Context

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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%.  

It is increasingly recognised that societal barriers hindering access for key populations (KPs) to HIV prevention, such as stigma and discrimination and gender-based violence (GBV), need to be addressed to get on track to end AIDS by 2030. The risk of acquiring HIV is 26 times higher for cisgender female sex workers than for other adult cisgender women, 34 times higher for transgender women than for other adults and 25 times higher for gay men and other men who have sex with men than for heterosexual adult men (UNAIDS, 2021). With the launch of the new Global AIDS Strategy 2021– 2026: End Inequalities, End AIDS measurable 10-10-10 societal enablers targets have been set addressing punitive legal and policy environments, stigma and discrimination and gender-based inequalities and all forms of GBV.

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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.  

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It is against this backdrop that Aidsfonds adopts an expansive definition of violence against sex workers to include ‘any form of abuse, coercion, and stigma against a sex worker by a group, institution, or government which leads to physical mental, political, social, cultural or economic harm’. Clients, the police, other state agents, partners, family members and members of the community are all responsible for violence committed against sex workers (Busza 2017). All of these varying elements of violence will be addressed and examined in both the quantitative and qualitative parts of this study. 

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The overall aim of this research is to ascertain whether the interventions of Hands Off 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.