Sisters With a Voice Project

The overall aims of SWV are to: 1) reduce HIV acquisition among sex workers; 2) reduce HIV transmission to their clients; and 3) improve sex workers’ rights, through providing clinical services supported by peer educators and community outreach.

In terms of behaviour change and communication-related activities, the project is undertaking the following:

Peer education and empowerment
Research shows that building strong networks of sex workers can reduce their risk of HIV and STIs as well as gender-based violence. Sex workers with strong networks are more likely to use condoms with clients and regular partners. For this reason, the SVW supports sex workers to work together by providing a safe space for them to gather and identify what issues are important to them. Community empowerment meetings are held at all sites and are run by ‘Sisters’ who have been trained as peer educators. The sessions cover issues that concern sex workers (self-worth, behaviour change, contraception, HIV, and cervical cancer), issues relating to clients and partners (communication, assertiveness, serodiscordance, sexual networks, and multiple concurrent partnering), and issues relating to the ‘sisterhood’ (advocacy, stigma, rights, and support). Through these regular meetings, sex workers develop power as a community and act to address some of the factors that increase their HIV risk. Empowerment also increases sex worker participation and leadership in the programme.

Advocacy
The programme undertakes advocacy in order to improve respect, protection, and upholding of sex worker rights to promote their universal access to HIV prevention, treatment, care, and support. The project implements workshops to sensitise district-level health officials, the media, and the police on the rights of sex workers.

Working with adolescent and young women sex workers
The project is making an effort to include adolescent and young women who sell sex. Formative research undertaken by the project points to the fact that adolescents who sell sex do not have the skills or experience to negotiate safe relationships or manage difficult clients; unequal power relations between themselves and often significantly older adult men further exacerbate their risk. SWV is therefore working closely with the Ministry of Health and Social Services, and SWV recruits to train and supports young (aged 15-24) peer educators, around half of whom will also be trained as lay child protection officers (case care workers). The programme for young sex workers uses age-specific materials that were developed and piloted by CeSHHAR. The programme activities encourage mobilisation around HIV prevention and treatment and the health and well-being of young women who sell sex so that they are able to engage in risk reduction and the use of health services. Click here [PDF] to download the “Working with Young Women Who Sell Sex: Facilitator’s Activity Pack”, which was developed for working with young sex workers.

Social Media
The programme has also run social media workshops with sex workers in order to provide information on the potential of social media to improve communication and networking between sex workers. For example, social media has the potential to provide information about services, can provide a means for sex workers to communicate with the world and tell their story, and can be used for advocacy and stigma reduction.

HIV/AIDS

Female sex workers are at very high risk of acquiring and transmitting HIV infection. In Africa, female sex workers have 11 times higher odds of having HIV than women in the general population. Modelling suggests that across Africa, 40% of new infections within the population are likely attributable to unsafe sex work, suggesting that 40% of new infection could be prevented if sex workers could be supported to be fully engaged with prevention and care services. However, female sex workers are marginalised, sex work is illegal in many countries, and female sex workers are often stigmatised by communities and health workers. Typically, female sex workers are also highly mobile. In Zimbabwe, where prevalence among sex workers is 58%, analysis of programme data from 2009-2014 suggests that annual HIV incidence is over 10% (ten times that in the adult female population), that only 67% are aware of their HIV status, and that less than half of all female sex workers living with HIV have a viral load.