex workers are still on the frontline in the battle against HIV/AIDS; violence against sex workers continues to occur with impunity, and sex workers are still stigmatised and discriminated against based on their occupation.

Undeterred by this lack of change, the Sex Workers Education and Advocacy Taskforce and the Sisonke Movement of Sex Workers in South Africa mobilised to put sex workers’ issues on the agenda at the IAC. We were there to make our struggle visible. We were there not only to occupy civil society spaces but to claim a space at the table that is usually reserved for the ‘professionals’ – doctors, scientists, politicians, policy makers. We were there as human rights’ activists, experts, and academics, to ensure there was ‘nothing about us, without us’.

Many of the conference sessions focused on sex work and sex workers are acknowledged globally as a ‘key affected population’ in HIV prevention, treatment and care, yet sex workers were barred from the conference – the very platforms that were created to ‘help us’. Two of our delegates were refused access to the conference because the accreditation process revealed they had previous criminal records and a number of our contingent experienced severe transphobia from conference organisers and security. The process was humiliating and a clear example of how criminalisation results in bizarre double-speak.

But these hurdles did not stop us. We arrived in our numbers determined not to be left outside. We were unrelenting and unapologetic in our calls to decriminalise sex work, and we can say with certainty that our voices were heard. Our voices were heard by our politicians (the Deputy Minister of the Department of Social Development wore our bright orange ‛This is what a sex worker looks like’ t-shirt), celebrities (Charlize Theron and Sir Elton John both showed their support for decriminalisation), and Constitutional Court Judge Edwin Cameron invited us to share the stage.

The question is now is not whether we were heard, but whether our voices are still ringing in the heads and hearts of South Africans. Will the Department of Justice finally release the South African Law Reform Report, whose process started 17 years ago? Will policy makers listen to the overwhelming evidence that decriminalisation is the best legal model to ensure that sex workers can access their rights? Will we be able to attend the next conference and not be criminals?


How PEPFAR’s anti-prostitution pledge impedes sex worker health

By Marlise Richter[1]
The US President’s Emergency Plan for AIDS Relief (PEPFAR) should end its anti-prostitution pledge. It prevents organisations that received PEPFAR money from advocating for law reform on sex work, which not only harms sex workers but is bad for health, especially HIV prevention and treatment.
PEPFAR is an initiative to diminish the impact of the global AIDS epidemic. During the 2016 International AIDS conference in Durban, PEPFAR pledged R5.7 billion ($410 million) towards the AIDS response in South Africa[2].

Between 2004 and 2014, PEPFAR invested $4.2 billion (approximately R47 billion) into HIV prevention, treatment and care in South Africa, and by the end of 2015, had assisted the South African government to achieve these remarkable goals:

  • Anti-retroviral treatment for 3 million people
  • Voluntary medical male circumcision for HIV prevention for 472,047 men
  • HIV testing and counselling for more than 9.9 million people
  • Care and support for 592,260 orphaned and vulnerable children affected by HIV/AIDS
  • Anti-retroviral treatment for 226,369 pregnant women living with HIV to reduce the risk of parent-to-child transmission[3]

Yet, there’s a big problem with PEPFAR funding. PEPFAR recipients have to commit to a perplexing promise: to oppose sex work. According to the USA’s ‛Leadership Act’, all recipients of PEPFAR money have to sign an agreement with PEPFAR that commits them to the following[4]:

No funds … may be used to provide assistance to any group or organisation that does not have a policy explicitly opposing prostitution and sex trafficking.

No funds … may be used to promote or advocate the legalisation or practice of prostitution or sex trafficking.

There are two problems with this ‛pledge’

(1) Muddled thinking: conflation between sex work and trafficking

Sex work relates to adult, consensual sex. It is a job, a way for people to make a living. Trafficking on the other hand is similar to sexual slavery and is a gross human rights violation.

The United Nations is clear that for a person to have been the victim of trafficking these conditions must be met:

(a) The person must have been moved.

(b) There must have been deception or coercion for the purposes of exploitation.

Trafficking and sex work are not the same thing, and conflating them is disrespectful to sex workers and minimises the severity of the crime of victims of human trafficking.

