With an HIV prevalence of 37%, Sex Workers are at a higher HIV risk compared to the general public and other key population groups in Uganda.
Understanding the HIV risk drivers among Sex Workers and working towards their elimination is very important if Uganda is to control the HIV epidemic, and achieve 2030 HIV targets. Here are six important reasons you should take note of that expose sex workers to a high risk of acquiring HIV/AIDs;
1. Criminalizing laws
In Uganda, as per penal code act, Sex Work is a crime, people who are engaged in Sex Work commit offence, and if convicted guilty, can be sentenced to a period of 7 years.
The criminalizing of Sex Work is adversely affecting Sex Worker’s access to HIV prevention services. Although use of condoms is key in efforts towards HIV prevention, and more so among Sex Workers due to nature of their work, condoms are being used by police for convictions as shared by Sex Workers across the hotspots.
“ The best way to protect yourself is to have enough condom, but sometimes its not safe to have condoms. When police do round-ups on streets and arrest Sex Workers, those found with condoms, it’s the proof that police use to charge you cases of engaging in Sex Work. So you find that some Sex Workers fear to equip themselves with enough condoms while on streets, yet it’s the main way one can keep safe from HIV” said Maggie, a Sex Work Peer Educator.
“When you go to police to report the case, or to get a letter such that you can seek urgent medical attention, the police can instead arrest you” shared Maria, a Sex Worker from Kamwokya slums.
Due to the criminalizing laws, a sex worker who is raped will generally have little hope of bringing charges against their perpetuator. This lack of protection leaves sex workers open to abuse, violence and rape, creating an environment which can facilitate HIV transmission, thus keeping the HIV risk high among Sex Workers.
2. Excessive drug use
Sex workers who over use alcohol, smoke marijuans, inject drugs and share needles are at a particularly high risk of HIV infection. In the Sex Work community, using drugs in one way of washing away the problems faced on streets, and getting confidence for work that involves facing clients from diverse background and behavior.
“Drugs are not taken because a sex- worker wish to or want to take them. Some times depression, stresses, loneliness, show -bie , mental disturbance, stigma among other factors cause drug usage resulting from high levels of unemployment yet there is need for basic needs.” says Ms. Doreen Nansimbe, the Drop-In-Centre Coordinator at Lady Mermaid, a Sex Worker-led Health rights promotion organisation.
In situations of one being drunk or out of normal senses due to drugs, the vulnerability to engaged in risky HIV activities is high.On the other hand, men can easily take advantage of them through sexually assault.
In some brothels where drug use is discouraged, Sex workers who use them are stigmatized and receives unhuman treatment. Thise drives many to work on streets where control over condom and drug use is compromised, hence increasing their exposure to violence and limited protection from HIV.
3. High Exposure to violence
Throughout their life, Sex Workers in Uganda are faced with multifaced violence ranging from physical, emotional and Sexual violence which increases vulnerability to HIV/AIDs. Common perpetuators includes police, clients, partners and the public.
“The Sexual violence is too much especially from our clients, many women on streets are raped, others forced into unprotect Sex. We have had cases of Sex Workers report incidents of clients removing a condom amidst intercourse, exposing the one to HIV.” said Ms. Doreen.
The COVID-19 curfew measures also increased the already worries violence situation among Sex Workers, the police use curfew to target Sex Workers. In a Focused group discussion with Sex Workers in Jinja, Lady Mermaid learnt that Sex Workers experienced intensified physical emotional and sexual violence perpetuated by the police officials.
“These days of curfew its too much for us, policemen go everywhere to search and arrest sex workers on streets, in many cases, when they arrest you, they demand that you choose, to have give in Sex or be thrown behind the bars, for breaching curfew laws, of course many of use are left with no options-but the worst part of it, some of these policemen don’t want to put on condom” Narrates Sex Worker Peer Leader, Jinja City.
The above state of violence as experienced by Sex Workers in Uganda only serves to increase their exposure and vulnerability to HIV/AIDs.
4. Stigma and Discrimination
Due to cultural and religious beliefs, the public is coupled with high stigma against Sex Workers. The situation is not any different in Health facilities where Sex Workers seek HIV prevention and treatment services. Stigma in the health facilities do not only make the facility environment unfriendly, but also force Sex Workers to fear seeking HIV services.
“ The way some health workers can look at you, and pinpoint you, one easily feel out of place, you might even regret why you disclosed to them (health workers) that you are a Sex Workers, Shared Yvonne, a Sex Worker from Mulago III.
The stigmatizing environment in some health facilities across the city is chasing away many Sex Workers from seeking HIV services, despite their need for priority support.
“The issue is many girls even fear to go those facilities, health workers are never easy, they can preach to you, yet they cannot come down to our communities, unless there is an organization leading them, Said Mugabe, Sex Worker Peer Leader, Kamwokya.
“Once people release that you’re a sex worker , they do-not want to associate with you. In this way u always alone on your own, this situation mental problems that force us into drugs, which increase vulnerability to HIV.” Says Doreen.
In light of the above, stigma remains a standing block that impede access to Sex Worker friendly HIV services, hence making them vulnerable to HIV/AIDs.
What Lady Mermaid is doing to support
In efforts to address the issues that put Sex Workers at high HIV risk, Lady mermaid train health workers to provide stigma free services, engage police and local leaders to reduce violence well as empowering Sex Workers with information and knowledge to protect themselves from HIV, and Supports and builds capacity of Sex Worker-led community health support structures of peer leaders.
Lady Mermaid also operates a community safe space (Drop-In-Centre) in Bukoto where sex workers freely walk in to received friendly HIV services. Lady Mermaid is committed to continue advocating against violence among Sex Workers and working closely with Ministry of Health and public health facilities to increase access to Sex Work friendly HIV services.