MAKING SEX WORK SAFER (2007)

Throughout the learning exchanges, it became evident that it is of critical importance that we find ways to discuss sexuality. This is especially so because sex is viewed as a taboo subject in most of Africa. Indeed, on many occasions East Africans felt that their counterparts in the Greater Mekong region had achieved much in opening possibilities for discussing sexual life.  There was a strong feeling that East Africans can learn from Asia the strategies for de-stigmatizing condom use.  The Art for Action on HIV/AIDS Festival held in Nairobi and which brought together partners from the Greater Mekong region and East Africa focused on stigma and allowed AAI participants to explore ways in which condom use can be de-stigmatized.  In this phase of the InterAction there will be more targeted approach to positive sexual life with particular attention to pleasure, respect, and caring among sex workers. We will draw on indigenous knowledge systems on sexuality to open up the discussions in the media, electronic and print in Kenya.

• Through the AAI we learnt that interventions in sex work settings work and as such;
• Successful prevention in commercial sex networks can avert multiple secondary infections and slow transmission through bridging populations into the general population.
• Where highly targeted interventions have been implemented with sex workers and clients on a large scale (for example in Thailand and Cambodia) increased condom use and declining HIV and STI trends among high risk and general population groups is documented.
• A number of activities are highly effective in preventing HIV transmission in commercial sex networks. These include several of the same activities - outreach, peer support, education and advocacy - that work for other vulnerable populations, as well as more specific interventions - condom promotion and STI control - that specifically address occupational risks.
• Availability of treatment provides an important incentive for people to make contact with HIV services. If, through integrating prevention and treatment, this leads to increased uptake and coverage of harm reduction services where HIV is spreading fastest, maximum impact on developing HIV epidemics can be achieved.

Over 75% of new HIV infections occur through sexual contact. Factors that increase the rate and efficiency of heterosexual HIV transmission include high rates of sexual partner change and the presence of other sexually transmitted infections (STIs). In many countries, sex workers are frequently exposed to HIV and other STIs. HIV prevalence as high as 60-90% are found in some places where sex workers have poor access to HIV prevention services. In commercial sex settings where condom use is inconsistent and access to effective STI treatment limited, half to two-thirds of women working as sex workers typically have a curable STI at any one time.
Only 16% of sex workers are estimated to have access to HIV prevention services. Regardless of the region, poor access to services correlates with high STI and HIV prevalence. Early in epidemics, HIV and STI prevalence frequently rises rapidly among sex workers and their clients, especially where condom use is low and access to health care services poor. In the absence of effective interventions, clients transmit infection both to sex workers and to their regular partners, extending transmission into the general population. In the absence of effective interventions, high rates of transmission in commercial sex and drug injecting networks continue to drive HIV epidemics even after HIV has spread more widely in generalized epidemics.

In Kenya’s legal framework, a sex worker is anyone who has ‘unlawful carnal intercourse’ or commits an act of ‘indecency’ with any person for reward. Sex work is defined as sex with anyone other than your husband or wife for a fee. The reward mentioned in the definition is not clearly explained but is generally considered to be money. At AHADI, we define sex workers as individuals who provide sexual services for financial reward. In reality sex workers are very diverse groups that it is almost impossible to generalize about who a sex worker is, why they are selling sex, or even how much money they make. In our experience the majority of sex workers are women who provide sexual services mainly to male clients. However there are also men and transgender individuals who sell sex. Men in the sex industry generally sell sex to other men although it is important to recognize that some men who sell sex to men do not see themselves as homosexual.

PROJECT GOAL
This project aims at prevention of HIV infection through sex workers as targets. It also aims to advocate for the rights of sex workers and possibly legitimization of their rights through the media and lobbying legislature through members of parliament (MPs)

OBJECTIVES

• To equip sex workers with life skills to make their work settings more safe
• To increase knowledge on HIV/AIDS and other STIs among sex workers
• To increase the number of sex workers using condoms while at work.
• To increase the number of clients insisting on safer sex practices.

ACTIVITIES
Together with our partners,

• Identification of sex workers and provision of information on protection and prevention of HIV infection by increased condom use.
• Formation of peer support groups where the sex workers can learn how to identify clients with STIS, negotiation skills among others beneficial to them.
• Lobbying other role players in sex work and clients to increase uptake of services using condoms and encouraging sex workers to insist on using condoms while negotiating. This will be done through education on HIV and STI prevention to other role players, clients and sex workers.
• Lobbying pub/ discotheque and club owners to avail condoms where they can be easily accessed.
• Building capacity and confidence of identified sex workers through training as peer educators to snowball the impact to other sex workers in Nairobi. This we will do with our partners from Thailand (EMPOWER, ACCESS, and CAR).
• Advocacy: With other human rights bodies in Kenya we will advocate for change in the legislation of Kenya towards sex work and the stigmatization of sex work in order to stem HIV and STI prevalence in the population. We will do this using the media

EXPERIENCES 

NEEMA; A SEX WORKER
Neema* is 21 years old and she live in a one bedroom house in Mathare South. She is formerly from Western Kenya and dropped out of high school in form two because her parents could not afford to pay for her school fees. She moved to Nairobi from her upcountry home that she shared with her family when she was 17 years old. Neema found it extremely difficult to find employment in Nairobi due a several factors including her level of education. She also found herself pregnant while still jobless.  Neema was introduced to this trade by a girl friend and a neighbor who seemed to be doing well financially. She invited Neema to go out with her one evening and showed her where she worked. She told Neema that if she wanted to live well and earn good money she had to join her in the streets where she waited for potential and would be clients.

