Health
A day in the life of an HIV+ sex worker
Publish Date: Jan 25, 2013
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By Moses Nampala

Probably no job is harder than a counsellor’s, especially when it comes to disclosing a client’s HIV status. On the other hand, no amount of counselling can be enough to prepare someone for sad news. But 30-year-old Josephine Nakato defied the odds. 
 
Four years ago, Nakato learnt she was HIV-positive. “I was not surprised by the results because for years I had earned a living from prostitution,” she confesses.
 
“The ailment had gnawed me; I had lost weight, had a rash all over my body and sore lips. But my health has improved since I started taking ARVs.”
 
Nakato, however, regrets that quite often, the time she takes her ARVs coincides with the time most of her clients seek her services. “I briefly sneak out to the latrine to take my ARVs,” she says.
 
 Nakato says when she first went to The AIDS Support Organisation (TASO) in Tororo district, about 10 young sex workers at the Malaba border would die of HIV/AIDS every month.
 
However, today, the deaths have reduced because many have embraced positive living.
 
HIV/AIDS high at the border
 
Yosiya Ogwang, an opinion leader in Obore village, Malaba town council, says Tororo and Busia have a high number of people living with HIV because the districts not only lie at the border area separating Uganda and Kenya, but the two districts also host the official custom entry points. 
 
However, because of the elaborate clearance system at the customs office, often the delays in cargo  clearance compel the drivers and turn-boys to spend nights at the border.
 
“The daily influx of drivers and turn-boys has for years promoted promiscuity around these places,” an official at the Uganda Revenue Authority, who preferred anonymity, says.
 
In addition, five other commercial sex dens have cropped up in Tororo as a result of the vibrant cement industry. 
 
Lifestyle of sex workers
 
Fabiano Oburu, a counsellor at The AIDS Support Organisation (TASO) Tororo centre, says commercial sex workers are discreet.
 
Their lifestyle is governed by rules that must be respected. For instance, TASO counsellors are not allowed to visit the sex workers’ homes during the day, or conduct themselves in a manner that suggests they are familiar with the sex workers. 
 
It is only in exceptional circumstances that the counsellors are permitted to visit the sex workers during daytime, for instance, when one is bedridden. 
 
Counsellors are also not allowed into sex workers’ homes dressed in their work attire, riding motorcycles, or driving cars bearing the TASO logo.
 
If a counsellor has to visit a patient, it should be on appointment and it should between 11:00am and 2:00pm.
 
“Sex workers are strict on visiting hours because they work at night, so they sleep during the morning hours and after 2:00pm, they do housework and prepare to resume duty,” James Byakika, a counsellor at TASO Tororo centre, says.
 
Accessories like cameras are also not allowed in this community.
 
The sex workers’ homes are tucked away in crammed semi-permanent structures amidst filthy drainages. They look like they would collapse amidst a storm.
 
But surprisingly, the interior is spotless clean and furnished with household property that would cost a fortune. The property includes imported big beds, 45-inch LCD television sets and hi-tech stereo music systems.
 
Esther, one of the sex workers, says the lavish décor in her apartment is intended to provide comfort to her clients and entice them so that they do not sleep in the nearby hotels.
 
Eight months ago, she was bedridden, suffering from diarrhoea and boils. “If it wasn’t for Nakato who introduced me to TASO, I would have died,” she says.
 
“I have not only gained weight from the time I started taking ARVs, but also become stronger.”
 
Racheal, another sex worker, says she confided in her colleague, Nakato, who would ‘smuggle’ in counsellors from TASO to give her the necessary medical attention. 
 
Challenges
 
However, while the sex workers who are living with HIV seem grateful, many say it is a challenge to live positively because a sizeable proportion of the clients prefer unprotected sex and it pays highly. 
 
Clients pay between sh60,000 and sh90,000 for unprotected sex and between sh6,000 to sh15,000 for protected sex.
 
“We often find ourselves in a dilemma, wondering whether to take the money at the expense of our lives, or settle for protected sex and earn less,” Mutesi says.
 
But Nakato adds that some of their clients are violent. “They refuse to use condoms and no amount of persuasion can stop them from demanding unprotected sex,”
 
Most sex workers are single mothers, widowed with several dependants, or victims of abusive marriages.
 
Some were once accomplished businesswomen, earning a living from smuggling, but abandoned the trade when URA cracked them down, confiscating their merchandise.
 
TASO trains sex workers
 
According to Byakika, TASO established structures among the sex workers. “A cross-section of the sex workers were trained in HIV/AIDS peer counselling,” he says. “The peer counsellors have convinced many truck drivers to test for HIV and get treatment.
 
Stephen Okoboi, a counsellor at TASO Tororo Centre, says most sex workers are aged between 16 to 55.
TASO Tororo Centre manager Annet Nandala, says the centre currently handles about 6,500 patients. 
 
“The greatest challenge is that the peer counsellors keep on moving to other places like South Sudan in search of greener pastures.
 
“We, therefore, have to constantly train more peer counsellors yet the resources are not readily available,”  Nandala says. “The centre is also sometimes overwhelmed by excess demand for the services.”

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