AIDS activists in South Africa hope that the inclusion of sex workers in an HIV research project will draw attention to the need for outreach programmes targeting this often marginalised group.
About 600 female sex workers in and around Durban, the capital of eastern KwaZulu Natal (KZN) province, are expected to participate in the study which begins at the end of July.
The project is being conducted by the Centre for the AIDS Programme of Research in South Africa (CAPRISA), a component of the Nelson R. Mandela School of Medicine at the University of KZN in Durban.
The Open Door Community HIV/AIDS Support Centre in Durban, one of the few NGOs in the province that offers HIV/AIDS education and support for sex workers, is assisting CAPRISA in the study.
With the help of Open Door's counsellors, CAPRISA will screen 600 sex workers with the aim of enlisting 200 HIV-negative women to participate in the study. Together with a community worker from CAPRISA, the counsellors will make first contact with the sex workers to gain their confidence, which Open Door's Dinesh Singh described as a "very slow process".
"Participation in the study is currently the only [official] way for us to reach sex workers," explained Singh.
CAPRISA study coordinator Francois van Loggerenberg told IRIN it would take up to six months to convince a sufficient number of sex workers to get tested and participate in the study.
However, with the recent start of the national antiretroviral (ARV) therapy rollout, people were generally more willing to get tested because they now have access to treatment, Singh said.
"Over time, sex workers will see the value of participating in the research," he added. As part of the study the sex workers will receive regular health check-ups, ARV treatment and counselling. In addition, they will receive meals as well as compensation for transport and the time spent away from work.
As all participants will undergo regular testing on a monthly basis, researchers will be able to detect HIV infection almost immediately, and closely observe the early response of the immune system to the infection.
It was expected that this approach would shed light on HIV progression from an acute infection to an advanced one, Loggerenberg told IRIN.
Of the 600 female sex workers who will be screened, CAPRISA expects about 400 to test HIV-positive. HIV-positive sex workers with a low CD4 count will be referred to ARV treatment programmes. [By keeping track of the number of CD4 cells in the bloodstream, doctors can tell how far HIV infection has progressed.]
Prior to the study, Open Door has provided "informal" support to sex workers. However, the NGO's operations have been routinely constrained by a lack of funds. "Donors do not want to be associated with an illegal trade and, secondly, supporting sex worker programmes is not as glamorous as helping [HIV] infected mothers or AIDS orphans," Singh said.
He argued that funding for HIV/AIDS support programmes targeting sex workers would remain socially unacceptable until South Africa decriminalises prostitution.
Singh hoped that the publication of the study would encourage funding for HIV/AIDS prevention, training, education and counselling for sex workers.