The Botswana Network on Ethics, Law and HIV/AIDS (BONELA) and Sisonke Association of Botswana wishes to express their views on an article by the Monitor dated 06 May 2015 titled “ARV for all sex workers” which covered a public statement from the honourable Minister of Health, Dorcas Makgatho.
It is commendable from the contents to note that the ministry is including key populations in its HIV/AIDS programming.
In the stated article, it is reported that Honorable Minister of Health, Dorcas Makgatho, spoke about providing ARV treatment to all sex workers despite their viral load as a preventive attempt to try and reduce the spread of HIV/AIDS. She recognised and acknowledged sex workers as key populations who also needed protection. She said that her ministry is ready to make a paradigm shift from curative to preventative health care beginning with primary health care.
BONELA, as a human rights based organisation, wishes to commend her honorable for coming up with ways that makes sure that there is inclusion in giving proper and better health care.
This initiative is in line with the World Health Organisation (WHO) manual guideline on Prevention and Treatment of HIV and other Sexually Transmitted Infections for Sex Workers in Low- and Middle-income Countries: Recommendations for a public health approach that encourages country to give out ARVs as preventative measure to ensure the curb of the virus.
According to WHO, sex workers face greater challenges than the general population to retention in care and adherence to treatment because of stigma and discrimination in health-care settings, and their mobility, which may be motivated by many reasons such as avoiding harassment from the police, brothel owners as well as looking for clients.
Further, these studies have shown that clinical and biological outcomes, such as increasing CD4 counts, can be maintained amongst sex workers. This is because HIV-infected sex workers have many sexual partners and are involved in extensive sexual networks, so it may be possible to reduce the risk of sexual transmission to others in the community by significantly reducing their HIV viral load through effective provision of ARV.
Providing ARV’s to sex workers has the potential to make a huge impact on the spread of the AIDS epidemic. As much as this exercise and preventative measure can be put in place, it would render ineffective if it is not extended to all sex workers in Botswana. To reach the zero new infections and zero death the roll out of the ARV should not be adverse to non citizens, as they are also providing services. On a holistic perspective and in regarding to a human rights based approach, the ministry must not discriminate in its dispensation of treatment.
Such an exclusion will lead to more infections and more deaths. If indeed we stress the need to fight the spread of HIV, we should include Zimbabwean sex workers on basis that most of their clients are Batswana. The 2012 Behavioral and Biological Surveillance Survey (BBSS) of HIV/STI Among Select High –Risk Sub-Populations in Botswana, was undertaken by the Ministry, with the assistance of civil society including BONELA. The study revealed that out of 947 participants there were 323 Zimbabwean female sex workers and 624 Batswana female sex workers where HIV prevalence was slightly higher in Zimbabwean sex workers, at 69.2% than Batswana at 56.7%. “It is on those basis that we urge the Ministry to rethink its position so to include all sex workers and not leave anyone behind in fighting HIV,” said Cindy Kelemi, Executive Director of BONELA.