Most evenings, Khadija’s workplace is Kisumu’s dim red-light district, popularly known as the Beer Belt due to a high concentration of bars. Typically, she picks a spot outside one of the bars and waits for clients. On a good night, she will sell sex to several men and head home just before dawn with at least 2,000 Kenya shillings – about US$20. “I love selling sex, I have no regrets,” Khadija says.
The 23-year-old mother of one has managed to stay HIV-negative – remarkable in a country where sex workers have the highest HIV prevalence of any group. One in three of Khadija’s peers is HIV-positive, including her friend Dorah.
Dorah is 35 and a mother of three. She has been a sex worker for 20 years. Hers has been a tough life in the streets. That experience is best exemplified by a recent night when a client attacked her, leaving her for dead.
The night had started well. The client drove an expensive-looking car and was stylishly dressed. He had promised to take her to a nearby hotel, but he kept driving deeper and deeper into the night, until Dorah sensed danger and was filled with anxiety. When they reached a populated stop on the highway and the man slowed down, Dorah lowered the car window and shouted for help. The man accelerated, then unlocked the passenger door and pushed Dorah out of the speeding vehicle.
People who witnessed the incident rushed to her rescue and took her to hospital, where she was admitted in critical condition. It took more than five months for her to recover, and a scar written across one side of her face is a lasting reminder of that night of terror.
Recounting that story, Dorah says she regrets having ended up a sex worker. She didn’t have much of a choice, she said, as an orphan who dropped out of school at third grade. With that level of education, she did not have many other options to provide for herself, and later her children. So she settled on selling sex, and kept doing it even after she got infected with HIV. Even after that dangerous attack. “I have had a miserable life,” Dorah says on a recent night at the Beer Belt.
One bright spot in Dorah’s difficult circumstances is the dependable support of a group of health workers that provide a range of services – including moral support. Most work for the Kenya Red Cross and LVCT Health – nongovernmental organizations that work with people most affected by HIV with support from the Global Fund.
Irene Moraa, program officer at LVCT Health says, “We come here because these are people who need our services the most. We know that if we do not work with sex workers and other marginalized and vulnerable groups, we cannot win the fight against HIV.”
The groups support the sex workers with their different needs, allowing them to stay healthy. The organizations provide services that seek to keep Khadija and other sex workers not infected with HIV free from the virus. They also work to keep Dorah and other sex workers living with HIV on treatment. That is important for the women’s health and reduces the risk of infection for their clients.
Health workers like Irene see clients at the Beer Belt in a mobile clinic mounted on a truck. They provide the sex workers with integrated reproductive health services that range from family planning and HIV prevention to cervical cancer screening. With long and unpredictable hours at work, Khadija and Dorah are often left out by mainstream health systems. But on a recent night, with the truck parked right outside the bar, the two of them went in for long consultations with clinicians. “They take good care of us, they do not discriminate against us,” Dorah says when they hopped out of the truck, each with a package of medical supplies.
Dorah says she would like to quit sex work and do something else – if she could just save enough to start a small business. Khadija maintains she is happy with her life and not looking to make a change. “People who want to help us should provide us with security, increase our supplies of condoms and lubricants and HIV test kits,” she says.
Either way, both women will spend their evenings at the Beer Belt for the foreseeable future and health workers supported in part by the Global Fund will help reduce the risk and impact of HIV.