(2) Direct and ‘chilling’ effects on organisations working with sex workers

Some PEPFAR recipients have documented how the pledge has limited the access of sex workers to health care and increased their vulnerability. This following extract is from an interview with a representative of a PEPFAR-funded organisation in southern Africa:

‛Our organisation is committed to combination HIV prevention. Evidence shows that biomedical, behavioural and structural interventions are all important for HIV prevention. The PEPFAR agreement our organisation has signed inhibits our efforts in structural HIV prevention in the following three ways:

  1. Public health evidence is clear that that structural interventions, such as the decriminalisation of sex work, can be important to improving sex worker health outcomes and yet we are not allowed to talk about this in our work nor advocate for this.
  2. Governments are increasingly recognising that the criminalisation of sex work can be a structural driver of HIV and seeking ways to address it through law reform. PEPFAR requirements mean that we may not participate in these discussions during government-convened meetings on sex worker health; and
  3. One of the key problems we encounter in our direct health-care provision to sex workers is mitigating the effects of violence, rape and abuse that sex workers experience from clients and the general public. Evidence shows that the high levels of violence sex workers experience are directly related to the on-going criminalisation of sex work. We are prohibited from advocating for changes to this system, and are placed in a position where we have to only deal with the on-going consequences.’

The Global Network of Sex Work Projects criticises the pledge saying that no clear guidance has been given on what is prohibited and allowed under the pledge, that some organisations have limited their services to sex workers, have withdrawn their partnership with sex worker organisations, have suppressed information of their work with sex workers and have used vague terms like ‛women at risk’ or ‛vulnerable populations’ to disguise the fact that they work with sex workers.[5] This is bad not only for sex workers but for evidence-based medicine because, as the Global Network of Sex Projects explains, it is particularly difficult to evaluate what programmes are effective on sex work issues, and how HIV affects this population.
A case study: The Wits Reproductive Health and HIV Institute

A South African example of the implications of the PEPFAR Pledge is the Wits Reproductive Health and HIV Institute (WRHI) based in Johannesburg. This organisation has been providing health services specifically aimed at sex workers in inner-city Johannesburg since 1996. It started receiving PEPFAR funds in 2003, and was able to expand its services to a great number of sex workers. Until 2010, it was the only sex work-specific health-care service available in South Africa.

The institution has accumulated a wealth of information on sex worker health problems. The staff have vital first-hand knowledge of the detrimental impact of the criminal law on sex workers. The voices of WRHI staff would carry particular authority on the public health implications of the criminalisation of sex work, and the urgent need to decriminalise sex work in South Africa. But their voices are effectively silenced by the PEPFAR Pledge. Indeed, in 2002, one of the Institution’s doctors provided expert testimony in a Constitutional Court case in which the criminal law on sex work was challenged (St vs. Jordan 2002 (6) SA 642 (CC)). Under PEPFAR obligations, this likely would no longer be possible. In the context of current debates on law reform of sex work – and those looming in future – WRHI may not be able to present input or take a particular view on the matter.

PEPFAR has direct funding agreements with approximately 120 organisations in South Africa[6] and other organisations are in a similar position as the WRHI. The medical anthropologist Paul Farmer and his colleagues have argued that health-care workers are the ‛natural attorneys of the poor’. PEPFAR funding agreements effectively stop these ‛attorneys’ from PEPFAR-supported organisation from speaking out about the cruelty and human rights abuses of the current criminal system.

Various courts in the United States have ruled that the PEPFAR Pledge violates the right to free speech of organisations bound by it. Regrettably, the judgements only apply to USA NGOs and their foreign affiliates[7]. This creates the astonishing paradox that countries outside of the USA are bound by the Pledge, but not those working within the USA. Fortunately, the Pledge does not apply to the Global Fund to Fight AIDS, Tuberculosis and Malaria, the International AIDS Vaccine Initiative, or any United Nations agency.[8]

The PEPFAR Pledge was drafted under the leadership of George W Bush and the laws that authorise PEPFAR funding included a number of other provisions based on right-wing, religious approaches to HIV/AIDS. Since the election of Barack Obama as President of the USA, most of these ideology-based provisions have been changed to reflect current evidence on HIV/AIDS. The PEPFAR Anti-Prostitution Pledge, however, has not.

Scores of organisations and individuals in South Africa, Africa and Asia are bound by the PEPFAR Pledge and may not be able to risk speaking out against its requirements.

This places a greater responsibility on those of us who can speak out, to demand the repeal of the PEPFAR anti-Prostitution Pledge and to move to evidence-based policy on sex work and HIV.

