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Sally-Jean Shackleton: Getting Away From One-Size-Fits-All Health Policies

February 2016

Sally-Jean Shackleton

Sally-Jean Shackleton is the director of the Sex Workers Education & Advocacy Taskforce (SWEAT) in South Africa. She has over 25 years' experience working in civil society organisations on issues relating to social justice, gender and sexuality. She started her career as a volunteer, counseling sexual and domestic violence survivors. Her focus is on marginalised populations and on the intersection between justice and rights. She was on the founding Board for the first South African organisation of transgender persons in Africa. She is based in Cape Town.

What got you involved in the AIDS movement and particularly around PrEP advocacy?

I work for an organisation called SWEAT -- which stands for The Sex Workers Education and Advocacy Taskforce. Our interest is in the health and wellbeing of sex workers, which means we work in the intersection of rights and health. PrEP is an important tool for prevention, and since we are based in a country with one of the highest prevalence rates, it's a key concern for us!

What is an example of PrEP advocacy work you have engaged in recently? Is there a particular tactic or approach you have used in your advocacy that you can share?

We have been partnering with a number of organisations making up the South African Sex Work Sector -- and as such, participating in the development of a national Plan for sex work programming, which includes PrEP. In December last year, Truvada was approved for use as PrEP and so the country is developing guidelines for its use and plans for its distribution. We are campaigning for sex workers to be in the room in these discussions and ensuring sex workers are knowledgeable about PrEP. Aside from policy work, we work with peer educators, who are themselves sex workers, to deliver services on a range of issues, and advocate for the decriminalisation of sex work in South Africa. We provide a safe, supportive space for sex workers to lead groups on topics of concern -- from motherhood to migrancy.

From your perspective, what are the top priorities for PrEP advocacy to advance an accelerated, more equitable response to AIDS?

Key is to ensure sex workers (trans and cis women, as well as men) are present in discussions on PrEP; especially sex workers from countries with the highest HIV burden. Secondly, we need to take a patient-centered approach. PrEP is only effective if it is used correctly -- this means we have to invest in ensuring that there are adequate support structures, that sex workers are informed and that we address current disparities in health care settings for sex workers. Thirdly, we must continue to address sex work stigma and structural barriers, and change laws that prevent access to health and justice. PrEP is not a magic bullet -- if we continue to apply new advances in the same, flawed and discriminatory health care settings, we will be wasting valuable resources.

What concerns you about expanded PrEP use?

What concerns me most is that guidelines and policies and their one-size-fits-all application often ignore the realities of sex workers' lives -- they tend to be without context and they tend to treat a diverse population as a single homogenous group.

If you were speaking to a young advocate interested in HIV and AIDS advocacy, what would you advise her/him about how to be effective?

Start with the most important aspect of prevention -- the person!


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