PODCAST | Pimps, police and pills: How nurses get healthcare to sex workers

2019-11-22 10:49

We take you into the world of brothels and show you how a clinic gets around the law to get HIV prevention pills and antiretroviral drugs to sex workers.

Music credit: Driven To Success – Scott Holmes

See the full script below:

PROMO SOUND BITES

We only work with sex workers. And if the whole community should know it is a sexworker clinic then a lot of the sex workers won’t come.

Tracey: They teach us how to drink our tablets. If you are sick with HIV. If you arenot sick then they give you PREP. They tell you things to do.

INTRODUCTION

How do you provide health services to sex workers in a country where the trade is illegal?

Welcome to this edition of the Bhekisisa Centre for Health Journalism’s podcast.

I’m Mia Malan.

Sex work is criminalised in South Africa.

It makes workers reluctant to visit clinics because they’re scared that they might get arrested.

But in Hillbrow in Johannesburg there’s a government clinic where sex workers can feel safe.

Our reporter, Paul McNally, visited the facility to uncover how workers get access to HIV services and how staff work with pimps, brothels and the police to make that possible.

Masego Rahlaga is voicing this report.

AMBIENT NOISE OF CLINIC

This is the Esselen Street Clinic in Hillbrow, Johannesburg.

It’s 8 o’clock and already packed with people.

We take the last available seat in the clinic and wait.

AMBIENT NOISE OF CLINIC

We’re here to see Rochell Hendricks.

She’s a project manager at The Wits Reproductive Health and HIV Institute.

The institute helps to run a sex worker project at the government facility.

But it turns out the clinic is the wrong place for us.

Hendricks comes to show us where we need to be.

UPSOUND:

Paul: Hi, how are you?

Rochell: Good thanks and you?

Paul: Good to meet you.

Rochell: Rochell.

We walk next door to a large unmarked room.

UPSOUND:

Paul: Ah, it is nice and quiet in here.

There’s a queue of about twenty plastic chairs in the centre.

It’s relatively quiet and people are being served much quicker than next door.

The facility serves a special population.

UPSOUND:

Rochell: We only work with sex workers. And if the whole community should know it is a sex worker clinic then a lot of the sex workers won’t come.

Rochell Hendricks is friendly and efficient.

The clinic has to make it as easy as possible for sex workers to get health services.

Otherwise, they simply won’t use the facility.

Sex workers need ways to protect themselves against HIV.

And those who are HIV positive, need treatment.

Female sex workers are far more likely to be infected with HIV than other women.

This is because they have more sexual partners and experience more violence.

In Johannesburg, almost three quarters of female sex workers are HIV positive, a 2014 survey has found.

But it isn’t enough that the clinic exists and its services are free.

Hendricks and her team first needed to gain the trust of sex workers.

UPSOUND:

So, how sex workers know about the clinic is we have peer educators. So, peer educators are either current or former sex workers themselves. So they are the ones who introduce us to the sex workers and make the sex workers trust us more as well.

Fezeka Tshofela is one of the peer educators.

She’s responsible for 40 sex workers.

UPSOUND:

We are the ones who educate them about the use of condoms and the importance of health and taking care of themselves. That is why I say as PEER educators we do, we approach them without the notion that we will say I also was once a sex worker. I understand what you’re going through. And we do emphasise the confidentiality. That no one has to know.

The peer educators know how and when to approach the sex workers and what lingo to use when talking to them.

UPSOUND:

Tshofela: Magumba, or something like that.

Paul: What is that?

Tshofela: That is referring to another sex worker.

Paul: Okay, what is that word?

Tshofela: Magumba

Paul: Magumba, okay.

Peer educators go on outreach excursions to brothels.

They use a sex worker who visits the clinic as a contact person to introduce them to a new brothel.

Hendricks says brothels mostly look like bars.

UPSOUND:

Rochell: When you go in you will find men drinking. And then you’ll find girls walking in between. And these girls are actually selling sex. And that will be for instance on your ground floor level. And then when you go one floor up. And two floors up. That is where the rooms are. So that is where the sex workers will work from.

Paul: Okay, and they will live there as well.

Rochell: Some of the sex workers will live in these rooms. Other brothels don’t allow them to live there. So they will rent on a daily basis. They will pay rent for that room.

Clinic workers have also had to gain the trust of brothel owners.

Otherwise, they wouldn’t be able to work from within the establishments.

UPSOUND:

Rochell: So they will give us a time. They will say can you please come at 12 and be out by 2, because at 2 is when we are picking up clients.

