Due to the nature of their work, the risk of female sex workers acquiring or transmitting HIV to their clients is quite high. The Kenyan government, together with other stakeholders have over the years been engaged in safe sex campaigns targeting these women. The promotion of consistent condom use is one of the messages passed on. Have these messages reached and possibly influenced female sex workers? Here are some details of a conversation I had with one such sex worker in Nairobi.
By Maryanne Waweru-Wanyama
Every evening, 35 year-old Susan Wangui welcomes home her four children from school. An industrious mother, she ensures they take their bath, supervises them as they do their homework and have their dinner. When they are well settled for the night, she bids them goodbye and leaves for work. Her children –three girls and a boy, are aged between three and eleven years. While away at work, the eldest child, a girl, watches over her siblings. They live in the slums of Huruma in Nairobi.
In the early morning, just before sunrise, Susan returns home to her children. She makes their breakfast and prepares them for school. Once all the children leave, she cleans the house and does their laundry before heading to the market to buy food for their dinner. In the evening, the routine is repeated.
Susan’s children believe she works in a bar in Nairobi’s central business district. But the truth is she is a commercial sex worker. Her base is in one of the streets in downtown Nairobi, around the Muthurwa area. Unlike many other sex workers, Susan does not roam the streets looking for clients. Her ‘office’ is in one of the bars in a dingy street, where she strategically positions herself as she slowly sips a drink. Clients know how to spot her kind, and she too knows how to spot those who need her services.
It is a job she has been doing for the last 10 years, one that she is proud of.
“I enjoy this job as it is what enables me to put food on the table for my children,” says the single mother. She makes about 8,000 shillings a month, which she says is sufficient enough to put a roof over her children’s head, feed and clothe them.
Female sex worker Susan Wangui during the interview.
Susan’s entry into the flesh trade business was as a result of desperation.
“I had searched for a job for a very long time, without any success. I found myself always borrowing money from my friends to feed my children. One day, my neighbour asked me:
“Why are you always asking us for money, yet you are a woman like us? Come I show you how to make easy money.”
Susan, a class 8 drop-out then accompanied her friend to town and was immediately introduced to a client, whom she ‘serviced’. And that marked her debut into the flesh trade. A decade later, she has no regrets.
Each night, Susan attends to between three to seven clients, charging between 200 – 300 shillings for each. On very few lucky occasions, she gets a client who pays 1,000 shillings. Each day, she is assured that she will have money to buy food for her children. Food is cheap in the slums, and with 100 shillings, one can comfortably feed a family of six. It does not matter if the meal is a balanced one.
Despite Susan’s love for her job, she is aware of the risks she faces as a sex worker.
“There is the scare of violence – from clients who want to rape you, as well as harassment from police and City Council officers.”
Susan and other sex workers also face the risk for HIV, Sexually Transmitted Infections, unwanted pregnancies and a myriad of other health problems such as pneumonia.
A fact acknowledged by Dr. George Githuka, Programme Manager for key populations at the National AIDS and STI Control Programme (NASCOP).
“Female sex workers are what we call a high risk group due to their behaviour. What I mean is that if she has several clients in a day, she can easily acquire or transmit HIV. If she is HIV negative, she runs the risk of acquiring HIV. If she is HIV positive, she runs the risk of transmitting HIV to her clients.”
Dr. George Githuka of NASCOP talking about the interventions the government is undertaking with regard to key populations such as female sex workers in Kenya.
Even more vulnerable is the contribution of social laws and legislations that make it harder for them to do their work.
“The stigma and discrimination that female sex workers face makes them hide the true nature of their work. Most of their activities are also criminalized, making it difficult for them to access health services, and also making it difficult for health workers to access them. This means services that would help reduce their vulnerability to HIV infection do not effectively reach them,” he adds.
Behaviour Change Programs
According to UNAIDS, review of data in 50 countries showed that 3 out of every 25 female sex workers were HIV positive. Further, the chance of women who engage in sex work being infected with HIV is 13.5 times higher than others.
A 2009 Modes of Transmission study found that in Kenya, sex workers contribute to 14.1% of all new infections at a national level.
It is such figures that the Kenyan government, in recent years, has embarked on programmes that target this population. The Ministry of Health, through NASCOP has initiated various interventions.
“In the past, health services were not tailored to be responsive to the health needs of sex workers. NASCOP’s Most at Risk Populations (MARPS) program is aimed at addressing this gap. We offer targeted interventions that are in tune with their needs, such as advocating for their free access to condoms, as well as advocating for their free HIV testing every three months. We also emphasize on STI screening each time a sex worker visits a hospital, and subsequent treatment offered where necessary,” says Dr. Githuka.
