Sex Work and HIV in Namibia: Review of the Literature and Current Programmes

This 24-page report shares findings of a literature and programmes review conducted to better understand the challenges sex workers face in Nambia when it comes to HIV prevention and care, as well as outline current related programming. Recognising sex workers as key population at higher risk of HIV, the objective of the review was to consolidate all known information about sex work and HIV in Namibia and provide an objective knowledge base that can inform programming and advocacy efforts as well as further research. Published by the United Nations Population Fund (UNFPA) and the Joint United Nations Programme on HIV/AIDS (UNAIDS), the review also includes a mapping of key partners working on HIV and sex work.

Overall, the review found that the available information related to sex work and HIV in Namibia is limited, and none of the studies can be considered to be nationally representative. However, it is clear that sex workers are severely affected by HIV and that they face many of the same challenges in relation to human rights and health that sex workers face in other countries in the region. Information on clients of sex workers is limited, although some programming has been conducted with mobile and migrant men, a large proportion of who pay for sex. Sex work is clearly diverse, with different locations and regions featuring different characteristics, and it is quite possible that the limited studies conducted to date may have missed important profiles and situations, since they were generally based on small, convenience samples. This underlines the importance that programmes should place on understanding each context and on responding in a tailored way to the needs in each place.

According to the report, while factors that make sex workers vulnerable to HIV are difficult to assess, some of the common themes emerging included the following:

• While overall knowledge of HIV seems to be acceptable, specific knowledge about the importance of contraception, lubricant use, and the risks associated with different types of sex have not been explored to date.
• Problems in negotiating condom use despite relatively good awareness of the importance of using condoms. Condom availability can be problematic, but negative attitudes of sex workers and clients to condom use are also a key factor and a major concern expressed by sex workers themselves.
• Attitudes toward sex workers from community members and health and social service providers are overwhelmingly negative, manifested by the problems sex workers face in accessing health services, and other services such as stable housing, credit and banking, and access to education for children.
• The limited amount of HIV-related programming directly reaching sex workers, and the legal situation and behaviour of law enforcement in relation to sex workers, are also major factors.

The report concludes that sources concur that programming specifically for sex workers has been very limited to date. The programmes that do exist are focussed either on HIV or on supporting people to leave sex work. Work to develop peer-led HIV prevention, to improve the quality and acceptability of clinical services to sex workers, and to tackle violence, stigma, and discrimination and defend human rights has been limited to date. The report outlines a few organisations involved in working with sex workers, such as Society for Family Health, Positive Vibes, Outright Namibia, Rights not Rescue Trust, C-Change, AIDS and Rights Alliance for Southern Africa, The Red Umbrella, Namibian Planned Parenthood Association, and King’s Daughters.