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This could be because sex workers in South Africa face high levels of stigma and discrimination and are restricted by the laws under which they work.

Although South Africa is moving towards decriminalising sex work, carrying condoms can still be considered an offence.

Now a mother, Motsumi says she wishes she had received more information at home and at school about risky sexual behaviour, and is using her experience to advocate non-judgemental, face-to-face conversations with young people about relationships with older men.54 South Africa has made impressive progress in recent years in getting more people to test for HIV.

In 2017, South Africa reached the first of the 90-90-90 targets, with 90% of people living with HIV aware of their status, up from 66.2% in 2014.55 56 57 This progress follows the launch of two nationwide testing initiatives: the national HIV testing and counselling (HTC) campaign of April 2010 and the HTC revitalisation strategy in 2013 which focused on getting people from the private sector, farms and higher education to test.58 Thanks to campaigns such as these, more than 10 million people in South Africa test for HIV every year.

The new strategy aims to provide the basis for more inclusive services so that LGBT communities have ‘the necessary tools to realise their health and human rights goals’.27 Among the recommendations made in this strategy is increasing the availability of lubricants for men who have sex with men and providing them with Pre-exposure Prophylaxis (Pr EP) to protect them from infection.28 Transgender women in Sub-Saharan Africa are twice as likely to have HIV as men who have sex with men.29 However, these populations have often been neglected by both policy and research in South Africa, where trans women have either been excluded from participating in studies or been categorised as men who have sex with men.

Recent research has shown that men often are reluctant to test, as they see health facilities as being ‘women’s places’ and so feel that testing for HIV is non-masculine and might be seen as weak.

In 2016, an estimated 17% of people who inject drugs in South Africa were living with HIV.34 However, people who inject drugs only account for 1.3% of new HIV infections in South Africa.35 A 2016 study of people who inject drugs in five South African cities found 32% of men and 26% of women regularly shared syringes and other injecting equipment and nearly half reused needles.36 People who inject drugs are also associated with other high-risk behaviours such as sex work and unsafe sexual practices.

For example, the same study reported fewer than half of those surveyed used a condom during their last sexual encounter.37 In 2017, an estimated 280,000 children (aged 0 to 14) were living with HIV in South Africa, only 58% of whom were on treatment.38 New infections have declined among South African children, from 25,000 in 2010 to 13,000 in 2017.39 This is mainly due to the success of prevention of mother-to-child transmission(PMTCT) programmes.40 The rate of mother-to-child transmission stood at 1.3% in 2017, down from 3.6% in 2011.41 This puts South Africa on track for eliminating mother to child transmission.

In 2015, the country was investing more than

Recent research has shown that men often are reluctant to test, as they see health facilities as being ‘women’s places’ and so feel that testing for HIV is non-masculine and might be seen as weak.

In 2016, an estimated 17% of people who inject drugs in South Africa were living with HIV.34 However, people who inject drugs only account for 1.3% of new HIV infections in South Africa.35 A 2016 study of people who inject drugs in five South African cities found 32% of men and 26% of women regularly shared syringes and other injecting equipment and nearly half reused needles.36 People who inject drugs are also associated with other high-risk behaviours such as sex work and unsafe sexual practices.

For example, the same study reported fewer than half of those surveyed used a condom during their last sexual encounter.37 In 2017, an estimated 280,000 children (aged 0 to 14) were living with HIV in South Africa, only 58% of whom were on treatment.38 New infections have declined among South African children, from 25,000 in 2010 to 13,000 in 2017.39 This is mainly due to the success of prevention of mother-to-child transmission(PMTCT) programmes.40 The rate of mother-to-child transmission stood at 1.3% in 2017, down from 3.6% in 2011.41 This puts South Africa on track for eliminating mother to child transmission.

In 2015, the country was investing more than $1.34 billion annually to run its HIV programmes.4 The success of this ART programme is evident in the increases in national life expectancy, rising from 61.2 years in 2010 to 67.7 years in 2015.5 HIV prevalence remains high (18.9%) among the general population, although it varies markedly between regions.6 For example, HIV prevalence is almost 12.2% in Kwazulu Natal 7 compared with 6.8 and 5.6% in Northern Cape and Western Cape, respectively.8 9 South Africa's National Strategic Plan 2017-2022 identifies a number of groups who are particularly at risk of HIV transmission.10 Nationally, HIV prevalence among sex workers is estimated at 57.7%, although this varies between areas, with prevalence estimated at 71.8% in Johannesburg, 53.5% in Durban and 39.7% in Cape Town.11 12 Certain factors increase HIV risk for South African sex workers, including poverty, the number of dependents they have and lack of alternative career opportunities.13 Injecting drug use is also common among sex workers, exacerbating their vulnerability to HIV infection.14 Studies have also found that understanding of HIV risk is often low among female sex workers.