Other players complementing and collaborating with the government in these efforts are those in the private sector.
One such programme is the Sex Workers Outreach Programme (SWOP). Run by Kenya’s University of Nairobi and Canada’s University of Manitoba, SWOP is a sex workers’ health project that promotes the health and safety of female sex workers. It does so by providing them with comprehensive reproductive health services, including HIV/AIDS services. It also educates them on the benefits of consistent and correct use of condoms.
Susan is a regular client at SWOP’s Nairobi clinic. She has attended a number of workshops and she has accessed various reproductive health services at SWOP.
“When I started sex work 10 years ago, I was not keen on condom use. I did not know much about condoms, and did not insist much about using them with my clients. But over the years, I have come to realize their value. This was after my friends and I were introduced to SWOP four years ago by a community health worker in my Huruma neighbourhood,” she says.
More Money for Unprotected Sex
Today, Susan does not compromise on condom use.
“My clients must use a condom. I don’t know them or where they come from, so I cannot accept that we have sex without protection,” she says.
According to the World Health Organization (WHO), male latex condoms have an 85% or greater protective effect against the sexual transmission of HIV and other sexually transmitted infections (STIs).
Susan often comes across clients who refuse to use a condom, and instead offer her a handsome amount of money.
“For me, a condom is a must. When someone offers me double or triple the amount, I always ask myself why. What is his motive for doing so?”
She says despite the enticing offer, she never gives in.
“I would rather get paid 200 shillings for using a condom, than 2,000 shillings for not using one. What will happen to me tomorrow if I take that 2,000? I may not live to see my children go to secondary school. No, that I cannot accept,” she says.
Susan has no regrets about losing a client who refuses to use a condom.
“There is no day I can miss a client. God always has good plans for me because he knows I need to feed my children, so I don’t pine over losing such a client,” she says.
With a career spanning over ten years, Susan has formed a clientele base of regular customers, some of whom she has offered her services for many years. Among them are married men, who often call her when in need. But despite the good ‘business relations’ she has with them, Susan insists on using condoms with these clients too.
“This is a business, this is not love. He is not my husband, so we must use protection,” she says.
A condom dispenser in a health facility, where those who need condoms can get them for free.
Challenges Accessing Condoms
Susan gets her condoms from SWOP, some health facilities, or at the numerous toilets around town that stock condoms in the condom dispensers. She picks as many as she can, sometimes even boxes at a go. While Susan may not have problems accessing condoms, NASCOP acknowledges the difficulties some sex workers get while trying to get them.
“Condoms are available from public hospitals. While it is normal for someone to pick two or three condoms, a sex worker may need to pick a whole box of them. However, when they attempt to do so, they face questioning from the hospital staff, with some being told to return the box and instead ‘just pick a few’,” says Dr. Githuka.
Susan however says that sometimes there are no condoms in public health facilities, which inconveniences her when she really needs them. During the world condom day on 13 February 2014, NASCOP assured all Kenyans of enough condom stock for anyone who needs them.
“We have about 100 million condoms in stock right now. Kenyans consume about 150 – 200 million condoms annually. This means that we are fully covered for the next 6 – 8 months,” said Dr. Martin Sirengo, Head of NASCOP.
Alcohol and Sex Work
As one who says that she insists on condoms, how does Susan introduce the issue to her clients?
“In this job, you have to drink alcohol. It is not possible to do this job while fully sober. That is why I must take a little alcohol to boost my confidence, but careful not to make me drunk. That way, my shyness evaporates and I am able to undress and have sex with a stranger. But I make sure I’m not drunk enough to forget to ask my client to use a condom.”
In an assessment of alcohol use among female sex workers in Western Kenya, researchers, led by L. C. Langat found that excessive alcohol intake was prevalent in the sex workers who were interviewed, with majority of them presenting indications of alcohol dependence. The researchers established that female sex workers consume alcohol as a coping mechanism in their work, and in response to stigma associated with the business.
A UNAIDS 2012 report showed that more than 60% of female sex workers interviewed had used condoms in the last 30 days with a paying customer. Preliminary results of the latest Kenya AIDS Indicator Survey shows a decline in Kenya’s HIV prevalence rate over the last five years. According to this report, the prevalence rate had dropped from 7.2 percent in 2007 to 5.6 percent in 2012. This achievement can be partly attributed to an increase in education and awareness campaigns –both by the government and the private sector. It appears that Susan is one such beneficiary of these stringent efforts.