Kenya has the largest number of sex workers in eastern Africa and the third highest in the continent.
A new estimate in 33 countries in Sub-Sahara Africa shows Kenya with 209,460 female sex workers way ahead of all its neighbours.
This is about 1.85 percent of all women of reproductive age in the country aged between 15 and 49 years.
It comes third after Namibia and Burundi, the former which has the highest concentration of female sex workers comprising more than two per cent of all women of reproductive age.
The estimates show Burundi has the second highest number of sex workers comprising 1.91 per cent of women of reproductive age followed by Kenya.
Other countries with high concentrations include Botswana, Mozambique, Equatorial Guinea, Zimbabwe, Swaziland and Nigeria in that order.
The survey by Global Fund to Fight AIDS, Tuberculosis, and Malaria, UNAIDS, Pennsylvanian State University, John Hopkins University, and the Imperial College London has been funded by the US Government.
“We estimate that there are 2·130 million FSW of childbearing age in sub-Saharan Africa. This represents a proportion as percent of all women of childbearing age of 0·905 per cent,” says the report posted on The Lancet Preprints this week.
“The estimated FSW proportion at the national level ranges from 0·294 percent in Togo to 2·158 percent in Namibia.”
The survey is especially important for donors and local and international lobbyists seeking increased funding for HIV programs targeting sex workers in Africa.
“Generating consistent FSW size estimates can help inform equitable resource allocation for national HIV programs to effectively reduce new infections,” justifies the study,
These size estimates, the authors say can also guide the programs that protect FSW from exposure to unsafe working conditions, increase condom usage, and improve reproductive health for this group.
The estimates are especially crucial for lobbyists in Kenya who since 2016 have been locked in disagreements with Global Fund and the US President’s Emergency Plan for Aids Relief (PEPFAR) over the number of sex workers in the country and how to get reliable estimates.
The lobbyists under the Kenya Key Populations Consortium have argued that current estimates, at 138,420 are gross underestimates.
The consortium representing 90 groups of LGBTs, male and female sex workers and drug injectors in the country estimate their numbers at about 700,000.
Consequently, they are likely to reject the new estimates on the grounds they are grossly underestimated and their members were not consulted or involved in the process.
PEPFAR and Global Fund have been concerned about data puffing and manipulation involving ghost recipients of HIV services and products in their funded programs in Kenya.
A 2018 Global Fund audit in Kenya had exposed high rates of data falsification and multiple billings in its funded programs. PEPFAR has also complained of similar happenings.
To cure the problem, the donors working with Kenya’s Ministry of Health had proposed a biometric registration of all sex workers in the country.
However, the consortium had successfully fought the proposal, despite the government with US funding having purchased expensive equipment for the exercise. It has since been shelved.
The consortium with assistance from the US based Health Gap lobby, argued that biometric registration would expose sex workers to various risk in a country where the work is illegal.
But despite the withdrawal of the proposed registration, PEPFAR had given Kenya Government to the end of this year to come up with a reliable process of identifying sex workers receiving services in their HIV funded programs.
UNAIDS which was part of the current study says in order to meet new 95-95-95 HIV targets, countries need to have updated size estimates of all key populations, including FSW.
“This will allow HIV prevention programs and implementation partners to allocate the correct amount of resources for the true population sizes.”
To implement programs that address the inequalities FSW face, the authors say it is first necessary to understand how many FSW there are and where they live.
“Our study provides the first answer to these questions for all sub national areas in sub-Saharan Africa,” wrote the authors.
By Gatonye Gathura