PEPFAR Planned Funding in South Africa, 2004 – 2015 (USD in Millions) 5


Marlise works as a Policy Development & Advocacy Specialist at Sonke Gender Justice.

[2] ′PEPFAR Investing More Than $410 Million Towards an AIDS-Free Generation in South Africa′ Available:


Accessed 3 October 2016

[3] PEPFAR (2016) ′Partnering to achieve epidemic control in South Africa′, available:


[4] It also noted that ′Prostitution and other sexual victimisation are degrading to women and children and it should be the policy of the United States to eradicate such practices′ in H.R. 1298 – 108th Congress: United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003. (2003). In GovTrack.us (database of federal legislation)

[5] Global Network of Sex Work Projects ′PEPFAR and Sex work′ Briefing Paper #01, available: http://www.nswp.org/sites/nswp.org/files/PEPFAR%20%26%20SW.pdf

[6] https://za.usembassy.gov/our-relationship/pepfar/about-pepfar/

[7] Centre for Heath and Gender Equity ′Anti-Prostitution Loyalty Oath′, Fact Sheet, August 2015, available:


[8] CHANGE Centre for Health and Gender Equity ′All Women, All Rights, Sex Workers included – U.S. Foreign Assistance and the sexual and reproductive health and rights of female sex workers′, 2016




Don’t make us criminals

By Sally-Jean Shackleton[1]

Address presented at a session entitled ‛South Africa’s National Sex Worker HIV Plan: Are you coming?’ at the 2016 International AIDS Conference in Durban. For a video of sex worker rights activism at the conference, see:

After 16 years the International AIDS Conference again occupied the city of Durban.

Much has changed in the 16 years since those 12,000 researchers, policy makers, donors and activists came together for the first time in a developing country. South Africa at the time had the highest prevalence rate in the world and, under the leadership of Thabo Mbeki, was facing AIDS denialism.

The conference, under the theme Breaking the Silence, took place just six years after our first democratic elections and four years after we adopted our Constitution. At that time SWEAT (Sex Worker Education & Advocacy Taskforce) was four years old, recently registered as an independent organisation, and had begun the hard work of organising sex workers. The Sisonke Sex Workers movement was just a dream, and sex workers were idealistically waiting for change.

Law reform on sex work pre-dated the AIDS conference – it was 1999 when law reform on sex work was first mooted and in 2002 an issue paper was released by the Law Reform Commission.

Yet, criminalisation of sex work still remains on the agenda 14 years later.

The release of the last report resulting from a discussion paper in 2009 has been ‘imminent’ for three years now.
Just how serious are we about addressing the needs of sex workers?

There are four things you need to know about criminalisation of sex work: It harms sex workers; it enables corruption and abuse against sex workers; it drives stigma, and it erodes our efforts to end AIDS.

(1) Harms

  • Sex workers were at the AIDS conference [in their] numbers, although continued criminalisation meant sex workers had to wait at the doors while criminal records were checked and some, whose past records had been unearthed, had to argue to be let in. We had to explain why sex workers were here, we had to answer questions for security personnel. This is an excellent example of the barrier that criminalisation poses to sex workers.
  • Sex workers are arrested for having consensual sex while their rapists never see the inside of a jail cell.

(2) Corruption and abuse

  • The law against sex work doesn’t work – after almost 60 years of criminalisation, sex workers are still here. The only thing the law has done is enable police corruption and abuse. It allows violence against sex workers to continue unabated – crimes against sex workers go unreported and those who abuse sex workers can do so with impunity. For the most part, when a sex worker is murdered, no one faces justice.
  • Sex workers are jeered at in police stations, and told they cannot report rape because ‛sex workers can’t be raped’. Sex workers are profiled by police, fined exorbitant amounts under by-laws, and are jailed if they can’t pay. They are routinely asked for money – and for sex – in exchange for their release from custody[2].

(3) Stigma

  • Stigma is a machine oiled by criminalisation, justifying the actions of those who would shut sex workers out and refuse [them] health and other services. Stigma also means
    Members of the public are encouraged to ask the sex work questions about things they have always wanted to know.
    Members of the public are encouraged to ask the sex work questions about things they have always wanted to know.

    sex workers anticipate being treated unfairly at health-care clinics and delay seeking help, if at all, for their health problems or worries.

