Mail & Guardian (Johannesburg) - February 27, 2004

The Reproductive Health Research Unit (RHRU), a privately-funded organisation attached to Wits University, has set up mobile clinics in hotels used by sex workers. A RHRU report on the initiative finds that it has had a considerable impact on sex workers' lives and behaviour.

The mobile clinic, set up in June 2000, consists of two nurses and two community workers. They have visited 12 hotels where sex workers were known to operate and, over a 15-month period, treated 1 243 sex workers for sexually transmitted infections (STIs).

"For us it really saves time because we are always busy," said one sex worker, as reported in the study by Jonathan Stadler, a researcher for the unit. "This has made life much better for us. [Normally, you'd] say, 'shit, I wish I could go to the clinic at Esselen [Street], but I don't have time.' But here we just run to [room] 401 and tell the nurses about broken condoms."

The study says sex workers tend to avoid public clinics because they are afraid of being humiliated, or being refused services: "The location of public health facilities and their hours of operation are also inconvenient for sex workers - [they] reported that nurses verbally abused them and used derogatory terms like 'magosha', meaning 'loose women', to address them."

The study quotes figures, published in 2000, estimating that there are between 5 000 and 10 000 commercial sex workers in Hillbrow, of which a high proportion were minors. Entering sex work was seen as an attempt "to forge a new way of life for themselves".

Tiisetso Motloung, one of the nurses who visits the hotels, told the Mail & Guardian that these places are often dirty and neglected. "We take our own screens and book a room so we can see the women in private," she said. The unit treats up to 25 women a day.

"I feel very sympathetic for these women because if you see the conditions where they live, you cannot judge them," said Motloung.

Sex workers have responded positively to the mobile clinics and their provision of sexual health services, Aids education and counselling, and STI treatment. A 1997 survey in Hillbrow showed that 45% of 247 sex workers tested positive for HIV. "Most disturbingly, those who had been working as sex workers for only three months displayed similar levels of infection to those who had been working for one year."

Motloung said the mobile clinic does not provide HIV testing. Sex workers are referred to the Esselen Street clinic. "The [HIV] stigma is still high among these women because they are scared to lose their clients. There is a lot of jealousy, so other sex workers may tell their clients they are HIV-positive."

The study argues that more attention needs to be focused on contextual dynamics that place sex workers at risk. Sex workers operating in hotels are generally at lower risk than those on the street. On the other hand, they are at greater risk from their romantic partners (with whom they are less able to negotiate safer sex) than from their clients.

An older sex worker is quoted in the report on the relative risks of these categories of sexual partners. "Our spinners [boyfriends] have girlfriends in most of these hotels. They don't use condoms. He comes back to infect you - at least clients are using condoms, but if your boyfriend is willing to use a condom you can go on with your affair."

The intervention of mobile clinics was limited in its capacity to change the relationships that placed sex workers at greatest risk. But it was able to change perceptions of health, and to emphasise the need to prevent disease.

"We are the ones with a problem because we use our bodies to do this job," said one sex worker quoted in the study. Another remarked that she would not have sex with a client without a condom for fear of infection, but also because she feared the reaction of the clinic workers if she was infected.The hotel managers reported that the presence of the mobile clinic improved health-related behaviour among sex workers. It also increased the popularity of those hotels used by sex workers, who used the clinic as a marketing tool, showing their clients cards from the clinic. This made "wary" clients feel "free and safe".

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