For Rachel Love Gawases, the conversation about HIV prevention goes beyond access; it’s fundamentally about freedom and urgency.
“My name is Rachel Love Gawases. I am an activist, mentor, motivator, leader, and a transgender sex worker working with sex workers in Namibia through sex worker-led and focused networks,” she says.
Gawases has spent years advocating for sex workers’ rights, but what she encounters daily is a gap between what exists and what is actually possible.
“Primarily condoms, limited access to PrEP, and HIV testing services,” she says, describing the prevention options available in Namibia.
But having options on paper does not mean having a real choice.
“Choices are constrained by availability, affordability, and the power dynamics between sex workers and their clients,” the Equal Rights for All Movement Executive Director expounds.
Across Eastern and Southern Africa, where 21.1 million people were living with HIV in 2024 (52% of the global total), the push for new prevention technologies is gaining momentum. Yet for many sex workers, the challenge is far more basic: consistent access to existing tools.
As outlined in the HIV Prevention Choice Manifesto, “programs must emphasize choice, not individual products.” It further notes that “it is possible to build a prevention program centered around choice, offering an array of options.”
For sex workers in Namibia, that vision is far from reality despite women accounting for 65% of total HIV cases, according to the country’s 2024 HIV estimates.
“There have been instances where I wanted to access condoms as a primary method of HIV prevention, but they were not available at the time,” Gawases explains. “This was due to stockouts and reduced outreach services, particularly following funding constraints.”
Without access, prevention becomes negotiation, and negotiation is not always equal.
“In such situations, the ability to negotiate safer sex becomes significantly compromised, especially given the power dynamics that often exist between sex workers and clients,” she says.
She adds that the unavailability of something as basic and essential as condoms highlights broader systemic gaps and underscores how prevention is not just about individual choice, but about consistent access to commodities and supportive services.
The manifesto reinforces that access must be practical, not theoretical: “Ensure available HIV prevention options are in the hands of women and girls”, and calls for “massive scale-up and increased access to all safe and effective HIV prevention methods.”
“Ensure women and girls have control over their health and their bodies and access to the full range of safe and effective options so that they can choose what works best for them at different times of their lives,” the manifesto states.
For sex workers like Gawases, these demands are urgent.
“Stigma, limited availability, cost in private sectors, and lack of tailored services,” she says, listing the barriers that stand in the way of accessing preferred prevention methods.
Legal frameworks add another layer of restriction. In Namibia, sex work remains criminalized, shaping both access to services and the willingness of individuals to seek care.
“HIV prevention must be recognized as a fundamental human right, not a privilege determined by legal status, funding cycles, or social acceptance. In Namibia, the continued criminalisation of sex work under the Combating of Immoral Practices Act, 1980 (Act 21 of 1980), directly undermines equitable access to prevention services and limits real choice for sex workers,” She argues.
Echoing Gawases sentiments, the choice manifesto highlights the need to confront these systemic barriers, urging stakeholders to “address structural barriers that hinder access to prevention services, including stigma, discrimination, and criminalization.”
On the other hand, recent funding cuts have further reduced already limited services.
“They have reduced already limited options, making prevention less accessible and less consistent,” she explains.
At the same time, new prevention methods are offering hope, particularly long-acting options that could reduce the burden of daily adherence.
“Awareness is emerging,” Gawases says. “Long-acting options are promising, especially for those who face adherence challenges, but access remains limited.”
Even as innovation advances, the manifesto cautions against limiting choice based on assumptions: “Ability to adhere should not be used as the sole criterion in deciding who is offered or talked about a product”, emphasizing that personal preference must remain central.
Still, she emphasizes that innovation alone is not enough.
“If I had full freedom to choose, what HIV prevention options would I want to access? A full range: condoms, lubricants, PrEP (oral and injectable long-acting), regular testing, and integrated sexual and reproductive health services.”
Advocates argue that without genuine choice, even the best tools will fall short. As the manifesto warns, “a program that pits options against one another or emphasizes a single option will not gain trust and may undermine prevention gains.”
For Gawases, the issue comes down to one simple idea: choice must be real, not theoretical.
“Policymakers must take immediate and time-bound action to ensure that, within the next 12–24 months, national HIV strategies are fully aligned with human rights principles and inclusive of sex workers as a priority population.”
This includes “guaranteeing uninterrupted access to a comprehensive range of prevention options such as condoms, PrEP (including long-acting options), and community-led services through sustainable domestic and international financing.”
But beyond policy, she calls for something deeper recognition.
“Meaningful engagement of sex worker-led organizations in policy design, implementation, and monitoring must be institutionalised, not treated as optional consultation.”
At its core, Gawases’s message is about agency.
“The right to choose how to protect one’s health must be realized in practice, not postponed.”
As the global HIV response continues to evolve, her story highlights a critical truth: expanding prevention tools is only the first step. Ensuring that individuals, especially those most affected, have the freedom to choose between them is what will ultimately determine success.
“The time for policy alignment, legal reform, and sustained investment is now, not in the future.”
