Increasing HIV Rate as the Reason to Decriminalze Sex Work

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Table of Contents

  • Background
  • Key HIV Risk Factors
  • Recommended Interventions
  • Conclusion


In its current state, HIV in South Africa is a severe public health issue. Following 2016 UN statistics, South Africa has the highest HIV rate on the planet, and over 7,100,000 people live with HIV in South Africa alone. According to mid-year population estimates in 2018, Statistics South Africa reports the country's HIV prevalence rate is 13.1 percent. The prevalence rate correlates to the death rate attributed to HIV/AIDS. According to Statistics South Africa, an estimated 25.03% of deaths in the country are due to HIV/AIDS in 2017. Having such a high number of the population living with HIV proves how more interventions are needed to reduce the rates.

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Key HIV Risk Factors

In this paper, I want to discuss three high risk factors shaping up the epidemic in South Africa. To begin, there is a 57.7% prevalence for HIV among sex workers. This makes being a sex worker an important determinant for HIV risk. On top of being a sex worker, risk can further be increased by additional risks such poverty, lack of new career opportunities and size of their client base. Injection drug use by sex workers is an additional risk factor as there is a possibility of using un-sanitized equipment. Knowledge of HIV risk is often small in the female sex worker community. A low percentage of female sex workers were able to properly define the hazards of HIV transmission. This lack of knowledge may be a result of the impact created by heavy stigmatism of sex workers.

Men who have sex with men (MSM) also have an HIV prevalence of 26.8% [8]. South Africa does protect the rights and freedoms of LGBT communities, however, MSM still deal with immense levels of stigma by conservative members of the population. Furthermore, issues experienced by MSM are not fully understood by all which makes it a challenge for MSM to reveal their sexuality to healthcare professionals to get the appropriate help they need.

Transgender women have high rates of HIV, more so than MSM. This indicates that being transgender is a major risk factor for HIV. This may be due in part to transgender women being classified as MSM for studies and being excluded in some cases. Like MSM, stigma plays a large role towards the high risk for transgender individuals. GenderDynamix’s study confirms stigma is a reason transgender women did not receive access to HIV prevention facilities.

Recommended Interventions

Since South Africa has the highest HIV prevalence, our first intervention would be to upscale the present interventions that are being utilized by the country. These interventions should be scaled-up, as all areas of the country may not equally included. This also serves as a method to help with the key risk factors not specifically discussed in our proposal.

Our recommended intervention to decrease HIV rates in sex workers is to decriminalize sex work. By decriminalizing sex work, it allows for the regulation and monitoring of sex work by the government. They can thus guarantee that sex workers are empowered and negotiate condom usage, enhance their access to public amenities, and defend them from violence and abuse. Where sex workers are criminalized, for fear of arrest, they may be hard to reach or reluctant to collaborate. HIV prevention programs could be implemented much more efficiently by removing legal constraint, as there is a lower sex worker HIV incidence compared to nations where sex work is criminalized.

For MSM, a target specific approach will be the most optimal intervention. For MSM, we will increase the accessibility of both lubricants and condoms so that they are readily available in appropriate locations. This would include locations such as gay clubs and bars, promoting condom and lubricant use and having them readily available for their clientele. Having lubricants and condoms readily available in these comfortable locations will be more effective as there is little to no stigmatism and fear for MSM in these locations than there are in public healthcare locations such as pharmacies.

Another vital intervention for MSM is the upscaling in the usage of Pre-exposure Prophylaxis (PrEP). PrEP is a form of medication used daily by individuals at risk for HIV and has been found to be an effective method to reduce HIV risk. According to the World Health Organization (WHO), 20-25% of new HIV cases can be prevented by PrEP. Therefore, it is necessary to upscale the PrEP program scope and increase the accessibility.

Interventions that address Transgender women can be improved as well. An appropriate intervention would be to create an established program the specifically targets transgender individuals. Services often address transgender women similar or the same as MSM. Services for transgender women should be designated solely to transgender individuals to reduce an individual’s risk of participate in high risk sex. Providing welfare, employment initiatives and more can help reduce the likelihood for transgender people to engage in high-risk sex. Having these transgender specific services will be beneficial as it reduces the stigmatism in play by health providers which can prevent access to HIV prevention services.


South Africa must continue along its path to reduce its HIV epidemic as best as it can. Prevention initiatives need to continue to be addressed and developed for those at a high risk for HIV transmission. Intervention methods tailored to the target population such as sex workers, MSM and transgender women will help in declining the rates of HIV in South Africa. The legalising sex work, increasing accessibility to condoms, lubricants and PrEP as well as establishing specific transgender services will work towards lowering the HIV rates. Exploring these methods will be an effective strategy to help the fight against the HIV epidemic. 

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