By Sharon Nakanwagi
Chantal dropped out of school when her father died. She was 15years old then and living with her stepmother who constantly nagged her over marriage.
Upon interaction with one of her cousins who had gone over for Christmas looking “loaded” with money she was advised to relocate to Kampala where she could find a job. In Kampala her cousin introduced her to sex work. She hesitated and wanted to return to the village but recalled her dire state and succumbed to sex work. One year later, she fell ill and centered with on and off sickness for which she self medicated.
During one of the HIV counseling and testing outreaches, she tested positive and was referred to the nearest health centre for care. Unfortunately the nurses in this facility lived in the neighborhood and knew she was a sex worker. Whenever she entered the health facility they sneered and often attended to her last intentionally.
When she was finally served the nurses often ridiculed her over the fact that she was breaking people’s marriages and that the money she was making was cursed thus suffering with the HIV as a punishment. Chantal later gave up on the medication and opted for a farther health facility but often missed clinic appointments because of transport costs especially when she hadn’t cleared the children’s fees.
Chantal is one of the many sex workers who face barriers to accessing HIV services in Uganda. With an HIV prevalence rate of 37% and contributing 11% of all the new HIV infections in Uganda, we cannot keep a deaf ear over these populations if we are to achieve zero HIV transmission. The 2013 Crane Survey estimated the number of female sex workers to be 32,000 in Kampala alone. These estimates are bound to keep increasing because of the many factors that push them into sex work like poverty, school dropout, loss of parents, broken marriages and peer influence.
Coupled with the above, the sex workers face many barriers to accessing HIV services because of self stigma and that from the service providers, different work times where they operate at night when most of the medics have retired, criminalization since sex work is illegal and lack of money and time as well as information. In addition health care workers have not been trained on how to identify and offer individualized health care to these groups. As a result care is compromised and many started on treatment later default like the case of Chantal.
Government and other HIV partners should consider providing special HIV services to these populations. Tailor made models of service delivery are therefore required to address the current multiple access barriers for the sex workers and explore options for reaching more individuals with HIV and AIDS services tailored to their lifestyle.
For example the introduction of special clinics for the sex workers and engagement of their peers in mobilization and follow up could make a big difference. Government should ensure that health workers are equipped with skills to deal with different vulnerable populations especially the sex workers in order to create a health friendly environment. Make shift clinics located where they operate like in the brothels would help to reach many of them with HIV services.
Reach out Mbuya HIV/AIDS initiative (ROM) a community faith based NGO operating in a poor mobile population with a large number of sex workers due to Kinawataka being a transport corridor for trackers, Acholi quarters a resettlement area for displaced persons and Luzira surrounded by landing sites which all provide ready market for sex trade introduced the mobile outreach services. This was due to the fact that despite the different satellite clinics the sex workers were not coming for treatment and therefore introduced the mobile outreach services to reach them.
The mobile van is used for make shift mobile clinics and parks at hot spots or drives through streets with an influx of sex workers so that they can come to counselors and treatment focal persons who attend to them (Some good coffee was provided to the sex workers who came to test and it was a big incentive since it would be cold on the streets).ROM also hires brothel rooms to house the medical teams who provide VCT to the sex workers.
In addition, ROM uses foot soldiers where staff carry back parks containing clinical equipment and materials to the hotspots housing different sex workers in areas where all other encounters cannot be used. This was used at Speak road to reach sex workers who were initially suspicious about the mobile van.
All the above are coupled with the use of staff who are specially equipped to handle these groups as well as peer educators of fellow sex workers to mobilize them for HIV services and empowering them with income generating activities to reduce vulnerability. With these approaches ROM has provided HIV services to over 600 sex workers thus contributing to the reduction in the HIV transmission risks.
The ministry of health together with other HIV agencies should adopt some of these mechanisms that target sex workers with friendly HIV services for the sex workers if the high HIV risk and prevalence among these groups is to be controlled.
The writer is works with Makerere University College of Health Sciences
School of Public Health.