01 December 2017

Shocking: 70% of SA sex workers don’t protect themselves against HIV

Scientific studies have shown that pre-exposure prophylaxis (PrEP) is effective in protecting people from HIV during both anal and vaginal sex.

Despite being offered a daily pill to protect them from HIV, almost three-quarters of women sex workers had stopped taking the pills after a year.

This is according to a study published in the PLoS journal last week, conducted by the TAPS Demonstration Study.

Only one pill

The study tested almost 700 women, and says that the average woman was “married or had a steady partner, worked in brothels, and were born in Zimbabwe”.

Almost half of the women tested were HIV positive (341). Of these, 139 decided to go on ARVs. Around 60% of them were still on the medication after a year.

The sex workers who tested HIV negative (351) were offered one pill, Truvada, to take every day to protect them from the virus. 219 women accepted the offer.

But a year later, only 49 women were still taking Truvada – although none of those still on the pills had contracted HIV.

“The final retention rate was lower than we would like. However, there were no seroconversions among those women who stayed on the PrEP arm,” said Robyn Eakle, a senior researcher from the Wits Reproductive Health and HIV Institute (WRHI), which was part of the study.

Infections occur in three groups

Using ARVs to protect people from HIV is called pre-exposure prophylaxis (PrEP). Scientific studies have already shown that Truvada is effective in protecting people from HIV during both anal and vaginal sex.

The Department of Health decided to offer PrEP at certain clinics that serve sex workers, despite being under pressure to provide ARVs as prevention more widely available.

Around half of the world’s new HIV infections occur in three groups – sex workers, men who have sex with men and injecting drug users. In South Africa, HIV rates are very high among sex workers.

“We found that many of the women cycled in and out of care as they felt more or less at risk, as reported by them,” said Eackle. “Some reported difficulties getting to the clinic at times due to work, family or other conflicts such as school.”

Eakle said this and other studies “suggest that PrEP use is likely to be cyclical for many women, which is fine as they develop new habits for remaining negative. Perhaps the act of engagement in care in the larger picture is what will keep them negative.”

Sex work still a crime

Sex work is illegal in South Africa, which makes it hard for health workers to reach and treat them.

But Health Minister Aaron Motsoaledi told Health-e that “South Africa does not need to wait for laws to decriminalise sex workers before protecting this sector from HIV”.

The country’s National Strategic Plan on HIV and TB recommends decriminalising sex work, but last year the SA Law Commission recommended that sex work remain illegal.

“The issue of sex workers is not just for the Minister of Health but involves other Ministers,” said Motsoaledi.

“India has not decriminalised sex workers, but health workers in Bangalore are working very openly with sex workers and police are not arresting them.” – Health-e News.

Image credit: iStock