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Be courageous. Recognize and take action. » Women's Courage

Be courageous. Recognize and take action.

March 3rd, 2011 by sbyron Leave a reply »

Dear Botswana Ministry of Health and distinguished officials,

Executive Summary

Currently Botswana’s National Strategic Framework for HIV/AIDS is not crafted to include the specific needs of sex workers. Botswana’s goal for an HIV-free generation is jeopardized by failure to assist commercial sex workers, the leading driver of the HIV/AIDS crisis. We recommend that the Ministry begin to 1) open a dialogue between the policymakers in the highest level of government about assisting commercial sex workers, 2) increase funding for organizations that develop innovative income generating projects that provide a way for commercial sex workers to escape their dangerous line of work.

Background

According to the latest statistics Botswana’s adult (15-49) HIV prevalence rate is 24.8%. In comparing different demographics, the prevalence rate is highest for young women (15-24) with a rate of 11.8% (1).

Botswana’s high-risk populations include migrant workers, diamond workers, and sex workers (2). At present Botswana’s laws and regulations present obstacles for effective HIV prevention and care for commercial sex workers. The commercial sex worker industry is highly concentrated in Francistown, Mochudi, Palape, Selebe-Phikwe, and Tlokweng (3).

Independent researchers studying commercial sex worker populations in Francistown and Selebe-Phikwe argue that the majority of commercial sex workers are forced into this line of work because of poverty (3).

Commercial sex workers are vulnerable to being raped and/or beaten by their clients. This population also faces discrimination at clinics. An investigation into the Botselo Clinic in Francistown revealed that nurses taunted commercial sex workers and wrongfully disclosed the sex workers’ HIV-statuses to other patients (3).

Although prostitution is illegal in Botswana, there are many grassroots organizations like Matshelo Community Development and Men, Sex, and AIDS that have in the past been involved with training peer educators to educate other commercial sex workers on correct condom use and disposal and HIV/AIDS resources/testing facilities/counseling services. Matshelo Community Development in particular is involved with income generating projects. However both of these organizations have stopped operating due to lack of funding (5).

Existing Policies

The National Strategic Framework on HIV/AIDS has initiatives (education programs and condom distribution facilities) that address the needs of migrant workers and diamond workers. However, the National Strategic Framework of HIV/AIDS fails to acknowledge and address the care for commercial sex workers (6).

Recommendations

In order for an HIV-free generation to exist, the Ministry of Health needs to intervene and take actions to deal with one of the leading causes of HIV transmission. We recommend that the Botswana Ministry of Health:

1) Open a dialogue between the policymakers in the highest level of government about assisting commercial sex workers

 2) Increase funding for organizations that provide education and prevention schemes and develop innovative income generating projects that offer an alternative way for commercial sex workers to escape their dangerous line of work.

In addition we recommend that the Ministry of Health strongly consider sensitivity training for nurses and doctors at all testing, hospital, and clinic facilities so that commercial sex workers will not be discriminated against. In addition, failure to respect the rights of patients must have tough legal consequences.

Conclusion

The discussion of addressing commercial sex workers in Botswana was first started by Deputy Minister Botlogile Tshireletso. Mr. Tshireletso’s call for the government to consider legalizing prostitution to fight HIV/AIDS was met by strong opposition. Due to strong cultural and traditional beliefs, Batswana are against legislation making illegal sex work a legal economic activity. The debate was quieted and no action was taken.   

However action is required. If Botswana is serious and dedicated to pursing an HIV-free generation, this goal will not be achieved without reform of the National Strategic Framework on AIDS to include assistance to commercial sex workers. Although legalizing prostitution will not be possible in the immediate future, the Ministry of Health can and must take steps to provide funding to organizations that are working directly with commercial sex workers. These organizations work to develop and disseminate education/prevention programs and income generation schemes and supporting their efforts will make a tremendous impact and more us close to a HIV-free generation.   

