Feature story

Sex workers advocate for access to health care and legal services

12 March 2012

Sex workers advocate for access to health care and legal services

Male and female sex workers marching through the Central Business District of Nairobi, Kenya claiming respect for their rights. 3 March 2012.

More than 150 male and female sex workers marched through the Central Business District (CBD) of Nairobi, Kenya on 3 March claiming respect for their rights. Participants wearing masks signifying the hidden nature of their work walked from Koinange Street—Nairobi’s leading venue for sex work—to the Mayor’s office at City Hall.

One of the main issues highlighted at the event was the stigma and discrimination sex workers face in their work and lives, including while accessing health care and other legal and social services. “If a sex worker goes into a hospital, he or she should be treated with dignity and respect, just like anyone else,” said Fabian who identifies himself as a gay sex worker.

Sex workers often report their difficult experiences with public health care providers. Poor interpersonal communication and even insults from health care providers together with inaccurate diagnoses are some of the problems they confront on a daily basis.

Fabian, who is also a peer support counsellor for the Sex Worker Outreach Programme in Nairobi, stressed that gay sex workers face a ‘double stigma’ that hinders them from accessing health care services. Most male sex workers opt for self-diagnosis and medication, further complicating their health conditions.

According to the 2009 Modes of Transmission Study done by the National AIDS Council, UNAIDS and the World Bank, 14% of new HIV infections in Kenya occur among female sex workers and their clients. Data from the Sex Workers Outreach Program (SWOP 2011) shows an estimated HIV prevalence of 30% among female sex workers and 40% among male sex workers on enrolment (first visit).

The national response to AIDS uses a public health approach to provide HIV services based on evidence. However, only a fraction of sex workers are reached. Fear of stigma and discrimination drive sex workers underground and makes it more difficult for them to access HIV prevention services.

Social and legal protection is critical

In Namibia, sex workers also joined forces to demand their rights through an advocacy event held in Windhoek. During the event, three reports were launched focusing on sex work, HIV and access to health services in Namibia. The reports had been produced by UNFPA and UNAIDS in partnership with the African Sex Workers Alliance (ASWA) in Namibia and the Society for Family Health (SFH).

The publications noted that sex workers are disproportionately affected by HIV due to the nature of their work—most of the time they can not negotiate the use condoms with their clients. They also highlighted that the attitudes and behaviours of health service providers, authorities and the wider community toward sex workers make them even more vulnerable.

Most of our children cannot be legally registered because they do not have fathers and they risk becoming street kids

Moreen Gaweses, a former sex worker

The stigma and discrimination towards sex workers also extends to their children, exacerbating their health risks and isolation. Family members of sex workers suffer from negative attitudes by their communities, which often manifests through verbal and physical abuse, and deprivation of basic rights.

“Most of our children cannot be legally registered because they do not have fathers and they risk becoming street kids,” said Moreen Gaweses, a former sex worker affiliated with The King’s Daughters, an organization that aims to help women who wish to exit sex work.

The 2011 rapid assessment report—a study about sex work and HIV conducted in five towns of Namibia—shows that there are no national guidelines for effective, rights-based programming with sex workers in the country. “We have no place to go for help and the nation needs to recognize that we also have rights” said Ms Gaweses, who gave birth to a baby girl just a week ago.

The reports include recommendations for action by national and local stakeholders to address these challenges and protect the human rights of sex workers. Such recommendations include addressing violence, abuse and stigma towards sex workers as well as reducing legal and policy barriers that block their access to HIV services.

“Decriminalization is the only way to bring down the HIV and abuse of sex workers,” said Scholastica Goagoses, a former sex worker and Director of The Red Umbrella, an organization of sex workers. “Only rights can stop the wrongs in Namibia!”