sex workers in gauteng

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Presentation by Dr Liz Floyd, at the National Sex Work Symposium in Boksburg, on 22 August 2012

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  • 1. DEPARTMENT OF HEALTHSEX WORK IN GAUTENG PROVINCEModels for implementationMODELS AND RESULTS 22nd August 2012

2. 1. Situation Analysis of Sex Work1. Poverty and survival of young women 1. Low education, no ID, unemployment 2. Some are abused or abandoned 3. Lifeskills and vulnerability e.g. OVC2. Informal settlements at mines: 40% of pregnant women HIV positive by 20021. Profile of sex work : 1. All CBDs, mines, mens hostels (? farms) 2. Very widespread: bars, shebines, clubs 3. Shacks/ flats/ hotels/ rooms/ houses/ bush/trucks2. Social norms which accept transactional sex3. HIV rates over 50%2 3. 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 support1. Peer education on best practice model (PSG): high outputs2. Recruit, train, support and manage CSW educators3. Provide social support and services4. Organization of CSW e.g. hotels, hostels and safety5. Support for children and link to families3 4. 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,skills3. ? Mobile clinics : criteria ?4. Residential care for very ill CSW (dumped)D. Increased access to social services: 1. Children, child care and ECD, ID, grants 2. Abuse, substance abuse, shelters, street kids4 5. 3. CSW logical framework for resultsPlanM&E Indicator SourceGoalImpactReduced new HIV in youth (15-24), adultsSurveys of HIVStrategic Out-come 1.Increased social norms e.g.Behaviouralobjectivetransactional sexsurveys2.Increased knowledge of1.Householdprevention2.BSS for CSW3.Increased regular condom use3.BSS for YOS4.Reduced social risks (defined)5.Increased knowledge of HIV status6.Reduced substance abuse7.? Reduced STIs, ? Youth pregnancy (tbc)ServicesOutputNumbers CSW reached with services : Service reports1.Peer educationVerified2.Health and Social ServicesManage- Process Quality and coverageAudit of servicesmentGuidelines, training, M&E systemRegisterssystems Management of CSW projectsReportsResources InputsBudget. Number of educators Financial, HRSupplies of condoms and materials Delivery notes 5 6. 4. What Research shows us:1. Evaluation of peer education model (PSG)Changes sexual behaviours : high condom useReduced 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 risks3. KYE report : refer to presentations4. Meta-analysis of HIV prevention by CIET :A cascade = combination prevention= social, behavioural and medical combined. 6 7. Research continued4. Behavioural surveys (BSS) of CSW in Joburg Central94% condom use @ last sex: 2003, 2004, 2007, 2013Low condom use for partners, low drug use (

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