oa South African Health Review - Sex work and South Africa's health system : addressing the needs of the underserved
Sex work remains illegal and highly stigmatised in South Africa, resulting in sex workers - the majority of whom are internal or cross-border migrants - experiencing ongoing human rights violations and a high HIV burden. High levels of unemployment, limited socio-economic opportunities and associated migration dynamics mean that sex work remains a key livelihood option for many cisgender and transgender women and men in sub-Saharan Africa.
This chapter reviews the health system's response to sex work in South Africa, with a focus on HIV-related programmes. The analysis is based on the World Health Organization's health system 'building blocks' framework and is informed by a policy scan, literature review, consultation with sex work experts, and reflection.
We provide an analysis of the politics of much-needed structural interventions such as sex work law reform, the removal of ideological provisions in donor grant agreements, and the need for strong political will to roll-out sex work-specific health programmes.
The authors argue that South Africa will not reach the United Nations Joint Programme on HIV and AIDS (UNAIDS) 90-90-90 targets unless adequate attention and political will are invested in sensitive, appropriate and evidence-based responses to sex worker health.
Limited but important progress has been made in expanding appropriate programmes for sex workers in South Africa. Much more is needed to reach and empower sex workers to keep themselves safe, safeguard public health, and achieve health-related sustainable development goals. Delays in addressing data gaps, implementing global recommendations on sex work law reform and evidence-based interventions continue to impact negatively on sex worker morbidity and mortality, and have wide-ranging implications for public health and related expenditure.
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