Durban, South Africa: Tania has to shout to be heard over music blasting out of a brothel in downtown Durban, South Africa, where dozens of sex workers slouch in chairs under the red glow of the bar or lean against walls as they wait for clients.
Dressed in a tight top and trousers, the 42-year-old looks younger than her age. Sex work is illegal in South Africa but the trade thrives, drawing women from as far away as Zimbabwe, Swaziland, Mozambique and Botswana to work alongside Tania.
Cracking jokes and quick to laugh, Tania said working in a brothel was safer than selling sex on the streets. But even so, the men can be aggressive. Condoms can burst, and when they do, sex workers are often reluctant to seek healthcare.
“Some of them are scared of going to the nurse for testing. They discriminate. ‘There is that prostitute’. And that name in public, it hurts,” said Tania, who declined to give her real name fearing reprisals.
In a report published in 2015, researchers found that the HIV prevalence rate among sex workers, one of the most at risk groups, and their clients in Durban was 53% – far higher than the national adult HIV prevalence rate of 19.2%.
Yet stigma is still one of the biggest obstacles to ending the AIDS epidemic three decades after it began, experts say.
In South Africa, sex workers speak of nurses that laughed at them, dismissed or shamed them for coming to a health clinic, even in a country with the highest number of people living with HIV – 7 million – and the largest number of people accessing anti-retroviral treatment – 3.5 million.
Deputy director of UNAIDS Dr. Luis Loures, who saw his first AIDS case in 1981, said medical advances in creating lifesaving drugs to treat HIV were “a historical achievement for humanity”.
“But when I see how much we progress as societies, in terms of achievements in discrimination, I feel we are still in the 1980s,” Loures told the Thomson Reuters Foundation, referring to the start of the epidemic.
“Having health systems that discriminate against gay men, sex workers and other key populations [means that] AIDS is coming back, in a very selective way,” he said.
Wake up the world
Sixteen years after South Africa first hosted the International AIDS Conference, the biggest gathering of its kind returned to Durban last month.
Some of the same campaigners who marched with President Nelson Mandela to break the silence around AIDS in 2000 were back. This time they were voicing alarm over unequal access to HIV treatment.
“People with HIV are mostly poor, they’re mostly marginalised,” said leading activist Mark Heywood from South Africa’s Section 27 rights group.
“They die in their homes, they die in hospitals,” Heywood said as he marched to ‘wake up the world again’ to the AIDS epidemic, which killed some 180,000 people in South Africa last year.
South Africa had 380,000 new HIV infections in 2015, accounting for nearly 40% of new HIV infections in eastern and southern Africa, according to UN agency UNAIDS.
International AIDS funding fell for the first time in five years to $7.5 billion in 2015 from $8.6 billion in 2014. Only 17 million of the world’s 36.7 million HIV-positive people having access to anti-retroviral treatment, UNAIDS says.
Rights activist Nana Gleeson said in neighboring Botswana, health worker prejudice against those on the margins of society like prisoners, foreigners and transgender people was widespread.
“It’s actually stigma that’s killing people. It creates an opportunity for people to then not give people access to treatment or whatever they need,” she said.
Oscar-winning South African actress Charlize Theron, who runs a HIV charity, has blamed racism, sexism and homophobia for fuelling the epidemic.
“We value some lives more than others,” Theron told the opening ceremony of the AIDS conference.
“We value men more than women, straight love more than gay love, white skin more than black skin, the rich more than the poor and adults more than adolescents,” she said.
Even as some 18,000 people attended this year’s AIDS conference, a few kilometres away, staff at a centre for Durban’s poor and homeless noticed that its regulars were not coming to the clinic for checkups.
“We know the police are regularly told to clear them away,” said the manager of the Denis Hurley Centre, Raymond Perrier.
“Almost half of the people we see in our clinic are refugees, because they tell us they don’t feel welcome in government clinics,” he added.
Human rights activists say the criminalisation of sex workers makes them more vulnerable with women working the streets reporting frequent arrest for carrying condoms, attacks and detention by the police.
Sex worker and activist Janet sees many sex workers who have given up seeking treatment and are rapidly deteriorating.
“Their skin is peeling off and it’s like maize-meal when they scratch it,” she told the Thomson Reuters Foundation.
Since June, Janet, who like Tania is HIV-positive, has been persuading women who are still negative to start taking Pre-exposure Prophylaxis, a daily pill that can cut the risk of getting HIV by up to 90%.
But the drugs will only work if people have access to them, UNAIDS’ Loures said.
“The only way to face things like discrimination is through activism. There is no drug that will fix that,” he said.