Public health sector still failing sex workers’ health needs

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Durban – A lack of sensitivity and discrimination in the public health sector has led to South African health advocacy organisations tasked with outreach at hot-spots and brothels becoming safe-havens for female sex workers (FSW). “FSW have limited access to healthcare due to factors such as stigma and discrimination from health care providers and police,” according to Nosipho Makhakhe of the Anova Health Institute, a non profit focusing on HIV. Makhakhe was speaking on the first day of the 8th South African Aids Conference at the Inkosi Albert Luthuli International Convention Centre in Durban on Tuesday. FSW and other key populations in sub Saharan Africa are regarded as residual drivers of HIV transmission. A survey conducted in three South African cities in 2015 among FSW showed HIV prevalence of 71.8% in Johannesburg, 39.7% in Cape Town and 53.5% in Durban.

Despite on going public debate and lobbying, sex work remains criminalised in the country, with sex workers’ main access to improved health care being through health advocacy organisations such as Lifeline, Sisonke, SWEAT and others.

Health advocacy organisations have a mandate to refer sex workers for further care to public hospitals and clinics, some also train sex workers to become sensitised to these facilities so that they can be treated with dignity and respect.

Makhakhe said that some sex workers didn’t follow up with referrals and some felt public health facilities were still not sensitive to their needs.

A female sex worker from Durban interviewed for a study, said: “We do get referred at the clinics but some of us don’t follow up. There are those when they get an STI that looks like a cauliflower they ignore that one, because it makes the client happy because it makes the vagina hot and tight. As much as they are sick, they always work and their life comes first.”

Another female sex worker interviewed for the same study said: “In clinics we get stigmatised. You go to a nurse and when you tell her that a condom burst during sex and you tell her that you are a sex worker, the nurse will call her colleagues and they will ask you why you selling sex and you are so young, and they continue making fun of you.”

Makhakhe said that apart from perceptions of stigma and discrimination, some FSW avoided public health care facilities due to operational issues, such as long waiting times and being told to come back at another time for the same service.

A female sex worker from Durban said she preferred using a private doctor because of long waiting times at clinics.

“More sex worker sensitisation training is needed amongst healthcare providers if the restoration of trust between FSW and the public health system is to be a success,” said Makhakhe.