Mobile clinic provide sex workers with health care
Wednesday 2 June 2004
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SOUTH AFRICA: Mobile clinic provide sex workers with health care

JOHANNESBURG, 4 March (PLUSNEWS) - Mobile clinics for sex workers in Johannesburg's inner-city suburb of Hillbrow have had a positive impact on encouraging women to seek health care, according to research just released in South Africa.

Between 5,000 and 10,000 sex workers operate out of rundown Hillbrow, one of the most densely populated areas in the country.

According to a 1997 study of commercial sex workers in Johannesburg, 45 percent of the 247 tested in Hillbrow were HIV-positive. Most alarming was that those who had been sex workers for only three months displayed similar levels of infection to those who had been working for a year.

The Reproductive Health Research Unit (RHRU), a privately funded organisation affiliated to the University of the Witwatersrand, launched mobile clinics in 2000 which visited 12 Hillbrow hotels used by sex workers. The project has brought health care services directly to women who tended to avoid public facilities due to concerns over stigma and discrimination.

A team of nurses and community health workers offer basic treatment, awareness and education covering sexually transmitted infections (STI), and provide condoms to women working in the brothels. The clinics operate in rooms provided by the hotel management. A referral network was also established for social welfare needs.

All clinic attendees are interviewed, using a standard questionnaire, screened and treated for STIs, and given free male and female condoms. During a 15-month period, over 1,243 women were screened for STIs at least once, with about half of them presenting symptoms of an infection.

Hotel managers and staff have welcomed the presence of the clinic, which transformed the image of their establishments, and of the women who worked and lived there, the RHRU study said.

One of these women explained: "In some of the hotels, girls say clients are happy because if they attend the clinic, that means they are clean and looking after themselves... Most of them, when they look at you, they will say you look like you have AIDS, but I would tell them I couldn't be [positive], because there is a clinic at this hotel that I attend. We tell them that we are being checked and examined regularly, and you will see them being relieved, and some look happy when they hear that."

Sex workers displayed their clinic cards, and thus used the clinic to better "their status and remove the stigma associated with being a sex worker". The research indicated that this "rehabilitated image" of the hotels was having a meaningful effect on attitudes toward condom use and safe sex.

Sex without condoms contradicted the image of a "healthy brothel". An older sex worker suggested that the clinic actually encouraged men to use condoms. "When they learn about the clinic they can then see how serious ... STIs are, so they will make sure that we use condoms with them," she said.

"The intervention had an impact on the immediate context of sex work, and transformed the image of the hotels from sites of 'dirt and disease' into 'healthy brothels'. We suggest that the impact of the intervention was more meaningful at this level than at the individual level," Jonathan Stadler, senior researcher at the RHRU, told PlusNews.

The study concluded that clinical interventions promoted impressive short-term outcomes that were, however, difficult to sustain. "Public health interventions that address structural impediments to behaviour change are perhaps most effective," the report noted.

But the research also pointed out that although public health messages provide information and skills for negotiating safer sex, these were not always realistic for women who earned a living from prostitution.

"Sex workers do not seek health care from existing public services, due to negative experiences, inconvenient locations and hours of operation, and an overriding fear of public ridicule," Stadler confirmed.

Of additional concern was that public health facilities at the government-run Hillbrow clinic offered HIV testing without pre- or post-test counseling.

The project will continue in the same 12 hotels, with plans to expand pending funding.

For more details:


Recent SOUTH AFRICA Reports

Government says paediatric ARVs to continue, 1/Jun/04
New challenge in achieving adherence, 20/May/04
World Bank competition for implementable, innovative projects, 18/May/04
Study of HIV risk in children sounds alarm bells, 13/May/04
SAHARA conference opens, 10/May/04


The Global Fund to fight AIDS, Tuberculosis & Malaria
The Global Fund to fight AIDS, Tuberculosis & Malaria
Mothers and HIV/AIDS

PlusNews does not take responsibility for info in links supplied.


PlusNews is produced under the banner of RHAIN, the Southern African Regional HIV/AIDS Information Network. RHAIN's members currently include:


  • IRIN

  • Inter Press Service (IPS)



  • Health Systems Trust

  • Health & Development

  • GTZ/Afronets

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