Lockdown unveils life obstacles sex workers face
Nduta Waweru @Nduta__
When Nio Kariuki, a male sex worker, went to a health facility in Nakuru county to get checked out earlier this year, a comment from a health official made him leave the place never to show his face again.
“The organisation that referred me to the facility instructed me to mention their name the moment I got there, so that I would be attended to hastily. This was not meant to be.
The health official had no idea about the organisation, about male sex workers and was clueless about men who have sex with men.
A remark, ‘Kwani wanaume wanajiuza (You mean men sell their bodies)?’ pushed me to the edge,” he says.
From then on, he opted to be going to pharmacies for his treatment or travel to Nairobi to receive Sexual Rights and Reproductive Health (SRHR) services.
Nio is not the only sex worker who has experienced discrimination in accessing sexual reproductive health services.
He belongs to a category considered as a key population by the United Nations Programme on HIV/Aids, which includes men who have sex with men, sex workers, transgender people, people who inject drugs and prisoners and other incarcerated people.
They are at a high risk of contracting and transmitting HIV and they struggle to access care, prevention and treatment services and their activities are criminalised and stigmatised
For Gabriella, a trans sex worker, the constant trainings they have received from key organisations that advocate for SRHR have come in handy.
“Things are much easier these days,” she says. Even though before Covid-19 hit the country in March, they were able to go to health facilities as a group and get to learn about each other’s sexual status, things have changed.
“The limited number of people in a space because of Covid-19 restrictions means we may not go into the consultation rooms as a group,” she continues, explaining that stigma still exists even though it has reduced tremendously.
“The general population at the clinic can embarrass you. Some pretend to be clients but their aim is to expose your lifestyle, and others provoke you by insulting you just to rile you up. If you respond, then they have a reason to beat you up,” she explains.
Emmy Nekesa, the Deputy Director of Smart Ladies, a sex worker-led organisation that provides legal services and medical referrals to sex workers in Nakuru county, says that stigma has not necessarily increased during this pandemic.
“In one incident, a health provider after consulting with a sex worker, left the room and announced to other patients, ‘huyu ni malaya (this is a sex worker), she is the one who steals our husbands.
In another incident, a health official told a sex worker that even if she found her at the brink of death, they would not help her instead they’d leave her to die,” she says.
It is such statements and treatments that have kept many sex workers away from medical facilities.
Consequently, they do not receive medication they need and end up keeping their struggles to themselves, which cause more problems, Emmy says.
“As an organisation, we have worked closely with health workers and trained them on how to handle key populations.
In many cases, we refer our members to specific facilities that have services friendly to such groups,” Emmy explains.
Smart Ladies was established to address brutal murder of sex workers in the county, some of whom were not only skinned, but had their private parts removed. Registered in 2015, it has grown to offer such vital services.
With Covid-19, sex work has been affected greatly. With hotspots such as bars and clubs closed and the streets got less busy due to the curfew, clients are few and far between.
Low earnings
“Without an income, many sex workers do not even have enough money for food, let alone for accessing health services.
Others have even defaulted on their medication, spending the little they have on food and other essential needs,” says Tabitha Wanjiku, a sex worker and advocacy officer at Smart Ladies.
Fortunately, with background as peer educators and navigators, they are able to help new sex workers navigate the system and get needed services such as Pre-Exposure Prophylaxis (PrEP), a daily pill that helps people who do not have HIV, but are at high risk prevent infection and Post-Exposure PLorophylaxis (PEP), a short course of HIV medicines taken soon after a possible exposure to prevent the virus from taking hold in the body. However, there are still other challenges.
“Violence has also increased,” she adds. “Because of tough economic times, clients may force sex workers to have unprotected sex. Others beat them up and even steal their earnings.
Sex without protection exposes them to diseases and unplanned pregnancies.”
Low earnings mean that besides changing lifestyles and moving to cheaper houses, sex workers suffer mental distress.
“Some of them get into domestic partnerships for food. In such cases, they do not earn anything, and this reduces room for condom use negotiation and leads to increase in violence as their partners believe they ‘own’ them.
Consequently, they face risk of STI and HIV infection,” Emmy explains.
These dynamics come at a time when Nakuru county government has been working with different cohorts who need special attention and programming including sex workers.
“It is true that to some degree, the key populations still faces stigma at health facilities from community members and health workers,” says Clara Kerich, County Coordinator of Reproductive Health, Youth and Gender Services.
“To address some of this challenge, we have partnered with various organisations to provide different services to them, including HIV/Aids, Family Planning and Maternal Care,” she says.
She adds, “Some partners have drop-in centres in places such as Sobea and Salgaa where sex workers access services.
In Naivasha, North-Star Alliance provides services such as family planning and screening.
Within Nakuru town Central Business District and providing these services is Kenya Youth Development and Education Support Association, and Family Aids Initiative Response.
Smart Ladies; also based within the CBD, works in areas on violence against sex workers.
It trains and sensitizes key populations on where to report cases of violence.”
Janet Lunayo, NCPD’s Regional Coordinator South Rift (Nakuru, Baringo, Narok, Kericho, Bomet and Samburu) acknowledges the impact Covid-19 has had on sex workers.
“They may not feel comfortable enough to get services. Since their peak hours are at night, they face harassment from the police and it is worse off now because of curfew.
The services of organisations that used to reach out to them at night are also interrupted as well,” she says.
Since reproductive services are not seen as an emergency, as compared to malaria, for example, where one has to receive immediate care; this period has made it harder for them to make a decision on whether to get contraceptives as needed.
Worse, when they get to facilities, they might get stock-outs or find out that facilities have been turned into isolation centres.
In some cases, Covid-19 regulations may cause limitations in terms of privacy.
Unplanned pregnancies due to lack of access to contraception could lead to population increase, exerting pressure on social amenities such as health, education, infrastructure and environment. Consequently, it will translate to poor quality of life in general.
Among interventions NCPD has in place is working with organisations in making sure that accurate information is shared, and mainstreaming ideas into county programmes such as male involvement which is vital in changing SRH indicators.
They are also working with training institutions to include SRH in their modules.
Actualise budgets
“Importantly, counties should actualise specific budgets for family planning and reproductive health and have it tracked for this specific role.
With donors pulling out after the elevation of Kenya to a middle-income country, counties need to be self-sufficient in catering for this,” she adds.
With such a budget, she explains, the impact on amenities will ease and thereby reduce the burden on development.
According to Evelyn Samba, county director Deutsche Stiftung Weltbevoelkerung, SRHR is a vital yet neglected aspect in the Covid-19 response.
“During times of health crises such as the Covid-19 pandemic, it is expected that our healthcare system will be pushed to the limit.
It is also expected that resources will be redirected to deal with the crisis at hand, leading to deprioritisation of other areas of healthcare.
One critical health programme likely to be negatively affected by the pandemic response is the reproductive, maternal, new-born, child and adolescent health programme, both at national and county levels,” she says.
She calls for stakeholders to pay attention to this programme and the impact of the pandemic on it to avoid worse outcomes.
