Stigma, Denial of Health Services, and Other Human Rights Violations Faced by Sex Workers in Africa: “My Eyes Were Full of Tears Throughout Walking Towards the Clinic that I Was Referred to”

Marlise Richter,Kholi Buthelezi

doi:10.1007/978-3-030-64171-9_8

Abstract

AbstractAn ethical and forward-looking health sector response to sex work aims to create a safe, effective, and non-judgemental space that attracts sex workers to its services. Yet, the clinical setting is often the site of human rights violations and many sex workers experience ill-treatment and abuse by healthcare providers. Research with male, female, and transgender sex workers in various African countries has documented a range of problems with healthcare provision in these settings, including: poor treatment, stigmatisation, and discrimination by healthcare workers; having to pay bribes to obtain services or treatment; being humiliated by healthcare workers; and, the breaching of confidentiality. These experiences are echoed by sex workers globally. Sex workers’ negative experiences with healthcare services result in illness and death and within the context of the AIDS epidemic act as a powerful barrier to effective HIV and STI prevention, care, and support. Conversely positive interactions with healthcare providers and health services empower sex workers, affirm sex worker dignity and agency, and support improved health outcomes and well-being. This chapter aims to explore the experiences of sex workers with healthcare systems in Africa as documented in the literature. Findings describe how negative healthcare workers’ attitudes and sexual moralism have compounded the stigma that sex workers face within communities and have led to poor health outcomes, particularly in relation to HIV and sexual and reproductive health. Key recommendations for policy and practice include implementation of comprehensive, rights-affirming health programmes designed in partnership with sex workers. These should be in tandem with structural interventions that shift away from outdated criminalized legal frameworks and implement violence prevention strategies, psycho-social support services, sex worker empowerment initiatives, and peer-led programmes.

Highlights

In 1993, one of South Africa’s academic health journals, the South African Medical Journal, published an article entitled “Prevention of sexually transmitted disease
We aim to describe contemporary sex worker experiences with health services and the health system in Africa as documented in the literature and supported by sex workers’ lived experiences
In a recent submission to the United Nation’s Committee on Economic, Social and Cultural Rights on South Africa, Human Rights Watch noted the following: On a positive note, the sex workers we interviewed told us they had free, fairly straightforward, and non-discriminatory access to health care, including reproductive health care and HIV/AIDS treatment

Summary

Chapter 8

Denial of Health Services, and Other Human Rights Violations Faced by Sex Workers in Africa: “My Eyes Were Full of Tears Throughout Walking Towards the Clinic that I Was Referred to”. I didn’t know what I did wrong by coming to the clinic for a consultation [...] So, in that way if sex workers continued to be treated in this way; it drives them away [from healthcare facilities]. It drives them away—Penelope Zulu (female sex worker, aged 45, inner-city Johannesburg, South Africa)

Introduction

Buthelezi Sisonke National Sex Worker Movement, Cape Town, South Africa

Conclusion

Findings

Secretariat