GREATEST GIFT TO HUMANITY
CASE STUDY ON WORKING WITH SEX WORKERS
It’s a chilly Tuesday afternoon when one of the Peer Educators in the just concluded Sex Workers PE training calls me aside in a seemingly private conversation. She shares what she has kept from even her sister (younger) for years now, precisely 8 years. Having lost both of her parents and elder brothers in the Post Election Violence in 2008 and a permanent home, she is forced prematurely to leave her home town and her sex work business in Eldoret.Landing in her younger sister’s home in Central Province who is happily married does not make things any easier. To find the clientele becomes an uphill task, she is forced to candidly share her HIV status which she came to know of in 2003.She harbors lots of bitterness towards her first boyfriend as she is convinced beyond any reasonable doubt that he infected her. As she narrates this, you can clearly tell from her facial expression that she is in deep pain and agony, one because of him and secondly towards the sister who has literally made her house help leaving her with no time to engage in sex work during weekdays, this makes her a beggar even to the most basic of needs. Two years ago, when she shared her HIV status with the two sisters one of whom is a step-sister, they kept insisting that she has to start the ARV regime. Tired of their persistence, she took the HAART but never consumed any; she piled them under her bed. The Clinical Officer where she attends Comprehensive Care Clinic knows her to be very adherent to the medication.
When I meet her she is carrying all the ARVs she has collected and they can barely fit in the big handbag, she shares that she did this because she wanted to make her sisters happy but she has no intentions whatsoever to start taking the medication. She has a strategy well laid out though; she will take her life once she gets to AIDs stage, how sad! With no time for sex work during weekdays due to babysitting, she pretends to go for overnight prayer meetings every Friday and only comes back to her sister’s on Sunday afternoons. During this period, she engages in sex wok to the best of her knowledge so to get some few coins.
She has taken solace in Khat and Marijuana, cigarettes are her cup of coffee and drink herself silly over the weekends, she attributes this to the stress and humiliation she gets from living with her younger sister. Her last CD4 count was 97, with a TCA(To Come Again) of 9th October 2010; she needs to go for a second CD4 count. She is damn worried because the CD4 may reflect to the Clinical Officer of her not taking the ARVs; she has been debating between stopping the collection of the ARVs or starting the same.
After listening to her sad story, we collectively develop a risk reduction plan which she promises to follow to the letter:
Avoid idling since these are the times she abuses the drugs, instead use the time conduct peer education sessions
Reduce the number of cigars and alcohol per day with intention to quit as they hamper the ARV efficacy
Enroll for vocational course preferably in hairdressing since she is talented in plaiting dreadlocks, the alternative income to rent herself a small room and get good nutrition which is part of positive living, she is a holder of Form Four(KCSE) Certificate
Reduce the number of multiple sexual partners and use protection with all partners, I supplied her with a number of condoms both male and female
Start taking the ARVs since they will boost her immunity and prolong her life so she can live to see her dreams come true.
We part ways with an agreement to review the progress in the next two weeks, I am optimistic she will change for the better. As we parted she had this to say: “Whenever I go, I will always remember that you are the one that saved my life, after sharing with you am so optimistic about life and willing to live long and fulfill the desires of my heart”.
Ever wondered what are the driving factors behind most women engaging in sex for money(Sex Work)?As it has been noted in Kenya according to the Draft Kenya Sex Workers Guidelines April 2010,entry into sex work is driven by:
• Poverty and limited economic/employment opportunities
• Economic support for the family (parents, children, spouse, etc)
• Gender inequality
• Low levels of education
• Breakdown or abuse by family members
• History of stigma and marginalization (especially for self-identified men who have sex with men)
• Substance use, abuse and addiction
• Humanitarian emergencies and post conflict situations
It is indeed a pity,to listen to their sad stories that led to the engagement in sex work,some are even married but since the husbands cannot provide adequately for their families they opt to substitute their family income.I work for an organisation which implements behavioural,biomedical and structural interventions that reduces the vulnerability of Sex Workers to HIV transmission.According to the KMOT 2008(Kenya Modes of Transmission Survey 2008),Sex Workers contribute 14.2% of new HIV incidences yearly.This is rather high and thus the dire need to budget and deliberately implement interventions targeting this Most At Risk Population primarily.What is the situation in your respective countries? Lets keep talking!