Backbreaking toil of sex workers

The study indicates that nearly three in every 10 (29 per cent) of commercial sex workers in the major cities and towns of Uganda are married or are living with a partner or spouse.
Overall, about 98 percent of the respondents engaged in commercial sex work were Ugandans, with an average of four clients per sex worker per day, and an average of two sex acts per client per day.
The average age of women involved in the sex trade was 28 years.

Dr Geoffrey Musinguzi, the lead researcher and a fellow at Makerere University School of Public Health, while releasing the finding of the study in Kampala on Wednesday, said at least 8 percent (about 636) of the sex workers were married, while 21 percent (about 1,669) lived with their spouses or partners.
The study revealed that 78 percent of the 7,947 respondents had financial dependants, while 70 percent had been homeless, with 47 percent having completed primary education, and 32 percent aged 15 to 24, and 46 percent were between 25 and 34, while 22 percent were between 35 and 49 years.

The report also indicates that one in three female sex workers lived with HIV.
The survey covered the 12 cities and districts of Arua, Busia, Buvuma, Fort Portal, Gulu, Jinja, Kampala, Lira, Masaka, Mbale, Mbarara, and Tororo.

Kampala picture

In Kampala, the survey among 1,589 sex workers aged between 15 and 49 who had sold sex to men in the last six months also indicated that married women were engaged in the vice due to different challenges.
In Kampala, the study, conducted between May and October 2021, indicates that, of the 1,589 respondents, at least 31 percent of the sex workers (about 493) lived with spouses or partners while 12 percent (about 191) were married.
A total of 74 of the respondents said they had financial dependants, with 63 percent having been homeless, with 53 percent having completed primary education, while 32 percent were between 15 and 24 years.
Dr Musinguzi said the sex workers were subjected to violence and stress, as some of them were not paid for the services they offered.

National picture

Dr Daniel Byamukama, the head of HIV prevention at the Uganda Aids Commission (UAC), told this publication on Wednesday on the sidelines of the dissemination of the findings of the Bio-Behavioural Survey that of the 150,000 commercial sex workers in Uganda, about 30,000 of them have permanent spouses or partners.
Dr Byamukama also disclosed that of the 150,000 commercial sex workers, about 45,000 of them are living with HIV/Aids.
He stressed the need for increasing access to Pre-exposure Prophylaxis (PreP) to minimise infections among this key population.
“We need additional resources to increase access to PreP. Currently, 24 percent of commercial sex workers are in need of PreP but only 20 percent are accessing it. Condom use may not be effective for this category because it needs cooperation from clients, which most times is impossible, increasing their vulnerability to HIV/Aids,” he said.

Hidden population

Dr Byamukama also said data on commercial sex work should be generated from different sources to avail information needed to guide provision of HIV prevention services.
“There are so many unanswered questions. We have heard reports that commercial sex work happens in some massage parlours but we haven’t said this should be prioritised so that we can get the information we need to offer targeted services,” he said.
Dr Byamukama also explained that the previous National Strategic Plans, including that of 2015-2020 did not recognise this population. “We need to make bold steps to ensure that surveillance covers the “hidden population” so that no one is left behind. We should also engage their clients who are disempowering them,” he said.

The HIV/Aids burden

The Bio-Behavioural Survey also shows that HIV prevalence sharply rose with age where more than half of the respondents aged 35 to 49 years were living with HIV. However, one in 15 sex workers living with HIV, had unsuppressed HIV, while nine in 10 female sex workers and sexually exploited children knew their HIV status.
The report further indicates that one in 33 respondents did not know that they were living with HIV, while more than one in three were infected with a high risk strain of human Papilloma virus putting them at a risk of cervical cancer.
Similarly, about one in 25 of the respondents were living with HIV but they were untreated.
About four in five had ever been pregnant and more than half had sold sex while pregnant.

Gender-based violence

Deaths were also reported among the commercial sex workers and sexually-exploited children. The report indicates that two thirds of the reported deaths were as a result of illness, with murder accounting for one in six deaths while deaths caused by failed abortion or during childbirth stood at one in 20 deaths.
Two in three of the respondents used family planning methods with majority using injectables.

HIV prevalence and poverty

Dr Musinguzi said the prevalence of HIV among the sex workers and sexually-exploited children sampled was high in Mbarara District, standing at 54 percent, while that of Kampala had stagnated at 33 percent in the last 16 years.
A total of 607 respondents were sampled in Mbarara and 1,589 in Kampala. Dr Musinguzi said poverty was the biggest driver of sex work. “Poverty remains the driver. About 70 percent said they have dependants to take care of. We need economic empowerment programmes for them,” he said.
Mr Willian Popp, the US ambassador to Uganda, said HIV prevention is the foundation of the country’s social and economic development.
Mr Popp pledged continued support of HIV/Aids interventions by the US government.
Prof Rhoda Wanyenze, the dean of Makerere University School of Public Health, said high HIV infections among commercial sex workers calls for intensified efforts to reach out to the key population.
Prof Wanyenze was, however, impressed by the high ARVs coverage and viral load suppression among those that were sampled in targeted districts.

She also noted that high levels of sexual violence increase their vulnerability to HIV infections.
Dr Wilford Kirungi, a medical epidemiologist at the Ministry of Health, said it is high time that the government supported activities implemented by different partners to prevent HIV infection among commercial sex workers.
“However meagre the resources might be, let us support their activities,” Dr Kirungi said. He, however, said there are a number of policies and laws that are in place to bridge gaps in service delivery.
The Uganda Aids Commission estimates that 1.4 million people are living with HIV.
Last year alone, about 38,000 HIV infections and about 19,000 HIV-related deaths were registered.

Way forward

In an interview with this publication, Dr Andrew Kambugu, the executive director of Infectious Diseases Institute (IDI), said skilling such women and girls so that they are economically-empowered, could get them off the streets and brothels.
Dr Kambagu said IDI through the Determined Resilient Empowered Aids Free Mentored and Safe (DREAMS) project supported by The US President Emergency Plan for Aids Relief (PEPFAR) and CDC had rescued thousands of former commercial sex workers and skilled them to gain financial independence.

Dr Kambugu acknowledged that some of the women and girls engaged in sex work are in other relationships but were forced into sex work due to financial hurdles.
A mother of two and married to a police officer in Kampala said she used to sell sex to some boda boda riders and men in the neighbourhood to raise money to take care of the family.
“My husband used to leave only Shs5,000 to cater for lunch and supper. The money was too little to meet our home demands. I was forced to sleep with other men to top up what I had. They usually paid me between Shs10,000 and Shs15,000,” she said.

She said she later quit prostitution, after an organisation volunteered to skill her and a host of other commercial sex workers.
She opted for tailoring and today, she is one of the best fashion designers in Kampala.