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The Sex Workers Leading the Fight Against HIV in Kenya

Homa Bay County has the highest HIV prevalence rate in Kenya, but a public health program that enlists sex workers to support and educate their peers is helping to slow the spread of the virus and tackle the stigma of sex work.

Written by Jennifer Huxta Published on Read time Approx. 5 minutes
The fish market in Homa Bay on Kenya’s Lake Victoria. Many young women living in the area have few options but to offer sex to fishermen in exchange for food or money. Jennifer Huxta

HOMA BAY, Kenya – Shantel sits in a bar lit by TV screens. Wet bottles of Tusker beer line the shelves, low cushioned chairs crowd the floor. A client waits for her in a back room.

Shantel’s parents died when she was 15, leaving her and her sister Magdari alone. “My parents died with HIV so I didn’t have anywhere to go. It’s when I started sex work,” she says. “I was desperate. I just decided to come [to Homa Bay town] and look for money. It was difficult because I was still young. When I went to clubs, I was being beaten. [People were saying:] ‘This small child, what is she coming to do here?’ So it was hostile, it was not easy for me.”

Shantel is an HIV-negative sex worker and sex educator for other young women who work at bars and beaches near Lake Victoria. She brings them condoms, teaches them about their reproductive and sexual health, and tells them what their rights are if a client becomes violent. (Jennifer Huxta)

Homa Bay County, on the shores of Lake Victoria in western Kenya, has an HIV prevalence rate of 26 percent, the highest in the country. Thousands of children have lost their parents to AIDS-related illnesses. The area’s economy runs on its fishing industry, and young girls like Shantel who are orphaned have few options but to go to the shores of Lake Victoria every morning to exchange sex for food or money.

“I was getting a little that could sustain me,” says Shantel, now 18. She started by offering men “shots” – quick sex for 500 shillings ($4). “But it was difficult. If he wants [sex] freely without condoms, you’ll be beaten up, and you know there’s nowhere you can go and report it.”

Shantel takes a motorbike taxi to pick up condoms and hand them out to young sex workers in Homa Bay. (Jennifer Huxta)

Until recently, police in Homa Bay were indifferent or hostile to sex workers, but a 2015 program supported by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) helped change their stance.

“We did a sensitization program with the police,” says Eunice Ojollah, a social worker at Makongeni Health Center, the only health facility in the area that offers free treatment and counseling for sex workers and their children. “We told them that we need to protect these people … They have their rights as sex workers, they have their rights as women, as our mothers, our sisters. So [the police] understood us and they have been helping on violence cases.”

There is no data yet on the young program’s impact, but anecdotally, authorities say they have seen a reduction in violence against sex workers since it began. If a client gets violent, now sex workers know they can go to the police.

Social worker Eunice Ojollah advises girls and women about sexual and reproductive health issues at Makongeni Health Center in Homa Bay. (Jennifer Huxta)

With the area’s HIV rates rising over the past decade, EGPAF also initiated the “key population” program in 2015, to enlist sex workers like Shantel to be peer educators, and hand out condoms to other sex workers in the bars and beaches around Homa Bay.

After her parents died, Evaline worked as a maid. “The family mistreated me. I decided to leave and started sex work,” she says. She has been a sex worker in Homa Bay for about ten years. (Jennifer Huxta)

Evaline is one of the 489 sex workers currently involved in the program. “As peer educators, we talk to girls about using condoms,” she says. “We tell them they should not go into a room with a man if they are drunk. If the man is drunk, tell peers. It’s you who must put the condom on the man directly. We have female condoms, too.”

Sex educators such as Evaline remain in contact with the women and girls they advise, often visiting them at home and making sure they get regular health checkups.

Sex worker and peer educator Evaline puts condoms into a designated box at a nightclub. (Jennifer Huxta)

“Those who are HIV-negative, we need to test them [for HIV] after every quarter,” says Ojollah, the social worker at Makongeni Health Center. “For those who are HIV-positive, we need to see them after three months for [sexually transmitted infection] screening and maybe family planning and follow-up on the viral loads. It helps us to follow up on their progress of HIV care.” The center also offers HIV-positive women anti-retroviral drugs for free.

Quinta’s parents died when she was 15. She stayed with her sister and started sex work at age 28. “I didn’t know much about sex work. I was just trying to get some money,” she says. “After going with one man, I had sex and he refused to pay. I was angry and I left him and went to look for another client.” (Jennifer Huxta)

Ojollah says that in the two years since the key population program started, there has been only one seroconversion – when the body develops HIV antibodies – among the women who were HIV-negative. “We are happy with that because it means they are using condoms consistently, they are adhering to what we are teaching them,” she says.

And over time, the stigma against sex workers has also reduced, she says.

“[The community] has accepted that they are here to stay. They are somebody’s sister, somebody’s mother. If we leave them out, we won’t succeed in fighting HIV/AIDS.

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