DEPARTMENT OF HEALTH

SEX WORK IN GAUTENG PROVINCEModels for implementation

MODELS AND RESULTS

22nd August 2012

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1. Situation Analysis of Sex Work 1. Poverty and survival of young women

1. Low education, no ID, unemployment2. Some are abused or abandoned3. “Lifeskills” and vulnerability e.g. OVC

2. Informal settlements at mines: 40% of pregnant women HIV positive by 2002

3. Profile of sex work :1. All CBDs, mines, men’s hostels (? farms)2. Very widespread: bars, shebines, clubs3. Shacks/ flats/ hotels/ rooms/ houses/ bush/

trucks4. Social norms which accept transactional sex 5. HIV rates over 50%

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2. CSW InterventionsA. Social prevention and protection for young women1. Vulnerable poor young women and OVC : parenting2. Increase education, lifeskills, training, income for young

women3. Reduce violence, substance abuse, exploitation4. Delay sex, reduce partners, increase safety for girls5. Improve social norms for transactional sexB. Peer education with social support 1. Peer education on best practice model (PSG): high

outputs2. Recruit, train, support and manage CSW educators 3. Provide social support and services4. Organization of CSW e.g. hotels, hostels and safety 5. Support for children and link to families

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CSW Interventions cont ….C. Increased utilization of primary health care

services: 1. FP, TOP, ANC/PMTCT/MCH (SRH), HCT, STI,

TB, ART2. Access: Hours, queues, transport, attitudes,

skills 3. ? Mobile clinics : criteria ?4. Residential care for very ill CSW (dumped)

D. Increased access to social services: 1. Children, child care and ECD, ID, grants2. Abuse, substance abuse, shelters, street kids

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3. CSW logical framework for results Plan M&E Indicator Source

Goal Impact Reduced new HIV in youth (15-24), adults Surveys of HIV

Strategic objective

Out-come 1. Increased social norms e.g. transactional sex2.Increased knowledge of prevention3.Increased regular condom use 4.Reduced social risks (defined)5.Increased knowledge of HIV status 6.Reduced substance abuse 7.? Reduced STIs, ? Youth pregnancy (tbc)

Behavioural surveys1.Household2.BSS for CSW3.BSS for YOS

Services Output Numbers CSW reached © with services :1.Peer education 2.Health and Social Services

Service reports Verified

Manage-ment systems

Process Quality and coverage Guidelines, training, M&E systemManagement of CSW projects

Audit of services RegistersReports

Resources Inputs Budget. Number of educators Supplies of condoms and materials

Financial, HRDelivery notes

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4. What Research shows us:1. Evaluation of peer education model (PSG)• Changes sexual behaviours : high condom use• Reduced STIs : no direct link to HIV (even for PPT)• Not proven to reduce new HIV : ? Reasons2. Evaluation of Mothusimpilo (CSW mines) by

Horizons • HIV spread to 40% of young women and men in mining

town• Narrow focus on CSW = low impact on general HIV

rates• Local risk analysis : informal settlements = social risks 3. KYE report : refer to presentations4. Meta-analysis of HIV prevention by CIET : A cascade = ‘combination prevention’ = social, behavioural and medical combined.

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Research continued

4. Behavioural surveys (BSS) of CSW in Joburg Central• 94% condom use @ last sex: 2003, 2004, 2007, 2013 • Low condom use for partners, low drug use (<5%)• Risks reduced through organization: hotels, brothels

5. BSS of unemployed youth (YOS) 2007, 2013• A combination of high social risks: alcohol, drugs, sex

partners, condom use, pregnancies. • In informal settlements and townships.• Social analysis: has spread to YIS, increased

unemployment from 2008

6. High HIV rates in sex workers : 60% plus

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Lessons from implementation1. Combined prevention for CSW =

Peer education + social support + health + social services

2. Aim for high coverage : ‘numbers reached’ ©1. Widespread CSW & transactional sex : decentralize2. High output, low cost peer education model : PSG3. Ensure minimum standards : quality & management4. Ensure high condom supply : male, female

3. Measure outcomes with behavioural surveys every 3 years :

Use BSS by FHI to compare across time and groups

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Lessons ….4. Access to primary health care services :

1. Including ‘SRH’ : FP, TOP, ANC/PMTCT/MCH, STI etc

2. HIV and TB, other services5. Access to social services :

Children, rehab, shelter, IDs, grants etc 6. Training for income : Labour Dept, EPWP, CWP7. Address social vulnerability = social protection

(DSD). 1. Lifeskills training. Social norms .2. Vulnerable girls eg OVC. Poverty relief 3. Reduce abuse : physical, emotional, sexual,

substance, trafficking etc.4. Provide exit services = support, train, income

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MODELS THAT WORK

1. CSW peer education ‘best practice’ model = PSG standards. For dense CSW populations.

1. Recruit, train, support and manage CSW educators2. Map area, weekly plan with review, records3. High outputs with quality education and condoms4. Social support and organization

2. Increased utilization of primary health care1. Primary health care including ‘SRH’ services2. Times, queues, attitudes, skills, ? Distance3. Mobile services for high risk wards & rural areas4. ? Criteria for dedicated CSW clinic services eg days,

brothels

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Models …3. Increased access to social support and services

1. Social support systems for CSW projects : defined2. Social services : children, violence, rehab, IDs, grants etc.3. Multi purpose centres (MPCs), ECD

4. Ward model = adaptation of peer education model1. Very high reach for risk areas & groups : informal settlements,

YOS, bars, OVC2. Referrals for poverty, social and health services with follow up3. Coordinated community worker and local services in wards –

schools, clinics, children’s services, NGOs etc 5. CBO community mobilization model

1. Train leaders to educate and support members2. Social action to reduce social risks eg alcohol, violence, OVC3. Inclusion of vulnerable groups (‘mainstreaming’)

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CSW models

Thank you