Initially Neema frequented Koinange Street in the company of her girlfriend. She got up to four clients per night who paid her relatively well in her opinion. She soon decided to venture into the business of strip- dancing with one of her friends and colleague from the streets business.  Currently Neema is involved in both commercial sex work and stripping in a famous strip club in Nairobi.  Active business starts at around 9.00 o’clock every evening of the week but depending on business she can be out until the early hours of the morning. She then spends most of the day resting and in preparation for the following night. Her Saturday nights double up for the sex work and stripping at the strip club.

Neema now has two children, one is as a result of her work as she has had not used had not used any contraception and had reported late for medical termination. This was either because of sheer ignorance which had resulted from low self esteem. After entry into sex work, she did not want to have children in since she was already a single mother. She however does not regret this as she is now able to provide through her job to both her children.

Neema always prefer unprotected sex but sometimes she has to contend with unprotected sex. In these instances the client could be willing to pay a lot of money. Sex workers also find it difficult to negotiate safer sex with intimate partners and clients in the context of physical and sexual violence perpetrated by some of them. This is usually when the client want to have unprotected sex.   Neema has extremely limited access to information and virtually no support network. She has never been involved in any form of support for her as a commercial sex worker.

Neema does not have access to Sexually Transmitted Infection (STI) and HIV/AIDS services. The reasons for this are varied, but violence or fear of violence and discrimination play a role. She says that health services are often hostile to sex workers, subjecting them to disapproval, refusal to treat their health problems, mandatory HIV testing, exposure of their HIV status resulting to stigma. This has made her reluctant in seek health services. Neema feels that violence and lack of control over ones life means that sex workers may give lower priority to their health needs and behavior change, over more immediate concerns for safety and survival

Neema considers violence "normal" or "part of the job" and do not have information about her rights. As a result, she is often reluctant to report incidences of rapes, attempted murders, beatings, molestation or sexual assault to the authorities. These incidents are very common and even when she is willing to report she is afraid that her claims will most likely be dismissed. In several settings she has encountered police using anti-prostitution laws to harass, threaten, arrest, beat and sexually coerce sex workers. Sometimes city council police, watchmen and policemen sweep the streets and arrest her and her colleagues. Sometimes she/they are forced to give some of their proceeds to the watchmen or police to avoid being harassed and arrested, since they will be taken to the cells and will eventually cost them more money.

NANCY OMONDI*

Contrary to the believe of many that call girls are only found in high market areas, Nancy* who is 42 years old and lives in Mathare with her three children; one son and two daughters has been acting as a call girl for a while now, she loves this business because although she gets to make money, she is assured of business particularly during all times in the month and safety in the course of the business. She has her own established clients who visit her or she visits them strictly on appointment.

Nancy’s day starts with her sleeping for the better part of the morning to compensate for the sleep lost during the night. She arrives in her house in the early hours of the morning and goes right to bed. Her children who share her small one roomed house are used to their mother coming home in the morning; lately her son is getting uncomfortable with this behavior and has been questioning her about where she goes for the night. She is starting to find this very difficult with her son growing older and understanding more about his surrounding and his mother’s life style.

Nancy has about 10 regular clients, she sees each one of them at least once per week, sometimes some of her clients don’t call for a week, and sometimes only gets one call leading to her income reducing.  This means that she sometimes has to subsidize her income by seeing other clients. She may then go out into the night looking for clients in the neighboring pubs or in the streets. Nancy is well known by her target clients so she easily gets the clients.All her regular clients are from her neighborhood, when they need her services they call her on her mobile phone and book an appointment with her. The business is sometimes conducted in her house if it is during the day and her children are away in school, and sometimes the client can ask her to join them in a rented room in the neighborhood. Her rates are fixed for her regular clients, so this makes it easy for her because she does not have to keep negotiating with them; her regular clients also pay her promptly and are less likely to refuse to pay her.

When all her clients have money which is usually at the end and beginning of month, her business is good because they call her more often. Her rates for other extra clients vary from one client to another, she can charge as low as 100/= and as high as 1000/= depending on her rating of the client’s ability. However she is not comfortable and does not entirely feel comfortable with these clients, she knows too well the risks of dealing with clients who have picked her from the pub or road side.

Nancy perceives her risks as lower than for other commercial sex workers peddling sex in the streets or in pubs. This she says is highly because she knows her clients and has developed some kind of bonding and trust with them. She feels that they are unlikely to harm her or even “exploit” her. Nancy is worried since her children are starting to ask her questions. She feels that her son’s disapproval will increase with time and reckons that they still do not know what her work entails but soon they will. She does not want her children to grow up knowing her lifestyle but she has no alternative. Her business has been good and is providing for her and educating her children, and she feels that this is all that matters for now. Nancy has had no access to any organizations that work with commercial sex workers nor does she know where she can get basic information on sexually transmitted diseases and HIV/AIDS. She is however interested in knowing where these services can be found.

* Names have been changed to protect the identity of the women.