Structural Approaches Are Building Power: South Africa’s National HIV Response Among Female Sex Workers (1990–2016)

Abstract

Unlike HIV epidemics in other southern and eastern African nations, South Africa’s HIV epidemic was characterized by concentrated epidemics among key populations such as men who have sex with men (MSM) and female sex workers (FSW) before its high-prevalence general population epidemic took off. Eventually, as HIV cases began to appear among women and men with no apparent history of sex work, male same-sex sexual activity, or injection drug use, it became clear that a generalized, heterosexually transmitted epidemic similar to those in other southern and eastern African nations was taking root. The impact of the missteps and misuse of science in South Africa’s national response to the generalized HIV epidemic during early post-apartheid years has been explored in prior research. However, less well-understood is how national political discourse among the scientific community, government actors, and civil society contributed to the erasure of MSM and FSW from the national HIV agenda – an erasure that is all the more remarkable given South Africa’s comparatively favorable legal, human rights, and civil society contexts for an effective response among these groups. This chapter critically examines the social and structural context in which FSW were made invisible and now are mobilizing to have their needs and voices heard, as the importance of this group in curbing the ongoing HIV epidemic becomes clear in South Africa and other settings characterized by generalized epidemics.