When Redempta*, 22, fled the violence in the Democratic Republic of Congo (DRC) two years ago and came to Kenya, she quickly had to find a source of income to feed and house herself and her two younger siblings. But as an illegal immigrant with no knowledge of local languages, her options were very limited.
"I met some women from my country [DRC] and they introduced me to sex work because I needed to pay for the house and buy food for my siblings. I couldn't get any [other] work," she told IRIN/PlusNews.
As an illegal immigrant she is especially vulnerable because she can't report violent clients to the police, and is too afraid to seek medical help for her injuries.
"When I refuse to have sex with them without a condom, some threaten to report me to the police. They say they will tell the police I stole from them," she told IRIN/PlusNews. "I don't have any papers to allow me [to stay] here, so I just have sex with them without a condom when they want."
Redempta sometimes has up to eight clients in two days, but despite not always using a condom she has only been tested for HIV once in the last two years. "I just tested once when they conducted a public one [testing campaign], but I fear going to a facility to test for HIV. I don't know what the health workers will tell me when I go there because I am not a Kenyan," she said.
The Kenya HIV Prevention Response and Modes of Transmission Analysis, 2009, noted that commercial sex workers and their clients together were contributing 14 percent of all new HIV infections.
An integrated biological and behavioural surveillance survey of migrant sex workers in Nairobi, Kenya's capital, released in April 2012 by the International Organization for Migration (IOM) and the Kenya National AIDS and Sexually transmitted infections Control Programme (NASCOP), revealed that HIV prevalence among migrant female sex workers was 23.1 percent, which is consistent with the rates found among Kenyan sex workers and more than three times the national average of 6.3 percent.
However, Kenyan sex workers had better knowledge of HIV and health-seeking behaviour, and 98 percent of female sex workers who were citizens had heard of sexual transmitted infections, compared to 70 percent of migrant female sex workers.
The study was conducted in 2010, when just over half of the 628 participants said they had ever tested for HIV, and 25.8 percent did not know that condoms protected against HIV. Some 72 percent of migrant female sex workers knew where to go for an HIV test, compared to 92 percent of women in the general population.
"Migrant female sex workers, due to various reasons, seem not to be following or to understand the campaigns around HIV prevention and treatment, and that could be reason for the disconnect between knowledge and behaviour," Kelsi Kriitmaa, the lead researcher for the study told IRIN/PlusNews.
"Services for this population could be integrated into programmes for general female sex workers, with special attention to regular sexually transmitted infections, and treatment and universal knowledge of HIV serostatus promoted. However, special care must be given to the language and cultural needs of the migrants," the authors recommended. "Awareness of post-exposure prophylaxis (PEP) and the importance of seeking medical treatment in case of rape or sexual violence among female sex workers are necessary."
The authors also proposed that stakeholders lobby the Kenyan government to provide a legal framework for the regulation of sex work, which would increase access to services and provide protection for sex workers.
Migrant female sex workers were more likely to engage in sexual activity at a younger age, and according to the study 93 percent reported having a vaginal sexual encounter when they were between 5 and 14 years old, which experts say could be due to the lack of support systems in a foreign country.
|I don't have any papers to allow me [to stay] here, so I just have sex with them without a condom when they want|
"Family support systems are important in cushioning young girls from sexual abuse or early sexual activity. Many migrant girls do not have this, and they are likely to use sex as survival tactic in a foreign land," Lucy Waweru, psychology lecturer at the University of Nairobi, told IRIN/PlusNews.
"There is a need to sensitize health workers on how to provide services to migrant populations, and take into account their vulnerabilities and provide friendly services that are, for instance, time sensitive," said Jason Theede, migration health programme officer at the International Organization for Migration (IOM).
IOM has is running a combination pilot programme to educate migrant sex workers about human rights and local languages as well as other issues, and the trained workers will then be expected to educate their peers.
"The mapping exercise that was done is aimed at finding out the hot spots where you are likely to find migrant sex workers. After this, we will embark on providing services that are friendly to them, but within the normal services provided to Kenyan sex workers," Helgar Musyoki, most at-risk populations programme officer at NASCOP, told PlusNews.
While acknowledging that illegal migrant status could hamper provision of services to these sex workers, Musyoki said health workers were under instructions to focus on providing the services, rather than on their migrant status.
"The legality or not of their migrant status is for other organs of the state to look into,” she said. “Our [job] is to provide health services, and that should be it."
*Not her real name