MBITA, Kenya – After her husband died recently, Margaret, 55, saw no alternative but to sell her body in order to feed her four children. She would walk down to the banks of Lake Victoria every day to buy fish from the fishermen to sell in the market. But before she was able to buy any fish, she first had to have sex with a fisherman.

For at least the past two decades, fishermen at Lake Victoria in Kenya have been demanding sex before selling their catch to female fish traders. Every morning tens of thousands of women line the shores of the lake waiting for the fishermen to come into land. Margaret lives in a town called Mbita in Homa Bay county, a region where fishing is the main industry, and low rainfall, poor soils and a shortage of paid jobs leave little alternative for making an income. Vulnerable women trapped in a cycle of poverty see no alternative but to engage in the transaction known as “sex for fish” or, in the local Luo language, “jaboya.”

No conclusive research has been done into the origins of jaboya, but the practice is thought to have been started as a means for fishermen to ensure they had buyers for their fish. “The men want to control the women,” says Theresa Wenma, chief of Gembe village in Homa Bay. “I have been chief for 20 years and jaboya was there then.”

And with fishermen having sex with multiple partners on a daily basis, sexually transmitted infections have become pandemic in the area. According to the National Aids Control Council in Kenya, Homa Bay has the highest HIV prevalence in the whole country: 26 percent compared with the national average of 6 percent.

“I was fearful of contracting HIV, but I had to put food on the table,” says Margaret.

It wasn’t long before she discovered she was HIV positive. While people around her in Mbita were dying of HIV-related illnesses, Margaret joined the Nyangina Beach Group, a group of former fishermen and fish traders who walk along the beaches near Homa Bay and speak to their fellow fisherfolk about jaboya and HIV.

Margaret’s friend Maurice, who leads the group, encouraged her to get treatment and leave the fishing industry. “After I was tested and found out I was HIV positive, I was ashamed at first, but I decided to be a member of the group,” Margaret says. “I started taking drugs and I saw my health get better to where I was before.”

She says most of the people she knew with HIV have died. “If I didn’t join this group, I think I would have died as well,” she says.

At least twice a week, Maurice holds group meetings under a tree near the beach, where members gather to share experiences and advice. As an alternative to fishing, they have a plot of land on which they grow vegetables to sell in the market. When Maurice was a fisherman, he says, he saw nothing wrong with jaboya.

“You can’t find a fisherman who doesn’t have a sexual partner. Even I was doing it. I used to go with at least two women a day. If she refused to have sex, I wouldn’t sell. Sex was something like added value,” he says.

His moment of clarity came during an International Medical Corps training course in 2013 when he was taught about HIV. “I was shown the impact of my actions, and that’s why after my training I started this group,” he says. “Jaboya is the major thing that we need to get rid of. People in Mbita are dying.”

But jaboya isn’t the only factor driving up HIV rates in Homa Bay county. Many women resort to sex work for money and teenage girls unable to afford their basic needs are enticed by motorcycle taxi drivers who give them cash for sex.

Patrick Ndeda, senior program officer at International Medical Corps, says there is still a low risk perception around HIV. “The information is out there, but people don’t think they will be affected,” he says. And even the information that is out there isn’t necessarily correct. “After being circumcised, men think they are immune to HIV transmission. And there is a relationship between farming and sex. It is a bad omen not to have sex before harvesting,” he says.

International Medical Corps Kenya is working with vulnerable young women to build a new generation that is freed from having to rely on sex for money. The organization advocates abstinence and encourages girls to pursue careers, sometimes assisting with school and uniform fees or giving cash to help women start businesses.

Activists working in Homa Bay say awareness of HIV prevention is finally making progress. “Stigma over HIV takes a long time to break down, and condoms were seen as a sign of promiscuity,” says Grace Atieno, program coordinator at International Medical Corps Kenya. “But now, when we go down to the beach, people come up to us asking for condoms without us even showing we have them.”

For Margaret and her fellow Nyangina Beach Group members, escaping jaboya will be a long, difficult journey. Everything rests on whether their farming business is successful. At the moment, their small patch of land is dry and the plants are withering, leaving the group with little produce to sell in the market. If the farm doesn’t bring in enough money, the fishermen at the beach pose a dangerous and depressingly easy way of earning a handful of cash. “I don’t want to go back into that work,” says Margaret. “I feel angry about it.”

She turns and continues to tend to her crops, her back to the lake, as a man steering a fishing boat passes by.