Every day, Cindy Manyosi and Onica Nyembe wait for clients in a bar in Yeoville, Johannesburg. As they prepare for their clients both women are nervous, not of sure the kind of clients they will get.

“Some clients trick us. They pretend to have put on the condom and only after you realise  that they took it off,”

says Manyosi.

“We are often left worried about HIV infections.  But clients also become aggressive and starts physically abusing us when we try to negotiate for condom usage,” adds Nyembe.

Neither women knew much about the Department of Health’s decision to offer the antiretroviral medicine, Truvada, as pre-exposure prophylaxis (PrEP) to HIV negative sex workers. PrEP has to be used before every sex act, so sex workers will be on PrEP permanently.

HIV testing

The women said that community health workers from the Esselen Clinic in Hillbrow often came to their residence for HIV testing and condom distribution, but they had not yet been offered PrEP.

“The last time I heard about PrEP was when they were approaching us for the study, but I was very afraid of the side effects as it was still under trial so I didn’t take part,” says Nyembe.

The recent South Africa Health Monitoring Survey found extremely high rates of HIV in sex workers. In Johannesburg, up to 72% of female sex workers are living with HIV, while in Durban this is 54% and in Cape Town 40% of sex workers are HIV positive.

While there is very high condom use with clients, only 10 percent of sex workers said that they used condoms with their regular partners, according to the SA Health Monitoring Survey. If their regular partners are their main source of infection, providing condoms and treating sexually transmitted infection is not enough.

Nyembe said she would take Prep anyday, also because she is worried about the husband that she left in Eastern Cape. “I don’t know what he does when I’m not around. My husband does not want to use a condom when I am back home and does not know the kind of work I do,” she said.

PrEP

Gauteng Health Department spokesperson Steve Mabona said that the PrEP is an additional prevention choice for sex workers alongside other prevention measures such as condoms.

“Sex workers should use Prep because it is for people with a substantial risk of HIV infection like sex workers, with HIV prevalence amongst female sex workers in South Africa that is estimated by 59.8percent, ” Mabona said.

According to Mabona, PreP is part of the country’s strategic plan on sex workers launched by the South African National AIDS Council.

Gauteng is starting to roll out PrEP by working with existing sex worker peer education programmes at the following facilities: Chris Hani Baragwanath hospital (PHRU), the Wits Reproductive Health and HIV Institute’s (WRHI) Sedipa Hope Clinic in Tshwane, Esselen Street Clinic in Johannesburg and Pomona truckers’ site.

AIDS conference feedback

Sex workers activist groups have welcomed the rollout of PrEP, and hope there will be feedback on it at the AIDS conference.

“We were delighted with the roll out of PrEP as it would help reduce HIV infections, but we are also waiting for the department to tell us about the roll-out,” said Lesego Tlhwale, a communications officer at the Sex Worker Education and Training organisation (SWEAT). – Health-e News.