Sex Workers’ Health – Highlights at AIDS 2022
The 24th International AIDS Conference (AIDS 2022), held July 29 to August 2 in Montreal, Canada, and online, brought together sex workers across Africa and other key stakeholders working to end the HIV/AIDS pandemic.
The sex workers community was strongly represented by global, regional, national and grassroots sex workers leaders from;
- The Global Network of Sex Work Projects (NSWP)
- Kenya Sex Workers Alliance (KESWA)
- National sex workers movement in South Africa Sisonke
- Uganda Network of Sex Worker-led Organizations (UNESO)
- Bar Hostess Empowerment & Support Programme (BHESP)
- Zimbabwe Rainbow Community
- Center for Popular Education and Human Rights Ghana (CEPEHRG)
- Sex Workers Academy Africa (SWAA) Faculty
- The new UNAIDS 2022 Global AIDS Update
The report In Danger: 2022 Global AIDS update reveals that during the last two years of COVID-19 and other global crises, progress against the HIV pandemic has faltered, resources have shrunk, and millions of lives are at risk as a result.
Overview of the update
As of 2021, UNAIDS key populations data shows that key populations (sex workers and their clients, gay men and other men who have sex with men,people who inject drugs, transgender people) and their sexual partners accounted for 70% of HIV infections globally:
51% of new HIV infections are among KP in sub-Saharan Africa.
MSM have 28 times the risk of acquiring HIV compared to people of the same age and gender identity while people who inject drugs have 35 times the risk, sex workers 30 times the risk, and transgender women 14 times the risk. For sex workers who are transgenders, MSM, who inject drugs, the risk is even higher.
More information here:
Other sessions involving sex workers included:
The Director of the Health Group, UNDP Bureau for Policy and Programme Support Mandeep Dhaliwal said that globally 153 countries criminalise some aspect of sex work. The decriminalisation of sex work could avert 33 to 46% of HIV infections among female sex workers. The South Africa Deputy Minister for Justice and Constitutional Development John Jeffery said that they are engaged in the process of sex work decriminalisation and added that they hoped to bring legislation to support decriminalization of sex work before the end of 2022.He also raised a concern that the people concerned about human trafficking arguing that decriminalization of sex work would increase the potential human trafficking and said it was useful to hear other countries’ sex work decrim aspects and how they are approaching the decrim process.
Watch the session here: https://youtu.be/I1sexmHgOvA
The Center for Popular Education and Human Rights Ghana (CEPEHRG) Executive Director Mac-Darling Cobbinah discussed that in Ghana they are facing a lot of challenges and so they decided to engage a tactic namely ‘revolution from within’ which involves building the capacity of LGBTIQ and Key Population members and organisations to accept who they are, embrace unity and support the community to seek health services and not focus on the people who spread whorephobia, homophobia and transphobia who may not shift from their hatred attitude and ideologies.
Watch here: https://youtu.be/Kb5aSLJJl04
The manager SDGs and UNAIDS HIV, Health & Development Group, UNDP Ludo Bok moderated the session. It was discussed that in the 2021 political declaration on HIV and AIDS and the global AIDS strategy, countries committed to ensure that 45% of people living with HIV and key populations have access to social protection benefits by 2025.
Watch more here: https://youtu.be/_x9mKnmyBcY
- A Global Village
A Global Village session brought together a panel of sex workers’ rights leaders and advocates who discussed sex worker leadership in HIV policy fora. Additionally, there was a discussion on the erasure of sex workers from HIV/AIDS policy, that sex worker-focused is not sex worker-led and that sex worker leadership should be included in HIV and AIDS policy.
Sex workers leaders spoke on the violence and human rights violations that stem from the criminalization and stigmatization of sex workers. They advocated for “nothing about us, without us” as it applies to laws and criminalization around sex work, noting that “if we can’t participate in the laws that govern us, how can we change them to make our communities safer?”