Bibliography

(1)   http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2010/20101123_globalreport_en.pdf

(2)   http://www.avert.org/aids-botswana.htm

(3)   http://www.mmegi.bw/index.php?sid=1&aid=34&dir=2008/February/Friday22

(4)   http://www.bonela.org/doc/brela_vol3_2009.pdf (page 26)

(5)   http://www.bonela.org/doc/brela_vol3_2009.pdf (page 37)

(6)   http://allafrica.com/stories/200610130316.html

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6 comments

  1. laurah21 says:

    Shelley! These are great recommendations and a great policy memo (now I know what one looks like hehe). I think you should definitely submit it! I think it’s great that you talk about the benefits of providing support for marginalized groups, particularly women in the sex industry. I think that perhaps you could use as an example other countries where they have legalized prostitution or where prostitutes at least can access health care and prevention tools and cite the success they’ve had. This could further increase the validity and strength of your proposal while subtlety suggesting that Botswana jumps in the bandwagon.

  2. Elise says:

    This is fabulous, Shelley. I have so enjoyed learning about Botswana from your stories and blog posts this quarter. You are in a unique position to be able to offer policy advice to a country where your relatives live! I am envious over the incredible impact your passion and wisdom will have. I think your proposal to educate sex workers about HIV/AIDS is precisely what Botswana (and MANY OTHER COUNTRIES!) need. The other aspect of your proposal that stood out to me was your suggestion for creative programs to help sex workers find other sources of employment, so that they don’t feel like their only chance of earning a livelihood is by selling their bodies and putting themselves at risk for contracting and spreading HIV/AIDS.

  3. ayflores says:

    Shelley,
    Thanks for you post. I was shocked to read that country like Botswana, which has such a high prevalence rate of HIV/AIDS, currently does not have programs in place to address the contracting and spreading of HIV/AIDS through commercial sex-work. Often times, governments do not recognize the needs of the workers involved in illegal, informal industries; yet, it is the health, protection, and access to care of these workers that will largely shape the efficacy of Botswana’s HIV/AID policies. I think your proposal targets a clear gap in Botswana’s HIV/AIDS response framework and I agree in thinking that BOTH front-end (addressing poverty, the root of women’s engagement in commercial sex work) and back-end (support, resources, education, rehabilitation) mechanisms need to be put in place to address these issues fully.

  4. csendax says:

    I found your policy memo to be very intelligent and with great effective potential! I appreciate your emphasis on bringing the intersection between the commercial sex industry and the HIV/AIDS epidemic from the academic domain into the public policy sector. I agree completely with you that creating an open dialogue about commercial sex workers with those high up policy-makers working on HIV/AIDS epidemic will has rippling effects for both issues. I found this recommendation to be most pertinent and intelligent, “Increase funding for organizations that provide education and prevention schemes and develop innovative income generating projects that offer an alternative way for commercial sex workers to escape their dangerous line of work.” It is very wise of you to recommend that the Botswana Minister of Health take the responsibility for generating new projects that can replace the dangerous commercial sex trade that is enabling HIV/AIDS spreading. For, allocating funds to HIV/AIDS prevention, as you note, will not solve the core issue propelling the epidemic, the commercial sex industry. I think all your recommends, your use of statistics and your organization of your ideas is very effective!

  5. vcarcia says:

    Thank you so much for your post! As someone who has also spent much of this quarter examining women, sex workers, and both of these groups’ high-risk status in terms of contracting HIV/AIDS, I really appreciated your recommendations, particularly those that called for an opening of dialogue amongst policy makers on sex work and how the women in this field are often vulnerable to HIV transmission and brutal violence. I also agreed with your recommendation to increase sensitivity training to doctors, nurses, and other individuals who are often in close contact with these sex workers. Just reducing shame and embarrassment and providing a safe space wherein these women can come to for help and not feel shamed or judged can and does go a long way, so thank you for making sure that your brief included this.

  6. hnorton says:

    What a great post, Shelley! It’s clear you’ve done a great deal of research and care a lot about this issue. I found your post to be very convincing. You clearly acknowledged the cultural limitations of legalizing prostitution and offered a solution that takes this into account. I am curious as to whether or not you think that the level of HIV transmission can be significantly reduced while prostitution remains illegal. To me, it seems that the education programs you are describing could be very effective, but only if the johns agree to wear a condom. Do you see this as a barrier?

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