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Sex workers hold up the first issue of Amaqhawe magazine

Creative thinking for the long-term fight against HIV

Alongside the immediate benefits of a development programme, there is the opportunity to produce lessons that can be adopted – and adapted – by other agencies and government departments down the line. The USAID-funded Amaqhawe Project, which worked to reduce the spread of HIV in the Gert Sibande district of Mpumulanga province, South Africa, illustrates how an inventive approach can raise the profile of a deep-rooted challenge and then offer inspiration for others to follow.

Before I joined the project I never wore a condom during sex. I always thought HIV was selective – only certain people could get it. Now I know that it affects everyone. I go for testing now and I am no longer scared to get tested.

Sex worker

Challenge

In terms of HIV hotspots, Amaqhawe operated at the epicentre. South Africa is home to the world’s largest epidemic, and infection is especially high in Mpumalanga. Within the province, the Gert Sibande district is the worst affected. The project took a strategic focus on Most At Risk Populations (MARPs) – of which, one group is sex workers.

The province produces 83% of coal for the entire country, as well as precious stones and gold. The many mines and major trucking routes connecting to neighbouring countries Swaziland and Mozambique bring in a large number of transitory male workers. By contrast, local women and girls face high levels of unemployment and poverty.

In the townships, pubs known as shabeens – often a lean-to or shack with a makeshift bar – are exceptionally popular with the mineworkers and truck drivers from a Thursday through to Sunday morning. Women are attracted from the surrounding communities by the promise of free alcohol and an income from sex work. These young women are often unable to negotiate safer sex practices, making them highly vulnerable to HIV infection.

Approach

In line with the national HIV, STIs and TB response, the overall aim of the project was to reduce HIV infections among 15-24 year-old sex workers in the shabeens, through a combination of education, outreach services and by connecting them to health services. With funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the women gained greater access to HIV counselling and testing, cancer screening, pap smears, legal and financial advice, and support for those living with the virus.

As implementation partner, our team held workshops for sex workers on how to lower their risk of contracting HIV, which included training to help participants pass on their knowledge to other sex workers, as well as distributing condoms and lubricants. Sex workers were involved in designing the programme every step of the way, under the motto ‘nothing about us, without us’. The women even chose the name of project, Amaqhawe, a Zulu word which means ‘those who overcome’.

The project proved resourceful in some of its interventions, such as Red Umbrella Days as a focal point for testing and screening, as well as a colourful magazine that covered beauty and fitness alongside educative articles about avoidance and management of the disease.

Progress

On the ground, the team were able to distribute hundreds of thousands of condoms and lubricants, and increase the uptake and access of sex workers and tavern patrons to HIV counselling, testing, referrals and support.

Importantly, the programme aimed to develop unique insights that could be integrated into South African government services at a provincial and district level. SANAC (the South African National AIDS Council) has since taken elements of the programme for use in other CDC (Centers for Disease Control and Prevention) outreach projects under a different banner.

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