Sex workers are one of the most vulnerable social groups in the world.
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They experience widespread stigma, discrimination, state and non-state violence and harassment. This in decreased access to services — including healthcare. This is a serious problem for female sex workers who have frequent sexual contact with multiple partners which puts them at risk of acquiring HIV and other sexually transmitted infections.
Other risks include unwanted pregnancies, induced abortion, sexual violence and cervical cancer.
HIV and sexual and reproductive healthcare, in particular, are critical for female sex workers. Any disruptions to access would have serious consequences. Estimates show that a disruption in the supply of ARVs lasting six months could lead to overHIV-related deaths among adults in sub-Saharan Africa.
In Kenya, to control the spread of the new coronavirus, the government enacted strategies to manage the disease which created major challenges for various groups of society, including female sex workers. These included movement restrictions, dusk to dawn curfews, social distancing measures and the closure of bars and nightclubs. There are at least 20, sex workers in Nairobi, most of whom are women.
Kenya does not criminalise sex work, but there are a of other laws which can be used to oppress sex workers. Sex workers are a marginalised and vulnerable group of women and young girls, with no recourse to public protection. This means the burden falls on NGOs to ensure healthcare is available and accessible. We collected data from female sex workers living in informal settlements in Nairobi. We also collected data from 15 healthcare providers and from workers at the Bar Hostess Empowerment and Support Programme — an organisation that supports sex workers.
Sex workers typically use clubs and bars as a safe a space to meet clients. But, under the restrictions, these were closed or had limited operating hours.
This meant that their livelihood was removed overnight. The restriction of movement in and out of Nairobi was a huge challenge for many. It was introduced abruptly leaving no consideration for those who had temporarily travelled out of Nairobi to go back to their homes. Some sex workers in our study were stranded outside the city without knowledge of alternative services which could meet their healthcare needs.
One sex worker said:. I am a mobile sex worker call girlI had travelled out of town with a client.
After the movement ban in and out of Nairobi, the client left to pick up something in Nakuru town leaving me in the hotel room. But he never came back for like two days. I was unable to sustain the bills so I had to be chased out of the hotel.
As one sex workers described:. I have missed my appointments to the clinic… I was supposed to go collect my ARVs but now with the lockdown, how will I go to collect them? I cannot visit the public health facility because of stigma and discrimination. These spaces are provided by three healthcare centres — run by the Bar Hostess Empowerment and Support Programme across the city and are accessed by hundreds of young people each day — usually for medication and reproductive health services.
They also use the space for education, to share their experiences and offer support. The night curfew also forced the sex workers to change their operations and work during the day. In some cases this meant that sex workers were forfeiting visits to the clinics because they had limited time during the day to work and go to seek healthcare services before the curfew hours. Curfew restrictions and cessation of movement coupled with police brutality on those found breaking the rules further intensified the challenges of accessing healthcare for sex workers as observed by a health worker:.
Recently some clients from Biafra tried to sneak out to come to the drop-in centre for services but the police found them and turned them back. The police are really mistreating them. There are solutions.
One of these was to use motorbikes to deliver essential commodities needed by sex workers, with a service user population of 20, sex workers. The programme is reaching out to many people each day to provide urgent medication, support and advocacy. In addition to this, a mobile phone application has been created to enhance access to the clinics and the facilities at Bar Hostess Empowerment and Support Programme for the service users.
This will cushion sex workers during the COVID period and the longer term impacts of this pandemic.
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This will mean a lot for our ability to bring you news, perspectives and analysis from the ground so that we can make change together. Please use a genuine ID and provide your name. A person living with HIV shows her clinic appointment and anti-retroviral drugs regimen card.
Clubs in nairobi
What sex workers said We collected data from female sex workers living in informal settlements in Nairobi. One sex worker said: I am a mobile sex worker call girlI had travelled out of town with a client. As one sex workers described: I have missed my appointments to the clinic… I was supposed to go collect my ARVs but now with the lockdown, how will I go to collect them?
Dusk to dawn curfew The dusk-to-dawn curfew was cited as a key barrier to healthcare access for sex workers.
Bars in nairobi
Curfew restrictions and cessation of movement coupled with police brutality on those found breaking the rules further intensified the challenges of accessing healthcare for sex workers as observed by a health worker: Recently some clients from Biafra tried to sneak out to come to the drop-in centre for services but the police found them and turned them back. A way forward?
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