IZINDABA

Give us peer educators, not nurses, say sex workers

Using peer educators to enrol sex workers into healthcare programmes is far superior to persuasion via traditional healthcare workers, who are seen as prejudiced and lacking understanding, Médecins Sans Frontiêres (MSF) research presented to a scientific forum at the University of the Witwatersrand last month shows.

The MSF research at two Mozambican sites in the Malawi-Beira transport corridor between January 2014 and June 2015 enrolled 1 810 sex workers to explore community-based testing strategies. Peer educators were able to reach out to their peers and gain trust, enrolling 1 461 sex workers in Tete and 349 in Beira, most of them from Zimbabwe, with a minority from Malawi. A full 59% of those in Tete and 54% of the Beira cohort were HIV-positive, with HIV positivity increasing with age (29 - 43% for age 18 years and younger, and around 78% by 35 years and older). There was a good response to testing, in spite of stigma and prevention challenges which included retention for retesting (24% traced for follow-up a year later) and sex workers experiencing prejudice and being undervalued by non-sex workers on the MSF team.

The aim was to keep HIV-negative sex workers HIV-negative, to link HIV-positive sex workers to HIV care and treatment, and to provide community outreach via HIV testing and counselling, female and male condoms, lubricants, retesting and sexually transmitted infection and family planning services. The team facilitated integrated, friendly services (antiretroviral drugs and viral load testing) plus in-country and cross-border referrals. Integrating peer educators into the MSF outreach programme proved pivotal. Presenter Dr Humberto Jassitene expressed excitement at the new South African HIV guidelines, which recommend pre-exposure prophylaxis for sex workers, something he hoped to emulate 'very soon'.

Chris Bateman

chrisb@hmpg.co.za