Drop in for help

It was a bitter-sweet moment when TB/HIV Care Association, the national Department of Health, the Centre for Disease Control and other partners opened a clinic in the city centre last week.

The clinic focuses on providing health services to sex workers and drug users. And while the event was a celebration for all who attended, it was also a reminder of the stigma attached to sex workers and drug users, and opened in remembrance of those sex workers who had been abused or contracted HIV/ Aids.

Health MEC Nomafrench Mbombo, who opened the clinic, dedicated the day to Nokuphila Khumalo, a sex worker who was beat to death by famous artist Zwelethu Mthethwa in Woodstock in 2013. Speaking at the launch of the clinic, she asked: “Why did this girl have to die just because she used her body to live? Why should people who are selling their bodies to make a living, be punished? Why can’t someone access health services just because they use their bodies to live?

“Today we are saying sex workers’ lives matter.”

The opening of the clinic came a day before SA Law Reform Commission released its report into sex work, which recommended that sex work shouldit remain a criminal offence.

The clinic and drop-off centre is situated in an unmarked building, and the media were asked to withhold the address to protect the identity of the clients. It offers ablution facilities, a “chill-zone” with computers, couches and coffee, psychosocial services such as counselling, as well as biomedical services such as HIV co unselling and testing, sexually transmitted infection screening, the provision of condoms, wound care, pre-exposure prophylaxis or PrEP, sterile needles and syringes and behavioural interventions aimed at safer injecting, overdose prevention and decreasing sexual risks.

Harry Hausler, the chief executive officer of TB/HIV Care Association, which offers health services in the Cape Town Central City through its mobile clinics, said the clinic had also added hepatitis screening for patients who visited the clinic.

He said he was particularly pleased with the introduction of pre-exposure prophylaxis at the clinic. “PrEP is helpful for HIV negative people who practise risky behaviour and they can take this to drastically lower their chances of contracting HIV.”
He said they would like to keep the clinic as open and flexible as possible, so that more people could access their services.

“The reality is that most sex workers don’t visit clinics and public hospitals. They prefer community-based programmes which is why our model has always been mobile. So here we created a very safe space for them.”

Charleen Matatin, who is now employed as a peer educator, was 18 years old when she had to leave the orphanage she was at and ended up on the streets.

“I didn’t know about living on the street. A friend told me that she knew how to make a quick buck. She showed me how to become a sex worker. I started to sell myself on the street because I had nothing.”

She said it was tough. “Sometimes they hit you or abuse you and treat you badly. There are rainy days. It’s cold.”
About 10 years ago, when she went to Green Point clinic for treatment for a sexually transmitted infection, a nurse spoke to her about HIV. She was tested negative for the virus, but never went back. This year, she visited the drop-inn centre and felt welcome. “They helped me with everything and they were efficient. I want to thank TB/HIV Care for making this space possible for us.”

Patron of the new clinic, Danny Oosthuizen, said: “When you live on the street, people treat you like nothing and you think you are nothing.

“This centre is the only safe space. Here you are a human being. There are clothes and shoes, computers for writing your CV. You can sit and just compose yourself. There are hot showers. There is HIV care, ARVs, treatment for hepatitis. We are in good hands. They are saving lives. They are saving people like me.”

He said people came to the clinic with big sores on their arms from using dirty needles. “Imagine what people would think if they had to walk into a clinic with sores on their arms. By providing people with clean needles people can protect themselves and that gives them more dignity.”

Helen Savva from the US Centres for Disease Control, said HIV eradication in key populations involved targeted interventions, as what works for the general public did not work for key populations. “We have to work smarter and better our approach. We need the target population to tell us what they need.”

She said PrEP was just one aspect of prevention, and that psychosocial support should also be promoted.

She said after a month of taking PrEP, about 60 percent of sex workers stop taking it. “We need to lobby for a PrEP package so that people don’t have to take a pill every day, such as perhaps an implant.”
Ms Mbombo thanked TB/HIV Care for providing a platform for health services without discrimination. “We adopted the charter for right to dignity, so we shouldn’t discriminate.

“Health is everyone’s business.”