Discrimination against people because of their profession, sexuality or recreational activities is nothing more than the spread of infectious diseases – be it Covid or HIV infection.
A case in point is sex workers. Health professionals often discriminate against sex workers, which prevents them from using health services – especially in countries where they work illegally. Models show that the decriminalization of sex work can lead to a large decrease – 33% to 46% – of HIV infections among sex workers, possibly because they are not afraid to visit health facilities and therefore will be tested or treated for HIV or ask for it. drugs that prevent infection, called pre-exposure prophylaxis (or PrEP for short).
While it is legal for adults to buy or sell sex, it is not only better for sex workers’ health but also for their physical safety, because they have a legal route to report violence or other crimes against them. Research shows that when gender-based violence (GBV) is high, HIV infection rates are also high. In addition, in places where sex work is not a crime, cases of GBV such as rape, studies have found.
It is the overlap between health and law that makes the legality of this type of work a prickly problem – and one of the draft amendments to the Bill in South Africa can help to solve it.
Activists have been fighting for the decriminalization of sex work for years and the law changes will also be incorporated into the country’s new action plan against HIV and sexually transmitted infections (STIs). South Africa’s new plan – for 2023 to 2028 – will be launched on March 24, the South African National Aids Council (Sanac) has announced. Look closely (Sanac coordinates the preparation of the plan).
But there is another winner: two government departments that were previously at odds are now aligning their minds.
The health department has been calling for the decriminalization of sex work for years and in 2017, they almost wrote it into the country’s current five-year plan to curb HIV and STI rates, but the justice department still believes in sex work. is a violation – until recently.
Mia Malan asked the Deputy Minister of Justice, John Jeffery, and Tlaleng Mofokeng, a sexual health doctor and also the United Nations special rapporteur on the right to health, about what the decriminalization of sex work means for South Africa – and what the meeting means. mind between the health and justice departments.
Mia Malan (MM): What does the decriminalization of sex work mean? [activists like] you and the sex workers too, after you travel a long way for them?
Tlalen Mofokeng (Dr T): This is an important milestone for South Africa. This means that the government has listened to the voices of sex workers, who are at the forefront of many human rights violations. I became involved in sex worker human rights issues as a medical student when I had to help sex workers [who experienced violence or needed healthcare]but those who cannot freely seek health services due to criminalization.
MM: The public comment period on the proposed changes closes at the end of January. What is happening now?
John Jeffery (JJ): Now these public comments must be considered and evaluated by the department. Then we will see if we think there are any changes in the bill. Then it has to go back to the cabinet – what they will ask for is permission to introduce it to Parliament. The first will go to the National Assembly, where they must follow the process of public participation, which includes public hearings. If approved by the National Assembly, it will go to the Provincial National Council. It’s still some way to go, but we hope it’s done before the end [current cabinet’s] term.
MM: Decriminalization of sex work can have a dramatic impact on gender-based violence. But what about the health of sex workers? What effect does it have on HIV infection rates, for example?
Dr T: Issue of [decriminalising] sex work is a human rights issue because it includes the principles of privacy, dignity, bodily integrity, autonomy and being able to have your own health in your hands – and having a health system that responds and supports these decisions. Criminalization limits the extent to which sex workers can go to health facilities [and] when they are there, it affects the quality of the consultation [they get]. For example, the nurse asks: “How many sexual partners have you had?” He could not answer the question honestly because of the impending punishment [with that]. As healthcare providers we then miss an important opportunity to give [them] information or provide safer sex tools, and ultimately help sex workers with issues of consent and navigate relationships in a safer way, especially in countries with high levels of gender-based violence. Sex work also puts women at higher risk because many work outdoors.
MM: If we decriminalize sex work, will we see, for example, special clinics for sex workers?
Dr T: Stigmatization is a big problem. Criminalization makes that even worse. When the system removes punitive measures to punish individuals, it sends a larger message to society that it is no longer acceptable to harass, call names and physically violate people because they are sex workers. Then we have to look at public health policy. For example, do we have enough specialized sexual and reproductive health clinics for the general public? When we examine the needs of key populations like teenagers, sex workers and men who have sex with men, we must ask whether we need independent clinics for each group or whether we integrate them in a more complete way in the existing public health. service.
MM: How will sex work be regulated if it becomes legal?
JJ: The law we introduce is not about regulation; it’s just about decriminalizing. Apart [existing] laws and regulations will [still] apply. For example, labor laws will apply if a person works in a brothel. Municipal ordinances will apply when considering the location of brothels or people selling sex on the street. The next part of the process will usually deal with regulatory issues. This is a complex issue, because it involves three levels of government: local, provincial and national. We have to look at what is best and most practical for South Africa.
MM: Do all districts have the same rules or can they make their own rules?
JJ: Zoning is a municipal function. Each municipality decides effectively because it already has legislation. We need to look at the broader framework issue, but unfortunately that’s just coming.
MM: What kind of laws are there?
JJ: There are municipal laws that relate to business zoning and where you can do business. For example, there are certain rules related to begging on the street, which unfortunately, many sex workers have problems with law enforcement officers. So all of these will be municipal bylaws specific to that place, and they can vary from place to place.
MM: What kind of implementing rules will health advocates see?
Dr T: There is a need for more training in human rights from the undergraduate level. We need to have nurses, doctors and health professionals who understand the special needs of sex workers. We need it too [people to understand about] safe type tools. For example, use a condom. Many sex workers must use condoms, which should be discussed with clients. We need more tools that sex workers, especially women, can do [not only] negotiate but also use themselves without having the additional burden to make sure that the client is buying into. We need to have pre-exposure prophylaxis for HIV available where people can be exposed. The issue of health education is very important, because it will remove a lot of stigma.
MM: Will sex workers be taxed and how will they work?
JJ: The effect of the decriminalization of sex work is that people can make money in any way they want because it’s not a crime — whether you want to grow vegetables and sell them and earn an income, or you want to give massages, or you want to sell sex. My understanding is that if people earn more than a certain threshold, they have to pay taxes. Sex workers will still be part of the informal economy, so Sars may have some involvement with sex work organizations and discuss how to make people pay taxes.
MM: If a sex worker feels they have been treated unfairly in the workplace, can they go to the Commission for Conciliation, Mediation and Arbitration (CCMA)?
JJ: There has been one CCMA case involving a sex worker. As I said, existing laws will apply. Any contract that is not performed can be enforced by a court. If a person is an employee, then in terms of working for a larger group, such as a brothel, the Labor Relations Act will apply.
MM: The decriminalization of sex work has been a long battle. Why did it take so long?
Dr T: This should be a very good decision. Some laws go back to the 1950s, and those laws take time to move. What many want is agility in the health system and also in the legal system, so that we respond quickly to research in new ways, not waiting decades to make these changes despite the evidence we see. Now we are here – and we are happy to have reached this point.
MM: A few years ago, you did not like the decriminalization of sex work. What changed your mind?
JJ: Originally my position supported partial decriminalization, but I had engagements with people, did research and read more. That’s what changed my position to see full decriminalization [meaning neither selling nor buying sex is an offence] is the best choice for South Africa.
WATCH THE FULL VIDEO
This story is produced by Check out the Center for Health Journalism. Register for bulletin.