WRHI Sex Worker Programme - Salamander Trust

John Mkandawire, PhD, MPH
WRHI Sex Worker Programme
December 5, 2012

Presenta)on Outline:
• Programme Background
• Package of Services
• Peer Educa)on Outreach
• Mobile Outreach Services
• Best Prac)ces
• Challenges
• Lessons Learnt
• Next Steps
• Acknowledgements

Programme Background
• Started in 1996 as a
microbicides study in
response to sex workers’
unmet sexual and
reproduc)ve health needs
and barriers to accessing
health care
• Same year started condom
distribu)on to sex workers
• 2002 – research project ends
in brothels
and sex worker project becomes
• Partnered with CoJ and DoH
fully fledged clinic at 17 Esselen
in 2000 to start brothel-­based
STI services
Street

Programme Background, Cont’d
• Sex Worker Project expands to
Mobile Outreach Services
providing services to 14 brothels
to address the unmet health
needs of sex workers
• 2006 – first male community
healthcare worker hired on the
team targe)ng male clients by
providing STI educa)onal talks
and condom distribu)on
• 2007 – project team expands to
2 nurses and 3 community
healthcare workers providing
health services at CoJ clinic and
14 brothels

Programme Background, Cont’d
• 2009 – mobile van
introduced to provide
services to street-­‐based sex
workers using peer
educa)on component
• 2010 – services increased to
22 brothels from 14 in 2004
• Programme aims to reduce
the rate of STIs and HIV
transmission by providing
HIV preven)on services and
care for related diseases to
sex workers and their clients

Current Services
• Provides comprehensive • Sex Work Project has 2 teams
clinic-­‐based services from and uses booking system to visit
Esselen Street Clinic brothels (2 professional nurses,
Monday to Friday from 4 CHWs and 10 peer educators)
08h00-­‐11h30
• Brothel-­‐based
comprehensive services to
15 brothels from Tuesday to
Thursday from 12h30
• Mobile Clinic Services to
street-­‐based sex workers on
Fridays (Mnyamandawo:
dark place)

Package of Services
• Sexual and reproduc)ve
health services
• HIV counselling and tes)ng
• Wellness clinic
• NiMART and follow-­‐up
• TB screening
• Pap smear screening
• Minor ailments
• Psychosocial support –
Crea1ve Space
• Referrals
• Condom distribu)on
• Health talks

Peer Educator-­‐Led Outreach
• Peer educators are current and
former sex workers who have
been trained to provide HIV
preven)on outreach to their
peers and to encourage them
to access health services
• Peer educators undergo
intensive in-­‐house training and
receive ongoing training on
HIV, STIs, TB and other
trainings as needed
• Each peer educator works in a
small loca)on among their
social networks making
systema)c and regular contact
with sex workers – both one-­to-­‐one
and in groups

Peer Educator-­‐Led Outreach, Cont’d
• Peers provide outreach services that
typically include informa)on and
counselling about HIV preven)on;
distribu)on of condoms; behaviour
change; and referrals to other
services such as legal assistance
• Some peers speak more than one
language – advantageous because
some sex workers do not speak
English
• Peers adhere to code of conduct
(confiden)ality, non-­‐ judgmental) in
addi)on to WRHI policies and
procedures
• Peer educators are employees of
WRHI and enjoy some of the same
benefits as regular employees
although they work part-­‐)me (leave,
holidays)

Peer Educa)on Outreach
Nine peer educators with one team:
• Work four hours per day, four days a week
• Are WRHI sessional employees
• Operate in two zones
• Mobilise and recruit sex workers at the brothels
• Provide peer-­‐to-­‐peer health educa)on to sex workers
and their clients
• Provide condom distribu)on and promo)on of safe sex
prac)ces
• Provide counselling to sex workers
• Make referrals to Sisonke

Who are we serving?
Characteris

Who are we serving, Cont’d
Behaviour
Last HIV Test Result (Self-­‐Report), n (%)
Posi

Mobile Van Outreach Services
• 2 mobile vans used to access hard-­to-­‐reach
popula)ons and support
HCT campaigns for CoJ, DoH, NDoH
• Fieed with examining and
counselling rooms
• Shared use by different
programmes in Community
Programmes
• Maintains regular spots at major
taxi ranks, bars, major cash & carry
stores
• Also used to carry supplies to
brothels, bars, taverns
• Some sex workers prefer receiving
services through the mobile vans
because of privacy concerns

Best Prac)ces
• NiMART-­‐ started late last year (90 sex workers
ini)ated)
• Provision of mobile clinic services to brothels
• Provision of services to street-­‐based sex workers
using mobile van
• Provides services to 400 sex workers monthly
• Crea)ve Space
• SAPS sensi)sa)on – to build healthy rela)onships
between sex workers and police
– Collabora)ng with SWEAT and Sisonke

What Are the Challenges Working with
• Lack of privacy and
confiden)ality – due to
lack of space at the
brothels
• Less than op)mum
working condi)ons for
the Sex Work team
• Safety and security of
staff (swimming)
• Parking problems at
some brothels
Sex Workers?

Acknowledgements
• CoJ
• DoH
• SWEAT
• Sisonke
• TLAC
• Sex Work team
• Brothel managers
• AIDS Fonds
• Global Fund
• PEPFAR
• Founda)on Open Society
Ins)tute
• Prof Rees