South Africa will soon begin providing HIV treatment to HIV-positive sex workers upon diagnosis as part of a new national plan announced late Friday. Currently, most people living with HIV must wait until their CD4 counts – a measure of the immune system’s strength – fall to 500 before they can start treatment.

At least 3,000 HIV-negative sex workers will also receive the combination ARV Truvada to prevent contracting HIV. When taken daily as pre-exposure prophylaxis, Truvada can reduce a person’s risk of contracting HIV by about 90 percent. In December, South Africa became the first country in southern Africa to register Truvada, which combines the ARVs emtricitabine and tenofovir, for use as prevention in December.

South African National AIDS Council (SANAC) CEO Dr Fareed Abdullah credited Health Minister Dr Aaron Motsoaledi for driving the plan’s creation.

It’s rare for a country to have such high-level leadership dealing with HIV among sex workers,” Abdullah said. “It’s a sign that government is taking this very seriously and working with non-governmental organisations and the community to make sure that the right thing is done and done properly.”

The plan comes on the heels of research released Friday that found about 72 percent of sex Johannesburg sex workers surveyed were living with HIV.

“The good news is that sex workers are showing a lot of responsibility and about three-fourths of sex workers are using condoms with their clients,” said Abdullah.

The bad news is although more than 90 percent of sex workers surveyed had tested for HIV, less than a third of those who were living with HIV had received treatment – far less than the national average, Abdullah added.

Globally, UNAIDS estimates that 50 million women are engaged in sex work and HIV prevalence rates among sex workers is often almost 14 percentage points higher than among the general population due to the inability to negotiate condom use, stigma and barriers to healthcare.

Sex work is estimated to account for as much as 20 percent of new HIV infections in South Africa, according to Deputy Health Minister Joe Phaahla.

‘Sex work is essentially work’

[quote float= right]We cannot reclaim the morality of society by excluding the most vulnerable whatever views we might have about sex workers”

The three-year national plan also aims to reach 70,000 sex workers with a standardised package of services, including PrEP adherence support, delivered in part via a network of 1,000 of their peers.

Deputy President and SANAC Chair Cyril Ramaphosa called the plan a chance for South Africans to affirm their rights.

“This plan is about the human rights, about the rights of ordinary people,” he told Health-e News. “It affirms the right of all South Africans to life, dignity and health regardless of their occupation and sexual orientation and regardless of their circumstance.”

Ramaphosa also cautioned against that moral arguments against sex works could not trump workers’ inalienable human rights.

“We cannot reclaim the morality of society by excluding the most vulnerable whatever views we might have about sex workers, whatever beliefs we have about sex workers, whatever statures are on our law books about the legality of sex work,” he said. “We cannot deny the human and unalienable rights of people who engage in sex work.”

“Sex work is essentially work,” said Ramaphosa, who ended his address by embracing national leader of the Sisonke sex worker movement Kholi Buthelezi.

Law Commission report on decriminalisation expected soon

Buthelezi joined other sex workers in calling for decriminalisation of sex workers to remain on the national agenda.

“We are the vanguards of pleasure,” said Mpumalanga sex worker Lesly Mntambo. “Stop criminalising my adult body and what it is capable of doing. I decide what to do with it.”

The South African Law Reform Commission has been reviewing possible changes in laws governing sex work as part of its an investigation into sexual offenses it initiated in 1998, according to South African Law Reform researcher Dellene Clark.

“The investigation looked into four legislative options, namely full criminalisation, partial criminalisation, regulation and non-criminalisation – popularly referred to as de-criminalisation,” Clark told Health-e News.

According to Clark, the commission’s final report on possible changes to laws governing sex workers is now with the Minister of Justice and Correctional Services Advocate Tshililo Masutha who is expected to announce the report’s release for public comment soon. – Health-e News.

An edited version of this story first appeared on Health24.com, SowetanLive and the Johannesburg Times.

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• Read more: Why PrEP among sex workers may be just the start of South Africa’s HIV prevention revolution