South Africa has come a long way in dealing with AIDS. The country has been successful in getting drug treatment to millions of people infected with HIV.
But the country still has one of the highest rates of HIV infection in the world — and the virus continues to spread. Nearly 400,000 South Africans are infected with HIV each year.
One health clinic in the heart of Johannesburg is attempting to break the HIV cycle by focusing on people at extremely high risk for infection — prostitutes.
Some researchers estimate that about two-thirds of sex workers in South Africa are HIV positive. Providing them with basic health care, including access to antiviral drugs, can save their lives while reducing the chance that they'll spread HIV to clients.
The University of the Witwatersrand is running clinics specifically for prostitutes.
One of its clinics in Johannesburg is located in the densely populated neighborhood of Hillbrow. It's an area known for drugs, poverty and prostitution.
After dark, Hillbrow takes on a post-apocalyptic feel. Storefronts are barred behind steel shutters. High-rise buildings with no electricity have been taken over by squatters and loom above the haze of the streetlamps.
The streets are eerily empty except for the occasional nervous pedestrian and pockets of prostitutes. At one corner, plump, middle-aged women hover around open fires waiting to sell sex.
A woman, who gives her name as Brenda, says she came to Johannesburg from Zimbabwe 18 years ago. Prostitution is illegal in South Africa, so she only wants to use her first name.
"I was working in a restaurant, and my shop was closed," she says. "Now I don't have money to pay my rent and my food and everything — or to help my parents [back in Zimbabwe]. That's why I'm here."
Brenda says that it's hard for most of "the ladies" to go to public health clinics. The people there look down on prostitutes because of the way they earn a living and because many of them are not from South Africa.
That's a problem the University of the Witwatersrand is trying to solve. It runs a clinic on the second floor of a public health facility just a few blocks from where Brenda and the other women work at night.
Brenda says she recently went there for help with a sexually transmitted infection. "They gave me good treatment, and I was fine," she says. "I really appreciate that."
She says the staff at the clinic understands her.
Nurse Maria Sibanyoni, who runs the project, says the biggest health issues facing her patients are sexually transmitted diseases, including HIV/AIDS. "We've got about 2,123 sex workers in our database, and about 68 percent of them are HIV positive," she says.
It's hard for many of these women to get health care elsewhere, Sibanyoni says. "You know, because people have got their own beliefs about sex workers."
The university's clinic offer the same general health care as others, but the staff also goes out to meet with women in the streets, in brothels and at truck stops.
Research has shown that HIV transmission is higher when a person is infected with other sexually transmitted diseases. The hope is that by treating conventional STDs, the risk of HIV spreading either from the sex workers to their clients or from clients to the sex workers is reduced.
The staff also can get women started on antiviral drugs, give them condoms and tries to stress the importance of safe sex. "By providing these services, we are trying to control the spread of HIV," Sibanyoni says.
Many other health providers don't want to deal with the chaotic lives of sex workers, Sibanyoni says. But to stop the spread of HIV, you can't ignore some members of the community. These women have to be included in any HIV-control strategy, she says, for it to be successful.
ROBERT SIEGEL, HOST:
Yesterday, we reported on South Africa's successful efforts to get hundreds of thousands of people with HIV onto life-saving drug treatment. But as a nation, it still has one of the highest infection rates in the world and the virus continues to spread there. According to a U.N. AIDS office report, roughly 400,000 South Africans are infected with HIV each year. One health clinic in the heart of Johannesburg is attempting to break that cycle by focusing one high risk group: prostitutes.
NPR's Jason Beaubien has that story.
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JASON BEAUBIEN, BYLINE: This is the neighborhood of Hillbrow, in the center of Johannesburg. It's one of the most densely populated neighborhoods in the city. It's an area known for crime, for poverty and for prostitution. Right where I'm standing, there's probably half a dozen women standing on the corner across from me. There's garbage in the streets. Many of the buildings around here have been hijacked, as they say - they've been taken over by squatters.
At this time of night, almost all of the buildings are shuttered. And in some areas, the only people on the street are women sitting in front of fires, waiting for clients to pull up.
BRENDA: I'm from Zimbabwe.
BEAUBIEN: You're from Zimbabwe.
BEAUBIEN: A woman who gives her name as Brenda is standing with a gaggle of other women in the shadow of a concrete awning. Prostitution is illegal in South Africa and she only wants to give her first name.
Brenda says she came to Johannesburg from Zimbabwe 18 years ago.
BRENDA: I was working in a restaurant, and my shop was closed. Now I don't have money to pay my rent and my food and everything, to help my parents. That's why I'm here.
BEAUBIEN: A local clinic just a few blocks from here is attempting to provide health care, including HIV treatment for Brenda and other sex workers. The philosophy of the clinic is that to stop the spread of HIV, you can't ignore some members of the community. Migrant prostitutes may be one of the most marginalized groups in the city, but they have vast sexual networks through which HIV can spread rapidly.
Brenda says she recently went to the clinic for help with a sexually transmitted infection after she'd had a bad experience at a hospital.
BRENDA: Before, I went to a general hospital. They give me some (unintelligible) tablets and (unintelligible) the infection which I had. When I went there, they gave me good treatment, and I was fine. I really appreciate that.
BEAUBIEN: She says the nurses at the clinic, in her words, understands us. She says they're welcoming to women from the street and don't look down on migrants. The sex worker clinic is housed on the second floor of a local government health clinic, but it's run by the Reproductive Health and HIV Institute at the University of Witwatersrand.
MARIA SIBANYONI: This is a specialized clinic for sex workers.
BEAUBIEN: Nurse Maria Sibanyoni runs the project.
SIBANYONI: In short, what you can say is that this is a sex work friendly clinic.
BEAUBIEN: The clinic has office hours in the mornings, then in the afternoons, the staff go out in a mobile van and offer health care to prostitutes on street corners, in brothels and at truck stops. Sibanyoni says the biggest health issues facing her patients are sexually transmitted diseases, including AIDS, and most of her patients are HIV positive.
SIBANYONI: We've got a database of sex workers. We've got about 2,123 sex workers which are in our database, about 68 percent of them are HIV positive.
BEAUBIEN: An earlier study in the South African port city of Durban found even higher rates of HIV in prostitutes. Among women who describe themselves as sex workers in Durbin, 79 percent tested positive. Sibanyoni says it's hard for many of these women, and it's mostly women, to get health care elsewhere. The majority of them are migrants from other parts of Africa and they're often discriminated against or belittled at other health clinics.
SIBANYONI: You know, because people have got their own beliefs about sex workers.
BEAUBIEN: The clinic treats gonorrhea, herpes, syphilis and other sexually transmitted diseases. Research has shown that HIV transmission is higher when a person is infected with other STDs. Also, HIV positive sex workers can get onto anti-AIDS drugs at the clinic. This, too, makes them less likely to pass HIV onto their partners. And the staff distribute condoms and try to stress the importance of safe sex.
SIBANYONI: So by providing these services, we are trying to, you know, control the spread of HIV.
BEAUBIEN: While some other health providers don't want to deal with the chaotic lives of sex workers, Sibanyoni says, these women are an important element in any HIV control strategy. Jason Beaubien, NPR News. Transcript provided by NPR, Copyright NPR.