Sex work, HIV cases climb after BCL�s fall
Onalenna Kelebeile | Friday May 12, 2017 12:09
SELEBI-PHIKWE: The first case of HIV/AIDS was discovered here in the mid-1980s and from then, the copper and nickel mining town has been the epicentre of the epidemic.
Various interventions by Government, Non-Governmental Organsations (NGOs) and corporates have reined in the prevalence and incidence rates to some extent. However, the closure of BCL Mine last October snatched the economic rug from under the feet of the town’s residents, some of whom have resorted to the oldest profession.
Figures provided by health authorities in the town show a spike in the number of commercial sex workers between October last year and April this year. Data show that the new entrants include girls as young as 15, married women and others aged 50 years and above.
Some have already tested HIV positive and of these, the majority have enrolled in Antiretroviral treatment. Authorities have noted that those who have resorted to sex work are mainly those who have close relatives already in the “business” as the more experienced initiate the newbies.
Some even go to the extent of passing their clients to the new entrants in the trade who are inexperienced to negotiate safer sex.
Between October and April, Silence Kills Support Group (SKSG), a local HIV and sex work NGO, made contact with 35 commercial sex workers aged between 15 and 19, 141 aged 20 to 24, 131 aged between 25 and 29 as well three aged 50 years and beyond.
By comparison, the NGO’s previous survey conducted between April and September last year, found only 16 sex workers aged between 15 and 19, compared to 35 in the latest study.
Many of the sex workers reached by SKSG were tested and those who were HIV positive were enrolled on treatment immediately.
Dalton Bontsi of SKSG says after BCL’s closure, many girls and women resorted to commercial sex work mainly because providers and sources of livelihoods dried up.
“BCL Mine was the economic mainstay so without providers some women are compelled by circumstances to end up practising commercial sex work. Sex work is serious now,” Bontsi said.
The NGO’s research has found that at least 70 of those who took up sex work were previously dependent on the economy created by BCL’s activities.
SKSG does not expect a spike in the HIV incidence rate, which is the rate of new infections. However, it does expect a higher prevalence rate, which the number of individuals infected, due to the fact that interventions such as ARVs allow people to live longer.
The NGOs approach of test and treat is effective, but Bontsi is unhappy about the level of support provided.
“Our target now is the key population. Our concern is that our interventions are not sustainable because Government’s support is very low. We only rely on funding from donors and once the funding stops the situation worsens.”
Bontsi is aware that securing government support is complicated by the fact that sex work is illegal in Botswana. He reveals that some of SKSG’s projects have failed after running out of funds, forcing the NGO to wait for the next call for proposals by donors.
“This results in clients being left hanging,” he notes.
“Another challenge is that a lot of community-based organisations in Selebi-Phikwe have closed shop due to donor fatigue and this is a major blow for the town.
“Those organisations were targeting the general population which SKSG is not targeting. It is possible that the general population could be left behind.”
Selebi-Phikwe Government Hospital Superintendent, Dr Joseph Sharma has equally noted an increase in commercial sex work in the town, caused by the downturn in its economic fortunes. He says that between October and December last year, surveys noted about 128 sex workers in the town of whom 26 were HIV positive. Between January and April, another survey found 281 sex workers, including young teenagers and elderly women, some of them married.
“The spike in the number shows that there are many new entrants into the practice,” he says.
At least 73% of commercial sex workers identified as HIV positive have been enrolled on treatment, so that the virus can be suppressed and to lessen the chances of transmission to others.
Dr Sharma, who is also head of the District Health Management Team, says the goal is to test as many people as possible. Thus far, in the general population, the town has achieved an 87.5% testing rate against the national target of 69%.
“The more we test, the more we will enroll on treatment. All our clinics dispense ARVs and this decongests the hospital and takes services to the people.” The Hospital has also strengthened its partnership with non-governmental organisations especially those dealing with sensitive populations, such as SKSG.
“Our collaboration is very good and they have good referral systems,” he says.
“Through interventions in place, we want to reduce the incidence rate as much as possible.”
Government health facilities in Selebi-Phikwe now accommodate 1,100 patients on ARVs. The facilities also inherited another 1,000 patients on non-communicable diseases and HIV from BCL Hospital after the Mine’s closure.
“A small challenge experienced is that some of the patients have relocated to the villages and therefore follow-ups on them has become difficult.
“We work hand in hand with the council through its social workers to do follow ups and it is working.”
For District AIDS Coordinator, Shathiso Daki their issues of concern include HIV testing, Sexually Transmitted Infections, teenage pregnancies and safe male circumcision.
Here again, testing is paramount and without it, those in need cannot access programmes available. “We are doing well in testing in Selebi-Phikwe and we have exceeded our targets. However, we are still experiencing low numbers of men as compared to women.”
“We work hand in hand with government departments and civil society to do outreaches, house to house mobilisation, couple testing campaigns and male soccer tournaments to reach out to as many people as possible,” he said.
Daki says between January and March this year, 190 people tested positive, which he attributes in part to the depressed economic conditions impacting on commercial sex work.
BCL mine closure has posed a health challenge citing that between January and March this year 190 people tested HIV positive and were enrolled into treatment immediately.
“Though there is a challenge of defaulters, that has only promoted intensified follow up strategies. PMTCT is performing well except that a few breastfeeding mothers are reluctant to follow treatment and this has resulted in two babies testing positive,” he says.
As authorities in Gaborone horse-trade for BCL Mine’s sale to investors, in Selebi Phikwe the battle for survival has literally become about life and death.