Or they will say, for instance, please don’t come at all on a Friday because we are busy throughout the day.

Paul: Okay. And what is that interaction like? Are those relationships that you have to build over time with the brothel owners, I imagine.

Rochell: When we identify a new brothel. It’s not easy for the brothel owners to trust us. So, it is relationships that we have to build over time. And maintain over time. A lot of them, in the beginning, are skeptical. As we know sex work is not legal in South Africa. So sometimes you have to go continuously, or phone continuously. And say we just want to provide health services.

Paul: Because they think that you’re gonna…

Rochell: Report them to the police. Yes.

Tracey is a sex worker who uses the clinic.

Tracey isn’t her real name — she wants to remain anonymous.

She has short hair and wears a velvet green dress.

It costs Tracey R10 to get to the clinic in a taxi from where she stays.

She’s originally from Zimbabwe and started working on the street after her husband died in 2014.

She first came to the clinic when she fell ill in 2016.

At the clinic, Tracey tested HIV positive.

The staff put her on antiretroviral treatment.

For Tracey’s colleagues who test HIV negative, the clinic has free HIV prevention pills, also known as PrEP.

If PrEP is taken daily, it can reduce someone’s chances to contract the virus by more than 90%.

UPSOUND:

They teach us how to drink our tablets. If you are sick with HIV. If you are not sick then they give you PREP. They tell you things to do.

The narrative from Hendricks and her team is that sex work is a job like any other.

It’s a way to earn money for food and school fees.

Some peer educators say sex work is a way to make money fast.

But Tracey says her reality is different.

The market is saturated.

UPSOUND:

Tracey: This business. We are a lot of people. We are a lot. To get a man. It’s not easy now.

Paul: You mean there are a lot of sex workers?

Tracey: Yes. We are too much. Like, the place where I am staying we are more.

Sometimes Tracy earns as little as R20 per client.

She has three kids.

But she can’t afford to send them to school.

Not even her eldest child, who is 11.

UPSOUND:

Now, they are not going to school, because things they are tough. I can’t lie. To my side. I can’t lie. Things are tough. For them to to eat.

The clinic’s team has nurses who assist assist sex workers.

They help workers to get pap smears and also administer their HIV treatment or give them HIV prevention pills if they’re HIV negative.

UPSOUND:

Alright, my name is Lindiwe Malingi. I work as a professional nurse here. I initiate antiretrovirals. I initiate PREP.

But this doesn’t come without challenges.

UPSOUND:

We go to different brothels right. Okay, we will test, we’ll initiate. Then the most important thing is we have to retain them too. Into the services. If we don’t want to lose them. We have to get them to continue on ART. We will initiate perhaps in place A. The following month when you go there you will find that they are no longer there. Because they change brothels.

The clinic team also helps to protect sex workers from their own clients.

Studies show gender-based violence rates among sex workers are sky high.

Clients often mistreat them, says peer educator Tshofela.

And, research shows violent sex is more likely to result in HIV infection than non-violent sex.

UPSOUND:

Tshofela: Some of them get raped by clients. Some of them will have clients that are abusive. Then they will have clients that are THERE to just have sex with them. And then they leave without paying. Some of them face challenges of no money to pay rent where they work, because they have to pay rent where they work first.

Paul: Wow.

Tshofela: Even the pimps. Some of them they don’t know how to speak to the pimps. So we approach the pimps first and try to get them to understand the importance of the clinic or the importance of the health that the ladies do need.

Hendricks and her team have had to form bonds with the local police.

UPSOUND:

Rochell: We have tried to sensitise police to sex work issues. And let them know that sex workers all have rights as well. And them confiscating condoms from sex workers is actually imposing on that right that they actually do have.

Paul: Is that something that they do.

Rochell: It used to be. It used to be. A lot of our sex workers are also undocumented so that was also the issue.

We have brothels that will be raided and sex workers that will be taken because they are in the country illegally. So we have a lot of brothels being closed down and that becomes an issue for us because you don’t know where the sex workers are. And you have them on ARVS. And especially like recently had the xenophobic attacks happening. A lot of the sex workers went into hiding.

OUTRO

Rochell Hendricks, from the Esselen Clinic in Hillbrow, ending that report voiced by Masego Rahlaga.

The script and interviews were done and recorded by our reporter, Paul McNally.

Danny Booysen handled the sound editing.

Until next time, I’m Mia Malan from Bhekisisa.

This story was produced by the Bhekisisa Centre for Health JournalismSign up for the newsletter.

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