Longitudinal study: sex work, violence and HIV reduction in southern Africa


Sex workers are some of the most marginalised workers in the world. In southern Africa, working within a context of stigma and criminalisation means that sex workers of all genders face high levels of violence, ranging from beatings, robbery and rape, to being arrested for carrying condoms and being arbitrarily detained or fined. This violence often causes inconsistent condom usage and stops sex workers from accessing necessary (legal) support and health care, making them considerably more vulnerable to HIV/AIDS.  

HIV rates in southern Africa remain high. In South Africa there is an HIV prevalence rate of 57.7% nationally, with variations between cities (71.8% in Johannesburg and 39.7% in Cape Town). Access to, and retention within, treatment for sex workers who are HIV positive is lower than for non-sex workers. Therefore, vulnerabilities associated with this diagnosis will necessarily be exacerbated. In the context of Botswana, there is less data than South Africa; however a 2017 Aidsfonds report found that 66% of sex workers had experienced some form of violence, which can lead to as noted, higher HIV infection rates. In Zimbabwe, it is estimated that there are 44,500 sex workers, 40% of whom are living with HIV. Unlike South Africa, sex workers are more likely to engage with treatment, with treatment prevalence being 72%. Data relating to sex workers in Mozambique is similarly limited in scope, although it has been estimated that rates of HIV infection within sex workers in selected cities varies from 17.8% to 31.2%. 

Given the prevalence of HIV in sex workers within the above-mentioned countries, reducing rates of new infections is imperative if the 90-90-90 target is to be reached. Therefore, there is a pressing need for interventions that address HIV infection, as well as violence against sex workers, such as the Hands Off programme, run by Aidsfonds. 

Research overview

The overall aim of this research is to ascertain whether the interventions of HandsOff Phase II have had a positive and sustainable impact on reducing violence and HIV infections amongst sex workers in: Botswana, Mozambique, South Africa and Zimbabwe. The study purpose is based on the following assumption - we can reduce the number of new HIV infections among sex workers by effectively addressing violence against sex workers. This results in increased condom-use and control over transactions and safer work environments. 

A repeated cross-section design will be employed, utilizing both quantitive and qualitative data. Surveys will be conducted in all four countries with sex workers to assess the impact of the programme on the reduction of violence and therefore HIV infection. We will also conduct semi-structured interviews with sex workers who have engaged with the HandsOff programme, as well as with the following stakeholders: project partners, community leaders, law enforcement, health care workers, and religious and traditional leaders.

This project is funded by Aidsfonds.