UGANDA: Sex workers missing out on HIV care
Underground and at risk
KAMPALA, 14 November 2012 (IRIN) - Sex workers in Uganda's capital, Kampala, are reluctant to seek HIV testing and treatment services, putting their health in jeopardy, preliminary results of a new study reveal.
The multi-site research study, named The Early Capture HIV Cohort (ECHO) RV217, is being conducted among high-risk uninfected female sex workers in Uganda, Kenya, Tanzania and Thailand. It is monitoring a group of high-risk sex workers to gather information on acute HIV infections.
from the Uganda arm of the study, launched by Makerere University Walter Reed Project, MUWRP, in 2009, showed 221 participants out of 631 tested HIV-positive, but a large number did not return for confirmatory tests.
"Out of the 105 participants who got their confirmatory results, 96 were referred for care and treatment at the centres of their own choice. Currently there are some 56 on [treatment], 13 didn't report and 27 couldn't be traced," Lillian Mutengu Kasirye, the community outreach coordinator for MUWRP, told IRIN/PlusNews.
Sex workers, Kasirye said, needed more counselling on the benefits of HIV testing and getting their test results.
"Failure to return to get confirmatory results and access to care is a lost opportunity for HIV prevention and a potential source for new infections among sexual partners," she said.
Sex workers in Kampala told IRIN/PlusNews that HIV was just one of the occupational risks of their profession.
"It doesn't matter whether it's live [unprotected] or protected sex, all I want is money - I have a child to take care of," Sophie*, a sex worker in Kabalagala, one of the city's red light districts, told IRIN/PlusNews. "The clients who want unprotected sex pay more money. I get about 40,000 shillings [US$16] a round."
Stella, another sex worker in Kampala, says the decision to use protection lies with the customer. "The truth is I am HIV-positive," she said. "If a man comes and asks for unprotected sex, it means he too is HIV-positive. I do it provided he gives 50,000 shillings."
Activists say the criminalization of sex work, discrimination and stigma is a major factor in sex workers remaining underground and failing to seek crucial health services.
Criminalized and at risk
"Because sex work is criminalized in Uganda, sex workers face discrimination, stigmatization and assaults from the hospitals and community members such as landlords and taxi drivers," Macklean Kyomya, the director of local NGO Women's Organization Network for Human Rights Advocacy (WONETHA), told IRIN/PlusNews. "They [health workers] are afraid to associate with them [sex workers] and sometimes openly attack some of the sex workers who are positive, blaming them for spreading the HIV virus."
According to the 2009 Uganda HIV/AIDS Modes of Transmission Analysis
, sex workers, their clients and their clients' partners account for 10 percent of all new HIV infections annually.
A 2011 study
published in the Journal of American Sexually Transmitted Diseases Association found that 37 percent 1,027 female sex workers surveyed in Kampala's red-light districts were HIV-positive; the country's national HIV prevalence is 7.3 percent.
Civil society organizations say the exclusion of marginalized vulnerable groups like sex workers and men who have sex with men was rolling back the fight against HIV in the country.
"The government should stop neglecting the most vulnerable populations. We need to design programmes that target high-risk groups like commercial sex workers and homosexuals if we are to bring the epidemic down," said Stella Alamo Talisuna, executive director of NGO Reach Out Mbuya Parish HIV/AIDS Initiative.
Health workers and some service providers, especially those supported by the US President's Emergency Plan for AIDS Relief (PEPFAR), have been accused of discriminating against sex workers, a charge senior government and US mission officials in Uganda have denied.
"All Most at Risk Persons, including commercial sex workers, are included in PEPFAR services across the board, including testing, counselling, prevention services, treatment, etc," Dan Travi, the public affairs officer at the US Mission in Uganda, told IRIN/PlusNews in an email.
Minister for Health Christine Ondoa said: "Our health workers don't discriminate against patients… When patients come for treatment, we don't ask whether you are sex worker. We take care of everybody."
Some organizations like WONETHA have begun sex worker friendly programmes, including training them as peer educators and providing psychosocial support. The group also distributes condoms, and lubricant and provides information to sex workers on where to get HIV services.
"We are engaging with sex workers, health practitioners and clinics in dialogue to provide friendly, non-discriminatory services to sex workers," WONETHA's Kyomya said. "We are organizing seminars and workshops to sensitize public health care practitioners on human and health rights of sex workers," she added.