More here: https://youtu.be/_FT2XYCw8ek
Youth Village: Zimbabwe Rainbow Community Director Lawrence Phiri was a panelist at the youth force youth village where he focused on issues affecting young male sex workers. He advocated for the recognition of young male sex workers health issues by policy makers, donors and other KP groups. His main advocacy ask was male sex workers better health services with equal opportunities as female sex workers. He also encouraged all sex workers groups to unite and advocate for one goal. He joined the protestors at the conference to advocate International Aids Society (IAS) to include key populations in their decision making and not let policy makers or scientists do it for KP. Additionally, his other advocacy ask was ‘prioritize Undetectable =Untransmittable (U=U)’.
At the global village, the young leaders called for strategies to increase the capacity and ability of young leaders, healthcare providers, policy makers, and programmers to better address the SRHR, HIV, and mental health needs of young key populations in healthcare settings.
- Satellite session
NSWP Global Coordinator Ruth Morgan Thomas introduced the session ‘’Communities leading the way: The importance of key population community-led responses in HIV 2022’’ and said “We are not simply patients or targets of prevention campaigns – key population communities need to be in the lead.”
The NSWP President, also the National Coordinator Kenya Sex Workers Alliance (KESWA) Phelister Abdalla stated ‘’ we are ready for sex work decrim’’ and added that in the future others would learn and benefit from the African sex work decrim movement.
After Phelister ended her presentation, she was joined by the National Coordinator of Sisonke in South Africa Ms Kholi Buthelezi to sing an incredible, uplifting, human-rights centered song.
Listen more here: https://youtube.com/shorts/uUCpGYpK_Ps?feature=share
Ms Kholi Buthelezi said that decriminalisation of sex work equals HIV prevention. She said Africa is ready for sex work decrim and urged all to ‘get on your marks, get set’ and run the race of sex work decrim.She also joined other activists to call for sex workers to be allowed entry in those countries hosting AIDS Conference and should not be denied visas to attend the conference.
Watch her here: https://youtu.be/Y_zVhJhyS-4
A workshop was organized by Bar Hostess Empowerment and Support Programme (BHESP) Kenya. BHESP Deputy Executive Director, Josephine ACHIENG highlighted that COVID-19 greatly interrupted access to HIV services for sex workers in Kenya and led to more economic uncertainty, behaviour that increased vulnerability, experiences of stigma and personal violence. She added that BHESP prioritized a differentiated service delivery model to move toward achieving the UNAIDS 95-95-95 targets during the COVID-19 pandemic. BHESP is guided by the key principle of client involvement, providing an alternative, stigma-free and needs-oriented service delivery model.
Daisy Kwala BHESP Care Manager was a panel in a session entitled ‘Getting person-centred care right: Good practice models of integrating HIV and other health needs’. She presented on people-centered care model for sex workers who use drugs in Kenya.
She explained that Person-Centered Care (PCC) involves improving overall health care outcomes of sex workers by putting them and their needs at the centre while ensuring their dignity and human rights are upheld.
Listen her here: https://youtu.be/_Rh9jeBXnDY
- Award Ceremony
Sex Workers Academy Africa (SWAA) faculty member Joyce Adhiambo received an award for advocating sex workers living with HIV to have access to HIV prevention and care services. Though Joyce did not physically attend the conference for having being denied visa to Canada, she virtually thanked IAS team for recognizing her as a ‘Me and My Healthcare providers champion’ in sex workers HIV response.
- Abstract Presentation
Uganda Network of Sex Worker-led Organizations (UNESO) Programs Manager Ms Naomi Mujuni presented an Abstract about “Increasing access and uptake of PrEP among sex workers in Uganda”.
Find the abstract here.
