The Importance of Sex workers interventions; the case of TaYA

In sub-Saharan Africa, sex workers have been especially heavily affected by HIV and other sexually transmitted infections (STIs), with levels of infection much higher than those among other groups of society. In Ethiopia, the first sera found to be HIV positive date back to 1984 and, by 1988, HIV prevalence among female sex workers /FSWs/ and their trucker clients had already risen to 17% and 13%, respectively.

Sex work is an important feature of the transmission dynamics of HIV within early, advanced and regressing epidemics in sub-Saharan Africa. HIV prevalence among sex workers and their clients today is commonly 10–20-fold higher than among the general population. With high rates of partner change, the potential for onward transmission of HIV from an infected sex worker to their partners may be more than 100 times greater than from other people living with HIV (PLHIV).
There are a number factors influencing sex workers vulnerability to HIV/AIDS. This includes;

Lack of access to health, social and legal services limits sex workers’ options when seeking to care for their health, protect themselves from HIV and STIs and get the assistance they or their families may need to address social or legal matters.

Even where such services are available to them, sex workers may not take advantage of them. Inconvenient hours and locations, unwelcoming or judgmental attitudes on the part of staff and other clients, charging sex workers higher prices, and overall poor quality of service are often cited as deterrents.

Limited information, skills, negotiating power and access to means of prevention may lead directly to behavior that puts sex workers and clients at risk of HIV infection. Unprotected commercial sex usually occurs because one (or both) of the participants does not care to protect their sexual health, does not know how to do so, or lacks the means to do so (e.g. condoms, lubricant, safe-sex skills). Sex workers also often lack the personal power to negotiate safe sexual practices, and may be working under the threat or fear of violence in retaliation for trying to do so. Risk of HIV infection is compounded when sex industry managers actively discourage or do not support safe sexual practices and where working conditions limit opportunities to negotiate safe sex.

With this in view, Talent Youth Association in collaboration with the Addis Ababa HIV/AIDS Prevention and Control Office and the Johns Hopkins University started a project with the main aim of mobilizing commercial sex workers /CSWs/ to access confidential HIV/AIDS and STI services. The clinics run by the Family Guidance Association of Ethiopia with a funding support of the US Center for Disease Control, through a PEPFAR grant.

The project targeting HIV/AIDS prevention and care programmes for those involved in sex work use a mix of strategies. The effective key strategies that have been used are: promotion of safer sexual behavior among sex workers, clients and institutions or groups associated with sex workers, promotion and availability of STI prevention and care services; outreach work that includes health, social services, peer education among sex workers, clients and associated groups, care of people living with HIV/AIDS (PLWHA).

In last two months (December 2011 and January 2012) we were able to mobilize over 300 FSWs using to peer to peer approach to heighten their awareness on HIV/AIDS and STIs.  Out of this, 241 CSWs accessed the service. We learnt that out of the 241 CSW, 11 of then found to be HIV Positive, which is nearly 5%. Among this 7 of them are between the ages of 15-24.
The data also indicate that there is 55% STI cases among those FSWs screened. This staggering figure is an indication where the prevention effort needs to focus on. Most at risk population like CSW need massive intervention in both the prevention and service aspects, in order to reduce new infection rates.
An important public health principle applicable to most diseases including HIV is that different population groups have an unequal risk of acquiring disease, and that those groups at higher risk require specific services.
These services, by necessity, must differ in intensity and type from services that target groups at lower risk. Over and above being one of the most vulnerable group to HIV infection, sex workers are also potentially a most important and effective partner in halting its ongoing transmission.

Ephrem Berhanu
Network of African Youths for Development
Tel: +251-116-185-323
Fax: +251-116-188-161
P.O.Box: 2187, Code 11110