SOMALIA: High-risk sex workers fly under the HIV radar
Transactional sex workers in Somaliland work in secret
Hargeisa, 31 March 2009 (IRIN) - Hodan* spends most of her afternoons sitting outside her tiny house in Hargeisa, capital of the self-declared republic of Somaliland, blowing fruity smoke from a hookah pipe, her face covered in a green paste to help her skin look its best.
She does not trawl the streets looking for customers; most of her clients make appointments to visit her at home. In this conservative Muslim country, commercial sex work is practised out of sight. Hodan says not even her neighbours know how she makes a living and if they ever found out, she is sure they would evict her immediately.
"I sleep with between one and three men every day; they usually pay me with khat [a mild stimulant widely chewed in the Horn of Africa] and money, maybe about US$3.50 for every man," she told IRIN/PlusNews.
The money she earns is enough to pay rent and feed and clothe her 10-year-old daughter, but what Hodan wants more than anything is to be able to make enough to learn new skills that would enable her to stop selling sex.
A shameful profession
"I would do anything, anything else," she said. "When I was younger I looked after my aunt's household, but when a man in the family made me pregnant, I was sent away, so I have no family to look after me."
Hodan has never been to school and can neither read nor write. Although she still hopes she can switch occupations, she knows it is highly unlikely that it will happen without a helping hand.
Somaliland has several NGOs that assist the disadvantaged members of society, but so far no organisation has tackled the issue of sex workers, largely because of fear of repercussions from the wider community.
"It [sex work] is very shameful in our culture so no one is prepared to work with them," said Yahye Mohamoud Ahmed, chairperson of the Somaliland National Youth Organisation, a local NGO that has several projects benefiting unemployed youth, but none directly targeting sex workers. "It would be good if we could find a way to help them, but it is hard."
Because they are outside mainstream society, sex workers tend not to visit regular health centres and despite the risk their occupation poses, there are no HIV messages specifically targeting them.
Research in 2007, by the International Organisation for Migration, to better understand the HIV-risk behaviour in Somalia's most at-risk populations, showed that transactional sex workers were vulnerable to HIV, especially as condom use was very low.
On the fringe
"Clients can be violent, and there is no way for the women to report to the police; they have no support networks - not family, friends or the government - to stand up for their rights," said a local NGO worker who preferred anonymity.
Hodan knows about HIV and has even been tested, but her use of condoms is sporadic, despite being diagnosed with a sexually transmitted infection in the past.
"I really fear HIV and try to use condoms always, but if the client doesn't want to use a condom I will have sex with him anyway - I need the money," she said, adding that the men usually brought their own condoms.
Somaliland's HIV prevalence is estimated at 1.4 percent, but experts say the epidemic is likely to be concentrated in high-risk populations such as sex workers, seafarers and truck drivers.
|They rely on their clients for condoms, or on middlemen who often overcharge them for the condoms
According to the NGO worker, most sex workers will not risk walking into a pharmacy to buy condoms, or even go to a health centre where they are available free of charge. "They rely on their clients for condoms, or on middlemen who often overcharge them for the condoms. Providing free condoms to sex workers also risks a backlash from the community."
Reaching sex workers with HIV services would require creative solutions. "They do not have normal access to health services such as VCT [voluntary testing and counselling] and clinics; they fear visiting VCT centres because they may be recognised and talked about, but creating special clinics and centres for them could be even more stigmatising," she said.
Baby steps towards a plan for sex workers
Nevertheless, the NGO worker said, "We are making some progress - there was a time when the government rejected the very idea that commercial sex workers existed in Somaliland, but now they accept that they are here."
Mohamed Hussein Osman, executive secretary of the Somaliland National AIDS Commission, said: "We know that they exist, but it is hard to reach them because culturally and religiously it is a very sensitive issue. They are at risk, and are also spreading HIV, so we need to come up with a plan to reach them."
It was also difficult to gain the trust of sex workers, but not impossible. "They want to be found, they want to be heard, and they want to be helped. Most of these girls and women do it because there is nothing else for them to do - they would quit instantly if they had any other alternative," the NGO worker said.
"There will always be consequences, there will always be risks and challenges, but we have to be ready for that,” she added. “We have to start somewhere."
* Not her real name