- Trans Inclusion in health program
It was discussed that though the trans community is now international recognized as key population, they are excluded in the National HIV Policy and Planning and other national policy documents.It was noted that chronic under-investment in trans sex workers’ health programs is clearly undermining the HIV response.It was noted that there is a need to capacity build trans sex workers community to be able to analyze and interpret data from academic studies in researches.Moving forward, multi sectoral partnership is vital to address global health response by ensuring that trans sex workers are not left behind.
More information here: https://youtu.be/PpK-ah_pxU0
- Long-Acting Anti-Retroviral Treatment of HIV (LA-ART)
Long-acting injectable antiretroviral therapy (LA ART) is a novel treatment option among key populations such as female sex workers (FSW) living with HIV. Compared to daily oral ART, bimonthly long-acting injectable ART (LA-ART) may simplify adherence, improve clinical outcomes, and decrease HIV transmission in key population.
LA-ART was found to be non-inferior to daily oral ART. Qualitative findings underscored enthusiasm for LA-ART and reinforced its potential to address sex work-specific barriers to daily oral ART adherence including work-related schedules and substance use.
It was noted that People Living with HIV (PLHIV) who were enrolled on LA-ART needed less frequent Anti-Retroviral Therapy (ART) dosing, and had reduced side effects and pill burden.
LA-ART provides choice, privacy, and less dosing. It’s convenient for those that work and travel. Large injectables can’t be self-administered. Community-driven approaches which include tailored health education and improved patient-provider communication and quality of care, as well as strategies to facilitate appointment adherence are needed to optimize LA-ART use among FSW.
Panelists wondered if LA-ARTs could be rolled out equitably to poorer countries with more health system challenges when high-income countries reported health system and infrastructure challenges. LA-ART requires bimonthly clinic visits, so we must redesign health systems.
- World Health Organisation (WHO) New Guidelines
The World Health Organisation (WHO) launched 3 new guidelines namely;
- New Consolidated guidelines on HIV, viral hepatitis and STI prevention, diagnosis, treatment and care for Key Populations
- New guidelines on the use of long- acting injectable cabotegravir (CAB-LA) as pre-exposure prophylaxis (PrEP) for HIV
- Technical brief to update and supplement WHO Implementation guidance on differentiated and simplified Pre-Exposure Prophylaxis(PrEP) for HIV prevention
- Consolidated guidelines on HIV, viral hepatitis and STI prevention, diagnosis, treatment and care for key population
Ruth Morgan Thomas, NSWP’s Global Coordinator, while speaking at the launch of the new Consolidated guidelines on HIV, viral hepatitis and STI prevention, diagnosis, treatment and care for key populations said “We saw meaningful involvement of key populations as we were consulted through the values and preferences survey for the development of the updated WHO guidelines”
The new WHO HIV, hepatitis and STIs in Key Populations guidelines provide an essential framework for the global community to progress toward the UNAIDS 95-95-95 targets and to lever action.
The guidelines update include caution regarding counselling-based behavioural interventions; early treatment of hepatitis C for people at continued risk and include revised recommendations for service delivery and the use of online interventions.
The guidelines focused on informing community advocacy, strengthening people-focused services tailored to key populations, integrating STIs and Hepatitis, integral involvement of peer navigators and tackling structural barriers and inequality.
The guidelines strong focus is on decriminalization of sex work and the inclusion of key populations for a more systemic change, acknowledges sex workers as people whose health is a human right.
The new WHO guidelines require robust evidence, however, the lack of robust data from some Low Middle-Income Countries (LMICs) i.e total size estimate of sex workers, including those facing violence across Africa may restrict a wider context of the challenges these settings face.
Download the new WHO guidelines here:
- New WHO guidelines on long-acting cabotegravir (CAB-LA)
World Health Organization (WHO) released new guidelines on the use of long- acting injectable cabotegravir (CAB-LA) as pre-exposure prophylaxis (PrEP) for HIV.
CAB-LA is an intramuscular injectable, long-acting form of PrEP, with the first 2 injections administered 4 weeks apart, and followed thereafter by an injection every 8 weeks.
