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Ending the suffering of sex workers in East and Southern Africa: a collaborative effort to ensure health and rights

JOHANNESBURG, South Africa—“Sex workers’ lives matter. We live in a world of inequality and those most marginalized suffer most when pandemics and humanitarian challenges strike,” said Beatrice Mutali, UNFPA Deputy Regional Director for East and Southern Africa.

“If we believe in addressing inequalities and ensuring that no one is left behind, we should take advantage of the opportunities of the Decade of Action, to change the suffering of all populations, including sex workers,” she said.

We should take advantage of the opportunities of the Decade of Action, to change the suffering of all populations, including sex workers.

Ms. Mutali was addressing sex workers, UN agencies, non-governmental organizations and development partners on solutions to the challenges faced by sex workers in their sexual health and livelihoods. This was at a recent consultation organized by UNFPA and the African Sex Workers Alliance (ASWA) to discuss the plight of sex workers in East and Southern Africa in the context of emergencies and humanitarian settings, especially the COVID-19 pandemic.

Grace Kamau, Regional Co-ordinator for ASWA, said it was heartening to witness growth in the sex worker movement during such adverse times, when sex workers in the region have faced increased violence and HIV infection, and a decrease in their socio-economic security.

“Where stigma and discrimination continue to exist, how do we as sex workers advocate to ensure that sex work and trafficking are not conflated? How do we advocate to ensure universal health coverage, which would reduce the vulnerabilities of sex workers?” she asked.

Sex workers increasingly marginalized by pandemic

The challenges faced by sex workers during COVID-19 were discussed, including difficulties in accessing health services, rising levels of violence by police, and discrimination. The role played by sex worker organizations to lessen the impact of COVID-19 on their members was discussed.

The key findings of a new UNFPA-led study, A Rapid Scoping Assessment of the Impact of COVID-19 on Sex Worker Programmes in ESA, were presented by Maria Stacey from Equal International Africa. The study found that the impact of COVID-19 containment measures has been greater than the impact of the pandemic itself for sex workers’ livelihoods, human rights and health. Lockdowns worsened criminalization, stigma, discrimination and violence towards sex workers, and increased exclusion from services.

The study found that sex worker HIV programmes are more effective if they combine prevention, community systems strengthening, peer education and microplanning, strengthened partnerships and co-ordination. Also, sex workers are better protected and have better health outcomes if they have social capital and are connected to organizations.

The study made recommendations: Sex workers should be included in social protection and humanitarian relief programmes. Efforts to decriminalise sex work and to reduce stigma and discrimination should be strengthened. Violence against sex workers needs to be addressed. Health services should be decentralized and de-medicalized. Internet-based services should be scaled up. Support for community-based and community-led service delivery should be strengthened.

Building resilience, ensuring rights

In a discussion on strengthening livelihoods resilience, Nonhlanhla Xaba from World Food Programme (WFP) spoke about sex workers’ right to integrated services, using lessons learned from the East and Southern Africa on integrating regional vulnerabilities into WFP food assistance programmes. She gave examples of how sex workers were included in other support programmes in Zimbabwe and Mozambique, and advocated for strengthened data collection and analysis of their vulnerabilities, as well as inclusion in social protection mechanisms. She noted current limitations brought about by the legal and policy environment.

UNFPA’s Tim Sladden provided an overview of the UNFPA/UNHCR Operational Guide: Responding to the Health and Protection Needs of People Selling or Exchanging Sex in Humanitarian Settings. He outlined the recommendations for health and protection clusters regarding the provision of non-discriminatory services, competent clinical service providers access to supplies and referral pathways, including an emergency and minimum response as well as a longer-term comprehensive response.

A discussion on the right to bodily autonomy, led by HeJin Kim from AIDS & Rights Alliance for Southern Africa (ARASA), took a focus on engaging with sub-regional mechanisms. Priorities are to hold governments accountable to commitments made; ensure that rights are not violated under the guise of public-health protection; identify laws and policies that impact sex workers; ensure the right to livelihood and to work safely; and target advocacy beyond policymakers and governments.

Lessons and success factors were presented on Kenya’s upscaled Key Populations programme. Other discussions focused on the Global Fund’s Community, Rights and Gender programme, breaking the cycle of sex workers being left behind in the HIV response in humanitarian crises, mobilizing trade unions to advocate for the labour rights of sex workers, and the protection of sex workers’ livelihoods. It was also noted that the SDGs provide an opportunity to strengthen sex worker programmes.

The meeting concluded with the presentation of a zero draft of the Four-year Regional Advocacy Framework for Strengthened Sex Workers’ Programming in Emergency/Humanitarian Settings in East and Southern Africa. Priorities and lessons shared during the meeting will be incorporated into the framework.