HIV prevention for sex workers by sex workers in Kenya
NAIROBI, 11 August 2010 (PlusNews) - By night, Viviane Muasi, 25, is a sex worker in Kenya's capital, Nairobi, but when not canvassing for clients, she spends much of her time convincing other sex workers to test for HIV and use condoms.
Muasi, a sex worker for nine years, is a peer educator with the Sex Workers Outreach Programme (SWOP) - a project run by the University of Nairobi and Canada's University of Manitoba.
"Initially when I came to Nairobi, I was employed as a house-maid," she told IRIN/PlusNews. "I was being paid little, so another woman introduced me to sex work and told me I could make more money."
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Through the SWOP programme, Muasi and her fellow educators have enabled more than 3,000 of their Nairobi peers to get tested for HIV and other sexually transmitted infections.
"We know each other and where they [the sex workers] live, so you just visit them at home and ask them to create time and go to the clinic," Muasi said. "They now have skills to negotiate condom use with their clients... we don't want to be infected and we also don't want to infect anybody.
"At first, the police would just round us up and force us to go for [HIV] tests; many commercial sex workers used to hide," she added. "But today, because the call to test comes from one of their own, they have embraced it."
Since 2008, the SWOP clinic in Nairobi, which is open 24 hours a day, has provided HIV prevention services to more than 7,000 commercial sex workers, 150 of them male. The HIV prevalence among those tested is 33 percent.
The prevention package includes condom demonstration and provision, sexually transmitted infection screening and treatment, family planning and post-exposure prophylaxis.
Sex workers are very hard to reach, given the illegal nature of their work in Kenya. According to Moraa*, health workers are often judgmental, discouraging women like her from visiting health facilities.
"We fear going to the health centre because you don't know who knows you and what you do... they can discriminate [against] you on that so you'd rather not go," she said.
"Commercial sex workers are very mistrustful of people because they are engaging in an illegal activity... but they can be reached by creating trust among them by using these peers to reach out to their colleagues," said Grace Aketch, a researcher with the International Centre for Reproductive Health.
"It is more effective to use commercial sex workers as a resource in the prevention of HIV than being hard on them," she added.
Aketch noted that involving sex workers in the fight against HIV also made it possible to reach the people who used their services.
"We have even convinced some of our clients to go for tests. When you can tell a client he needs to be tested for HIV, they even trust you more; they know you have good intentions," Muasi said.
According to Cecilia Kariuki, coordinator of the SWOP clinic in Nairobi, HIV prevention among sex workers must be an ongoing process. "There must be [continuous] sex education targeting them to get better results... a one-off thing doesn't work well," she said.
A 2008 study carried out by the International Centre for Reproductive Health in Kenya's coastal city of Mombasa found that the use of voluntary systems and trusted peers significantly increased the use of condoms by sex workers and their clients.
According to the Kenyan government, sex workers and their clients contribute to an estimated 14 percent of new HIV infections nationally; the national strategic plan to fight HIV highlights a need to create policies that will increase access to HIV services for the country's estimated 80,000 sex workers.
*Not her real name