By Gatonye Gathura
It is good news in Nairobi County as HIV infection rates among female sex workers drop dramatically.
The rates have dropped from a high of 17.5 per cent in 2008 to 4.8 per cent – lower than the 6.6 per cent in the general adult female population.
This may suggest the risk of any John stumbling onto a HIV infected sex worker in the city is no greater than from the ordinary Jane at the office.
“This is welcome news,” said Cally, a HIV peer educator within the city. “But it is not yet time to drop caution or protection,” advises Cally, who introduces herself as a transgender and insists we use her street name.
Cally, 38, who says she still got about another decade on the road, despite worry over competition from online-savvy Generation Y, is proud to be part of this success. “Today our girls are ever more cautious about HIV than ever before,” she said.
For more than a decade she and hundreds of others have been engaged by the Sex Workers Outreach Programme (SWOP) which runs a chain of HIV prevention and treatment clinics in Nairobi.
“Our work is to recruit, sensitize and direct sex workers to the clinics where they get information, screening, treatment, counseling, and support on HIV.”
SWOP was started 12 years ago by Canadian researchers, the University of Nairobi and the National Aid and STIs Control Programme (Nascop) of the Ministry of Health.
In a study published early this month (5th November 2020) in the journal Aids the researchers say their efforts have paid off with a hefty drop in HIV rates in their charges.
“We analysed the trend of HIV prevalence among 33,560 female sex workers accessing services at seven of the SWOP clinics between 2008 – 2017 and found a decline in all age groups,” says the new study.
The biggest decline was among younger women aged below 25 years. “HIV prevalence was 17.5 per cent in 2008–09, decreasing to 12.2 per cent in 2010–11, 8.3 per cent in 2012–13, 7.3 per cent in 2014–15, and 4.8 per cent in 2016–17.”
Over time, the study says the women reported increased condom use, particularly with regular partners, more frequent prior HIV testing, and were less likely to report a history of vaginal discharge.
The team attributes the success to “a consistent scale-up of HIV prevention and treatment efforts, both in sex workers as well as in the general population.”
While the number of sex workers in Nairobi and nationally is contested, the over 33,000engaged in the SWOP study consists most of those operating in the city county.
A national census by the Ministry of Health in 2014 estimated there were about 170,000 active sex workers in Kenya and about 34,000 in Nairobi.
The seven SWOP clinics each located along Keekrook Road around River Road area, Majengo, Donholm, Thika Road, Langata, Kawangware, and Korogocho are widely distributed indicating the good news is well shared out.
The census data showed the highest number of sex workers in Nairobi to operate in Starehe which covers the CBD, followed by Embakasi, Kasarani, Langata, Dagoretti, Kamukunji, Makandara and Westlands in that order.
In Nairobi, Nascop says the women were operating in about 2,539 hotspots, while 20 per cent are married or cohabiting with the majority reporting first sex by age 14.
Most are predominantly of Christian faith – either Protestant, 49 per cent or Catholic 41 per cent, Muslims 5 per cent and non-religious 6 per cent. On average they reported about three clients per day most of these, 97 per cent, being paying customers.
The census numbers however are highly contested by both donors to HIV and lobbyists, the latter arguing there are many more sex workers than the government’s estimate.
The donors on the other hand say numbers are being puffed up for more funding and have demanded a biometric system to identify those benefitting from their money.
However the lobbyists are having none of this arguing such a system would be discriminative, a violation of human rights, and can be abused by security agencies.
Despite the hiccups, Cally says the observed drop in HIV rates is good for their health, their clients and for business.