Good Practice Guide to Integrated Sex Worker Programming - Based on the Experiences of the Red Umbrella Programme

"Sex workers face many hurdles, including severe and systematic abuse of power by security services, and violence from police, clients and intimate partners. Sub-stance abuse and an increased risk of contracting HIV/AIDS and other STIs are two major health concerns. Compounding these challenges are the difficulties in accessing health care, legal resources, and social services."

This guide looks at the Red Umbrella National Sex Worker Programme in South Africa and some of the best practice strategies that were identified at a Red Umbrella Programme Best Practice Workshop held in April 2015. The guide documents and shares the lessons and successes identified by the implementing partners who were involved in the national sex worker programme scale-up. The programme is being implemented by the Sex Worker Education and Advocacy Taskforce (SWEAT) in partnership with organisations from all provinces in South Africa.

The document outlines the history, development, and objectives of the programme. In brief, the aim of the programme is to prevent HIV and sexually transmitted infections (STIs) amongst sex workers through a combination prevention approach; it is founded on bio-behavioural interventions with sex workers. Interventions include: HIV counselling and testing; distribution of condoms and lubricants; referrals to relevant services (health, substance abuse, and others); safe sex and human rights education using peer educators; distribution of information, education, and communication (IEC) materials; provision of paralegal services; and conducting risk reduction workshops, counselling, and training.

Overall, the guide calls for sex work programmes that treat sex workers as “the whole person” who should have access to knowledge and skills development, emotional and psychological support, health and HIV support, and empowerment and human rights knowledge. The guide offers a list of principles for implementing successful sex work programmes. These are:

• “Nothing about us without us” - Sex workers should be central to the development of sex worker programmes.
• “First a person, then a sex worker” - It is vital for programmes to provide support to individuals as whole people, and not to treat clients merely as sex workers or as HIV positive people. Individuals should be acknowledged for their multifaceted entirety, and not simply for one or two aspects of who they are. Offering psychosocial services is a part of offering holistic services. An important aspect of this is to acknowledge individuals as mothers, daughters, women, men, gay, straight, transgendered, HIV positive, HIV negative, old and young, etc. - to acknowledge all identities and aspects of the person.
• “Working together we can do more” - To run an effective sex work programme, it is important to form strategic partnerships.
• “Only rights can stop the wrongs” - Human rights are the bedrock of working towards improvements for sex workers. For example, Phase II of the Red Umbrella Programme included activities such as the training of paralegals (termed human rights defenders) to support sex workers who are arrested, to assist sex workers to lay charges against the police or clients, and to document and report cases. It is recommended that advocacy and movement building for human rights are included in sex work programmes from the start.

The report then goes on to highlight some of the programme’s best practices, with guidelines on how each is achieved or implemented. Firstly, the report explains the importance of working with sex workers as a whole person when implementing activities that deal with: knowledge and skills development, emotional and psychological support, health and HIV, and empowerment and human rights. For example, in relation to HIV and health, the report states that “[A]lthough the core focus of programmes that work with sex workers is to reduce HIV, effective sex work programmes need to approach the treatment of sex workers and their health from a holistic perspective and to provide comprehensive and accessible health services.” The report describes the need for a three-pronged approach that includes the biomedical approach (HIV tests and treatment), the behavioural approach (health seeking behaviours and seeking legal recourse when human rights are abused), and the structural approach (supportive laws, providing safe spaces). Central to these approaches is the peer education system developed by the programme. Peer educators - who are current and former sex workers - provide prevention services, including condom demonstrations, emphasising the importance of getting partners tested, and teaching how to reduce sexual risk.

In terms of treating sex workers as a whole person, the report also states that any sex work programme should be committed to empowering sex workers and helping them to progress. To empower and protect their human rights, the programme has implemented a SWEAT helpline for sex workers to reach out to when they have been arrested. The Helpline staff refer callers to relevant partner organisations to assist with specific needs, such as the Women’s Legal Centre to advise on court processes or organisations who are able to assist with food and accommodation. The report shares stories of sex worker empowerment achieved through the Red Umbrella activities such as skills building workshops, peer education training, and promotion of sex workers as peer educators and site coordinators. A story of Dudu explains how her passion for lobbying and human rights got her appointed to the lobbying and advocacy programme in Sisonke (one of the implementing partners). She is now a member of the United Nations Women’s Advisory Group and works with the parliamentarian lobby group.

The report also highlights the importance of keeping sex workers connected, which is achieved through: the peer support approach; the creation of creative spaces and support groups; outreach; and telephone, SMS (text messaging), and the Helpline. The peer support approach is explained in detail here, including recruiting peer educators and training them on a variety of issues, which include basic lay counselling, trauma containment, financial management, teamwork, and communication skills. More specialised training can include paralegal training, research protocols, and management skills. The report also offers guidance on how to assess the number of peer educators required for a site, as well as managing, retaining, and supporting peer educators.

In terms of keeping sex workers connected, the report stresses that “connecting sex workers with each other has proved to be an incredibly successful and necessary programme activity, with multiple benefits”. This is done through creative space meetings that are structured in such a way that sex workers are encouraged to share their stories and experiences, establish friendships and connections with one another, and learn how to tackle challenges and solve problems. The report offers guidance and tips on how to conduct successful creative space meetings.

Outreach has also been a core component of the Red Umbrella programme. “Outreach can be done by going into sites and finding sex workers, and providing them with information, and inviting them into the sex worker community. Because of the marginalised, underground, clandestine nature of sex work in South Africa, communication needs to be tactical. Besides traditional IEC materials like brochures and posters, other effective methods to reach sex workers include a dedicated 24 hour Helpline and sending bulk SMSs to a database of sex workers’ contact numbers.” The report describes how the project has implemented its outreach activities (including how to reach hard-to-reach sex workers and keeping track of sex workers), and the importance of working with brothels and hotels.

Building relationships with sex work stakeholders was also identified as a good practice by the programme implementers. In order for sex workers to be able to use community resources (such health, social, and legal resources) effectively, it is essential that awareness is raised about sex worker issues, and community support is gathered. Also, partnerships with various stakeholders are essential for sex work programmes to be more effective. The report offers a list of potential partnership activities and examples. For example, it suggests building relationships with the police and police forums by inviting them to creative space meetings to listen to sex worker challenges, sensitise them to sex worker rights, and get a champion at the police office who will assist and protect sex workers.

Finally, the report stresses the importance of creating an enabling environment for sex workers though advocacy and the protection of human rights. It offers some strategies that partner organisations have found effective in creating a better environment for sex workers such as: creating good connections with the South African Police Service, so that they protect rather than harass sex workers; creating sex worker teams for sex workers in unsafe areas so that someone knows where each person is when they leave with a client; and offering continuous education on human rights with and for sex workers through a variety of platforms and human rights campaigns. Legal support is also key to creating an enabling environment, as it forms part of advocating for the human rights of sex workers. Legal support interventions include: court monitoring; direct, visible action against abuse; community outreaches to problem areas; and community mobilisation.