In Durban it was reported that only 4.6% of female sex workers could correctly identify HIV transmission risks and reject myths.15 In 2015, it was found that only 19% of female sex workers living with HIV in Johannesburg were accessing treatment, rising to 25.6% in Durban and 27.7% in Cape Town.16 These rates are well below the national average.

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Recent research has shown that men often are reluctant to test, as they see health facilities as being ‘women’s places’ and so feel that testing for HIV is non-masculine and might be seen as weak.In 2016, an estimated 17% of people who inject drugs in South Africa were living with HIV.34 However, people who inject drugs only account for 1.3% of new HIV infections in South Africa.35 A 2016 study of people who inject drugs in five South African cities found 32% of men and 26% of women regularly shared syringes and other injecting equipment and nearly half reused needles.36 People who inject drugs are also associated with other high-risk behaviours such as sex work and unsafe sexual practices.For example, the same study reported fewer than half of those surveyed used a condom during their last sexual encounter.37 In 2017, an estimated 280,000 children (aged 0 to 14) were living with HIV in South Africa, only 58% of whom were on treatment.38 New infections have declined among South African children, from 25,000 in 2010 to 13,000 in 2017.39 This is mainly due to the success of prevention of mother-to-child transmission(PMTCT) programmes.40 The rate of mother-to-child transmission stood at 1.3% in 2017, down from 3.6% in 2011.41 This puts South Africa on track for eliminating mother to child transmission.In 2015, the country was investing more than $1.34 billion annually to run its HIV programmes.4 The success of this ART programme is evident in the increases in national life expectancy, rising from 61.2 years in 2010 to 67.7 years in 2015.5 HIV prevalence remains high (18.9%) among the general population, although it varies markedly between regions.6 For example, HIV prevalence is almost 12.2% in Kwazulu Natal 7 compared with 6.8 and 5.6% in Northern Cape and Western Cape, respectively.8 9 South Africa's National Strategic Plan 2017-2022 identifies a number of groups who are particularly at risk of HIV transmission.10 Nationally, HIV prevalence among sex workers is estimated at 57.7%, although this varies between areas, with prevalence estimated at 71.8% in Johannesburg, 53.5% in Durban and 39.7% in Cape Town.11 12 Certain factors increase HIV risk for South African sex workers, including poverty, the number of dependents they have and lack of alternative career opportunities.13 Injecting drug use is also common among sex workers, exacerbating their vulnerability to HIV infection.14 Studies have also found that understanding of HIV risk is often low among female sex workers.In Durban it was reported that only 4.6% of female sex workers could correctly identify HIV transmission risks and reject myths.15 In 2015, it was found that only 19% of female sex workers living with HIV in Johannesburg were accessing treatment, rising to 25.6% in Durban and 27.7% in Cape Town.16 These rates are well below the national average.

.34 billion annually to run its HIV programmes.4 The success of this ART programme is evident in the increases in national life expectancy, rising from 61.2 years in 2010 to 67.7 years in 2015.5 HIV prevalence remains high (18.9%) among the general population, although it varies markedly between regions.6 For example, HIV prevalence is almost 12.2% in Kwazulu Natal 7 compared with 6.8 and 5.6% in Northern Cape and Western Cape, respectively.8 9 South Africa's National Strategic Plan 2017-2022 identifies a number of groups who are particularly at risk of HIV transmission.10 Nationally, HIV prevalence among sex workers is estimated at 57.7%, although this varies between areas, with prevalence estimated at 71.8% in Johannesburg, 53.5% in Durban and 39.7% in Cape Town.11 12 Certain factors increase HIV risk for South African sex workers, including poverty, the number of dependents they have and lack of alternative career opportunities.13 Injecting drug use is also common among sex workers, exacerbating their vulnerability to HIV infection.14 Studies have also found that understanding of HIV risk is often low among female sex workers.

In Durban it was reported that only 4.6% of female sex workers could correctly identify HIV transmission risks and reject myths.15 In 2015, it was found that only 19% of female sex workers living with HIV in Johannesburg were accessing treatment, rising to 25.6% in Durban and 27.7% in Cape Town.16 These rates are well below the national average.

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