Supported by the United States Centers for Disease Control and Prevention (CDC), with funding from the President’s Emergency Plan for AIDS Relief (PEPFAR), The Aurum Institute, in collaboration with Anova Health Institute, are leading the second South African Health Monitoring Survey (SAHMS), a biological and behavioural survey with female sex workers (FSW) in South Africa.

This study is a significant collaboration between South African civil society and academic partners, and the international community. These include National Institute of Communicable Diseases (NICD), Sex Workers’ Advocacy and Education Taskforce (SWEAT), Sisonke, TB/HIV Care Association, Wits Reproductive Health Institute (WRHI), Perinatal Health Research Unit (PHRU), and Oasis. The University of California, San Francisco (UCSF) will provide technical assistance to the South African partners.

This study, which started in June 2018, is conducting in the same three metropolitan areas as the first SAHMS of 2013-14; Cape Town in the Western Cape; Johannesburg in Gauteng; and the eThekwini in KwaZulu-Natal. Repeating the survey in the same metropolitan areas provides an opportunity to measure progress in the national response to the HIV epidemic among FSW. In addition to HIV prevalence and risk behaviour indicators, SAHMS 2 will track progress in FSW uptake of important HIV programming initiatives begun in 2016 under the National Sex Worker Plan, including expanded HIV testing services, linkage and retention in HIV treatment, viral suppression among HIV-positive FSW, and uptake of pre-exposure prophylaxis (PrEP) among HIV-negative FSW.

Additionally, the study will refine previous estimates of the size of each metro’s female sex worker population. These population size estimates are critical to securing appropriate funding for FSW programming, and measuring progress sizes that will be produced from the study, are important for informing decision making to ensure adequate resourcing for female sex worker programmes.

Reflecting upon the significance of the study, The Aurum Institute CEO Dr Dave Clark said: “Conducting the second round of surveillance on female sex workers in South Africa is a landmark achievement for the generation of strategic information to guide policy and programme implementation in South Africa. The information we will get from this study will help various partners to advocate for services required by female sex workers, develop appropriate prevention and care interventions, guide future research, and assess the impact of the response to the HIV epidemic over time. As the technical capacity of local organisations to conduct these studies continues to grow, we can do more for other Key Populations as well and meet our shared goal of ending HIV as a public health threat in South Africa”

Prof Tim Lane of UCSF, principal investigator of SAHMS 1, echoed Dr Clark’s comments: “It has been a pleasure to work with our South African partners on launching SAHMS 2. This survey is an example of how South Africa is leading the region in understanding and addressing Key Populations HIV epidemics, and especially with FSW. UCSF Is proud to support this team of outstanding partners.”

Anova’s Albert Manyuchi, National Surveillance Coordinator, who is managing the survey, said: “This second biological and behavioural survey (BBS) will greatly help fill the information gap on FSW in South Africa, especially providing some new and invaluable insights for policy, programmes and advocacy. Since this is the second BBS amongst FSW, my hope is that this survey will empirically demonstrate that overall the various interventions by various stakeholders are helping in controlling the epidemic amongst population group.”

Findings of the survey will be shared with the Department of Health and released early next year.

Sex workers and men who have sex with men (MSM) are the most at risk populations for HIV acquisition and transmission. The Anova Health Institute, an NGO dedicated to improving the health of all South Africans with particular emphasis on HIV, welcomes the unveiling of the National Sex Worker HIV Plan for 2016 – 2019, as well as the launch of the much-awaited South Africa Health Monitoring Study (SAHMS). The Plan provides for early treatment and the provision of pre-exposure prophylaxis (PrEP) medication. PrEP is a combination of two antiretroviral drugs, which if taken daily by HIV negative individuals, can drastically reduce HIV infection.

Anova was a collaborator in the SAHMS, which is the very first integrated biological and behavioural survey (IBBS) conducted amongst female sex workers (FSWs) in South Africa. The Study revealed that the prevalence of HIV ranges between 40% and 72%. This, despite the fact that condom use with clients is relatively high.

In addition, HIV prevalence among local MSM has been estimated at 10% to 43% in various studies. MSM are at particular risk for HIV acquisition and transmission as biologically, unprotected receptive anal sex is about sixteen times more likely to transmit HIV than unprotected vaginal sex.

Anova, who have recently rolled out their ground-breaking WeTheBrave.co.za campaign in the Western Cape, is of the opinion that PrEP is the most effective form of prevention from HIV and as a result are leading the charge with PrEP demonstration projects in the Western Cape and Gauteng amongst gay men and other men who have sex with men (MSM).

Professor James McIntyre, CEO of Anova, says: “We have been working closely with government in defining policy and urge them to extend access to PrEP to MSM as soon as possible. MSM continue to be at high risk for HIV acquisition in South Africa. The strongest evidence base worldwide for the use of PrEP comes from studies in MSM and Anova believes that this life saving intervention should be made available as soon as possible for all those who wish to use it.”

To this end, WeTheBrave.co.za is the first large scale South African sexual health campaign to specifically address gay men and other men who have sex with men (MSM). Funded by the Elton John AIDS Foundation, the campaign addresses both prevention and treatment issues in an affirming, non-judgemental and sex positive way, which is entertaining and engaging. WeTheBrave.co.za asks MSM to be brave enough to make healthy sexual choices like wearing a condom, taking PrEP, getting tested regularly and knowing their status.

For more information on the campaign, or to find an Anova Health4Men clinic, visit www.wethebrave.co.za or join the conversation on Instagram, Twitter and Facebook.

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