In 2018, an estimated 1.4 million people in Uganda were living with HIV, and an estimated 23,000 Ugandans died of AIDS-related illnesses. The epidemic is firmly established in the general population. As of 2018, the estimated HIV prevalence among adults (aged 15 to 49) stood at 5.7%. Women are disproportionately affected, with 8.8% of adult women living with HIV compared to 4.3% of men. However, as of 2018 around 27% of adults living with HIV and 33% of children living with HIV were still not on treatment.
Some of the key populations affected by HIV in Uganda include sex workers, young girls and adolescent women, men who have sex with men, people who inject drugs and people from Uganda’s transient fishing communities as per the Avert Information on HIV organization.
The prevalence of sex work was at 13.7% .The majority of youth engaged in sex work started engaging in sex work at ages 15-16 (47.5%), and the majority accepted money for sex work (97.5%). A large percentage of youth also were paid in alcohol for sex work (40.7%) as per a survey on Prevalence of HIV and Associated Risks of Sex Work among Youth in the Slums of Kampala conducted by Aids research and treatment in 2016.
In terms of condom use, 25.0% of youth reported that they or their clients always used a condom, 44.0% reported sometimes using condoms, 21.4% reported most of the time using condoms, and 9.5% reported never using condoms. Reasons for not using condoms included “when a client or customer pays more” (55.5%), “when dealing with a regular customer” (40.7%), or “when a customer looks healthy” (11.1%). This survey clearly represents the vulnerability of sex worker getting infected with HIV/Aids due to either greed for money or ignorance about the consequences of having unprotected sex with clients.
Sex work is associated with a number of risk factors, including alcohol and substance use, adverse childhood experiences, including previously being sexually or physically abused and parental substance abuse, and social factors, such as orphan status or a lack of educational training, poverty. Among a sample of female sex workers in Kampala, 49% reported being raped at least once in their lifetime. Youth who are orphans or those who do not attend school may resort to sex work for food, shelter, and income
Additionally, sex work has been linked to numerous adverse health consequences. HIV prevalence among those who engage in sex work is nearly 12 times higher than the general population. A study examining 16 countries in Sub-Saharan Africa reported a 37% HIV prevalence among females engaging in sex work. Clients of commercial sex may request unprotected sex and have reported paying more for this sex, further increasing the risk of HIV and other STI acquisition.
It’s upon this back ground that an advocacy group that brings together sex workers dubbed WOMAN ORGANISATION FOR HUMAN RIGHTS ADVOCACY, established in 2008 to address rampant discrimination in health care systems, social stigma and as well as advocate against punitive and restrictive legislation and policies that encourage violations of sex workers’ rights identified gaps that needed urgent attention amongst sex workers communities in some parts of Uganda. Most notable amongst these was the irresponsible sex lifestyle of the workers and limited or no condom use.
WONETHA then embarked on a vigorous mass sensitization exercise amongst the workers on how best to protect themselves from HIV especially through promoting condom use and empowering the women to always make right informed decisions.
Sarah Kisakye Mpooma, an advocacy officer at WONETHA says that they distribute condoms and carryout sensitizations across the country including the five regions of the country that’s: Rwenzori region, Eastern region, West Nile, Mubende region, Masaka region and various highlands where they are situated.
“We found out that our colleagues especially in the fishing and landing sites were much tempted by the bigger amounts of money which lure them into risking their lives. We took up a deliberate campaign of sensitizing the sex workers about the importance of safe sex or Condom use as well as distributing them. As sex workers we now know that Condoms are our capital, so WONETHA distributes them to the regions where we are situated and on request by leaders in the areas of need.” Said Kisakye.
Kisakye reveals that they found out in their sensitization campaignthat some sex workers don’t know the proper use of condoms since some use teeth and pair of ceasers to cut or open condoms while others have no esteem of commanding their clients to put them on or even help them out ware them properly. This then became an area of focus.
She says that on average they distribute about 4 to 5 million condoms monthly across the country with each center on average getting about 18,000, each sex working getting at least 350 condoms depending on the need.
WONETHA gets the condoms from Ministry of Health through the Joint Medical Stores and other donor partners that she requested not to reveal.
Kisakye however notes that sometimes the distribution of condoms is limited by the lack of transportation since they have just one van that distributes them across all the five regions in the country yet at times they get calls from several areas requesting for them at the same time thus the distribution doesn’t get to the places in time. She thus called on government and donor partners to help them with vehicles and also government to make condoms available for sex workers at all the health centers which will reduce on their burden.
Hadijah Nabwiri a sex worker in Mukono narrated that before the intervention of Wonetha, she had to reach out in her pockets to buy the condoms since she had nowhere to get them for free.
“It used to cost us who valued our lives so much to buy the condoms since we had nowhere to get them from at no cost and this proved to be so expensive. Most of our colleagues got infected with HIV/Aids because they were never educated about safe sex further spreading it to the customers who were as well not bothered about condom use. I therefore thank WONETHA who took it upon themselves to send us free condoms whenever we request for them and for the sensitizations that have tremendously changed our mindset” said Hadijah
Nakitende Annet a sex worker in Kitubulu landing site, who is HIV positive regrets the fact that WONETHA wasn’t instituted earlier because may if it had been, she would have done things differently through making wiser choices and just may be her fate would be different. “May be I wouldn’t be positive and suffering with all these medications, I was stupid for trading my life for just a few shillings.” She says.
“ In 2018, I joined this job because I had been abandoned by my husband and had three children to take care of, My friend introduced me into the job. Time came when I surely needed about 500,000 shs to take my children back to school and meet medical bills of mother and the only option available was selling my body which could go for 100,000-200,000 for unsafe sex thus I risked my life with various men and that’s how I got infected. On a visit to a health centre after severely getting sick I was told am positive, they enrolled me on medication and counseling program which has really helped but still I regret why I wasn’t sensitized early enough since taking medication is not easy.” Says Prisca Kivumbi another sex worker who also regrets that WONETHA reached out to her when it was too late.
I want to commend WONETHA because of the constant sensitization programs and distribution of condoms since we have new entrants now and again and at least women here are now empowered and know the importance of Condom use.” Nakitende notes.
Hadijah Asiimwe, a sex worker in Kibuye, Makidye division, Kampala, narrated how she has been denied condoms several times at health centers even when she communicates to them the kind of work she is engaged in.
“All the times I have been to government health centers like Kiruddu Hospital and Kisenyi heath centre requesting for free condoms I have been turned down, they either tell me they are not available or they are not for donation to business people like us which is unfortunate. Being at the high risk of getting and spreading the virus, Government should sensitize its health workers on the importance of making available condoms to people like us in order to tame the spread of HIV/ AIDS” said Hadijah
She says it’s a relief that she is just assured of a constant supply from WONETHA which is just a call away or since it’s within reach from her work station, she could always just access the centre at Salaama in Makindye division Kampala district to acquire the lifesaving condoms at no cost whatsoever and here she doesn’t have to worry about judgmental behavior as is the case at public health facilities.
The sex workers are now calling for more support for their initiatives especially at the health center levels which are easily accessed by grassroot levels.
WONETHA has also urged other development partners in areas of Sexual and Reproductive. health to provide them with more logistical support especially in terms of transportation of the condoms to ensure timely delivery.
Kisakye also reveals that they intend to carry out more outreach programs in addition to the sensitizations and condom distributions that target behavioral change. She says they now wish to widen their scope in to financial empowerment of these sex workers through their savings groups and vocational study programs so that they venture into other jobs away from sex work.
She calls on government to involve sex workers as a target group for those to benefit from government programs such as operation wealth creation, Emyooga and parish development model.