  • After all, sex workers are criminals. At the AIDS conference, we assumed we would be supported – but again, sex workers were pulled aside and questioned.
  • We have to ‘sensitise’ health-care workers and the police to do their jobs because sex work is stigmatised. Just like the entry to the Conference, we must answer questions before being let in.

(4) Erodes efforts to end AIDS

  • Sex workers and sex work allied organisations have a Plan, as delegates heard from the CEO of the South African National AIDS Council, Dr Abdullah. The Plan is comprehensive, it includes sex workers as peers, as partners, and sex workers collaborated in its development. It also includes the decriminalisation of sex work. It was launched in March this year, with our Deputy President affirming the urgency of its implementation.
  • We have evidence of a crisis, as heard from Prof Lane in a session at the AIDS Conference[3]. HIV prevalence in sex workers, to use the words of our Deputy President, ‛is the highest we have seen in any community’. HIV prevalence among sex workers is a judgement on South Africa’s HIV response. We have failed.

Can we say we are serious when our government, through the police, burns condoms provided by another arm of government?

Can we say we are serious when condoms are confiscated from sex workers as evidence of criminal activities?

Can we say we are serious about HIV when sex workers are refused access to this conference?

Can you say you are serious about the needs of sex workers when your commitment is only on paper, and not in practice?

Now that you know criminalisation harms sex workers here are some things you need to know about decriminalisation.

Based on evidence, decriminalisation will enable sex workers to address violence against them, enforce their rights and report violence against them[4].

Based on evidence, decriminalisation will not increase the number of sex workers exploited, women trafficked or children exploited[5].

Decriminalisation will not increase the demand for sex work – evidence suggests that the legal framework has little impact on the demand for sex work[6].

We have made so many gains since 2000: We changed the racist and oppressive laws that prevented progress; we progressed beyond AIDS denialism, and vastly improved the numbers of people on treatment.

The law that criminalises sex work is the last remaining apartheid era law and a significant barrier to progress in reducing infections among sex workers.

The Deputy Minister of Justice said in his address to delegates at the AIDS Conference on 18 July that his ministry had received a report from the Law Reform Commission, but Cabinet wanted to ‛form its own opinion’. He admitted that the law was not working. Deputy President Ramaphosa said in March that South Africa had ‛an inability to develop a coherent approach to the challenges facing sex workers’[7] – this is a clear indictment on criminalisation.

Courageous activists attended the AIDS Conference, and had to fight to be there. Some didn’t make it – we have lost many of our colleagues to untreated illness and violence.

Organisations delivering services to sex workers have done their work with significant funding and other challenges, and continue to do the work to ensure sex workers have access to prevention, treatment and care. Rights organisations like SWEAT, Sonke Gender Justice, Treatment Action Campaign and the Women’s Legal Centre continue to defend sex workers rights while the Sisonke Sex Workers Movement organises sex workers’ resistant to injustice.

We are asking for the same courage and commitment from our country’s leaders to make true the promise to leave no one behind, and decriminalise sex work.


[1] Director: Sex Worker Education & Advocacy Taskforce

[2] Police Abuse of Sex Workers: Data from cases reported to the Women′s Legal Centre between 2011 and 2015. Women’s Legal Centre April 2016, Cape Town.

[3] Prof Tim Lane UCSF 18 July, see South African Health Monitoring Survey: an Integrated Bio-Behavioural Survey Among Female Sex Workers

[4] The Impact of the Prostitution Reform Act on the Health and Safety Practices of Sex Workers – report to the Prostitution Law Review Committee Nov 2007, Gillian Abel, Lisa Fitzgerald Cheryl Brunton,

[5] Prostitution Law Reform in New Zealand, Prostitution Law Review Committee, New Zealand, June 2012 https://www.parliament.nz/en/pb/research-papers/document/00PLSocRP12051/prostitution-law-reform-in-new-zealand

[6] Moving Beyond Supply and Demand Catchphrases: Assessing the uses and limitations of demand-based approaches in anti-trafficking – Global Alliance Against Traffic in Women

[7] News 24 Wim Pretorius 11 March 2016 ′Ramaphosa launches ″historic″ plan to aid sex workers′  http://www.news24.com/SouthAfrica/News/ramaphosa-launches-historic-plan-to-aid-sex-workers-20160311