CAB-LA was shown to be safe and highly effective among cisgender women, cisgender men who have sex with men, and transgender women who have sex with men in 2 randomized controlled trials, HPTN 083 and HPTN 084.
The overview highlighted data demonstrating LA CAB as superior to oral PrEP for HIV prevention given ‘near perfect’ adherence comparatively. Studies found that use of CAB- LA resulted in a 79% relative reduction in HIV risk compared with oral PrEP where adherence to taking daily oral medication was often a challenge. Long-acting injectable products have also been found to be acceptable and sometimes preferred in studies examining community PrEP preferences.
WHO will continue to support evidence-based strategies to increase PrEP access and uptake, including through the adoption of CAB-LA. Key actions include:
- WHO will support countries and partners to include CAB-LA safely and effectively in HIV prevention programmes.
- WHO is working with Unitaid and other partners to develop implementation science projects to answer outstanding safety issues, implementation challenges, and understand people’s preferences for CAB-LA among other HIV prevention choices.
- WHO is working with countries, communities and donors including The Global Fund, PEPFAR, and the Bill & Melinda Gates Foundation to support the inclusion of CAB-LA in their programmes and to catalyze implementation science and monitoring of programmes so that CAB-LA can be implemented, safely and effectively, for greatest impact.
- The WHO Global PrEP Network will host webinars this year on CAB-LA to provide up-to-date information for countries, communities and implementers and increase awareness.
- In April 2022, CAB-LA was added to WHO’s list of Expressions of Interest for evaluation for prequalification, and WHO is working with countries on regulatory approval.
- Technical brief on update to WHO Implementation guidance on differentiated and simplified Pre-Exposure Prophylaxis(PrEP) for HIV prevention
Starting, using and stopping oral PrEP Oral event-driven PrEP.
- (ED-PrEP) can be used toprevent sexual acquisition of HIV by cisgendermen and trans and gender diverse peopleassigned male at birth who are not takingexogenous estradiol-based hormones.
- Hepatitis B virus (HBV) infection is not a contraindication for ED-PrEP.
- Individuals eligible for oral ED-PrEP can start oral PrEP by taking two doses 2–24 hours prior to potential exposure, regardless of whether they intend to use an oral daily or ED-PrEP dosing regimen, and continue to take one dose per day until two days after the day of the last potential sexual exposure.
- All other individuals should start daily oral
PrEP by taking one dose per day for seven days prior to potential exposure to HIV and can stop taking daily PrEP seven days after the last potential exposure
Download the technical brief here:
Dr Luke Armand Bodea, director of the next International Conference on AIDS and STI in Africa (ICASA), stated, “We are in danger,” referencing the newest UNAIDS report. “Who is ‘we’, it’s mainly us, from Africa”, he said. “As long as health services in our countries are not free, there will be no improvement in policies to better serve Key Populations.”
The sessions showed that unless we address political, financial, and social inequity, racism, and structural barriers to care, among those most vulnerable, we will never reach our goal to eliminate HIV. Through collective social action, we need to remove visa barriers, ensure that a diversity of racial, social, and gender identities are represented (including non-binary, cis, transgender women and men), and simultaneously, engage all key populations – the sex worker, the person who injects drugs, the adolescent and aging adult, at the table, with not only a seat but also food on their table.
Finally, consequences of the Canadian government’s denial of visas to many sex workers delegates were painfully clear. One sex worker delegate who attending virtually because of the visa denial described seeing in-person delegates contribute more effectively to sessions and receive more speaking time in comparison to online attendees. His clear assessment and response was “It’s not fair’’.
Key recommendations for achieving progress against HIV on sex workers community
- Deliver high-quality, evidence-based and people-centred health services to sex workers.
- Optimize systems, sectors and partnerships for sex workers’ health impact.
- Generate and use data to drive decisions for sex workers’ health actions.
- Engage empowered sex workers.
- Foster innovations for sex workers’ health impact.