Sex workers abandoned as Covid-19 crackdowns undo Africa’s HIV efforts

Before the Covid-19 crisis, Lillian Namiiro a sex worker at the Uganda-Tanzania border also connected her community to the national HIV response.

She reminded government workers to send antiretroviral drugs (ARVs) to nearby health centres. She checked whether sex workers needed drug refills, and gathered them for health talks about HIV tests, pre-exposure drugs (PrEP) or ARVs.
But with the Covid-19 crisis, “all that ended. The sex workers who want drugs can’t get them,” Namiiro says.

Uganda’s ban on public gatherings ruled out health talks for sex workers, fisher folk and other at risk groups. When transport was prohibited, except for cargo trucks, most organisations grounded their health outreach teams.

Health system disruptions
Countries across Africa rolled out similar measures, causing major health system disruptions. People were afraid or unable to visit hospitals for regular care such as antenatal services, childbirth and immunisations.

openDemocracy has learnt from 24 interviews across five countries that the most disrupted HIV-related services are those meant to prevent new infections, especially among populations considered most at risk of HIV – including sex workers.
Health workers and sex workers in Uganda, Kenya, South Africa, Nigeria and Mozambique said they have found creative ways to ensure registered HIV patients continue receiving drugs, such as home deliveries by bike and multi-month refills.

But HIV testing, PrEP, drop-in centres for vulnerable groups, and medical male circumcision have been scaled back and sometimes stopped completely – though all are vital in detecting and preventing new infections.
“People are going to die! Aids is going to multiply!”

“We expect many more new cases of HIV to be reported in the coming months and weeks,” says Thomas Abol, executive director of Keeping Alive Society’s Hope (KASH), a Kenyan group that serves sex workers and LGBTIQ people. UNAIDS and the World Health Organization (WHO) have sounded similar alarms.

KASH closed its drop-in centre – a safe space in Kisumu for HIV services, for people who may not feel safe going to a regular clinic, such as sex workers and LGBTIQ people, for a month during the coronavirus lockdown.
In South Africa, Megan Lessing, spokesperson for the NGO Sex Workers Education and Advocacy Taskforce (SWEAT), says for the first five weeks of the lockdown, they stopped going out to talk to sex workers where they live and work – and their walk-in HIV clinic, located in a red light district, was also closed.

In Cape Town, where they work, the government also moved homeless sex workers into a camp shelter far way from their HIV services.

Before the pandemic, South Africa, Kenya, Mozambique, Nigeria and Uganda were registering nearly 620,000 new HIV infections a year, according to WHO data from 2018. But now, “Aids is going to multiply! People are going to die!” Namiiro warns.

In 10 other African countries, similar reductions in HIV services were reported to an International Planned Parenthood Federation (IPPF) survey of its network of clinics in March.

Abandoned, without food or financial assistance
In all five countries, sex workers said they have not benefited from the official cushions meant to tide people over the coronavirus restrictions, and so could not stop working.

For example, sex work is illegal in South Africa, so sex workers are unable to claim unemployment benefits. “I have applied for the one-off relief of R350 (Shs77,000) that the government announced for unemployed people, but so far I’ve got nothing,” said a sex worker in Cape Town.

In Uganda, even after health authorities warned sex workers off truck drivers, a major client group, the government denied their request for food aid, says Macklean Kyomya, who runs Alliance of Women Advocating for Change (AWAC), a member organisation of 10,000 sex workers.

“We were asked to disclose the number of individuals in every district and their names and contact information,” she says. Knowing that these same authorities had previously conducted raids on sex workers to enforce the “no contact with truckers” directive, Kyome did not reveal these identities. The food aid was denied.

Even at community level, in Uganda and Kenya, sex workers were passed over during government food aid distribution, because many live and work in motels, which were supposed to be closed, per the coronavirus lockdown instructions.

“Girls actually live in these brothels, other than just working there,” said Peninah Mwangi, director of Bar Hostess Empowerment and Support Programme (BHESP), in Kenya. “So when they were closed, they were closed with the girls in there.”

Steeped in stigma
Across the continent, Covid-19 responses are seen to be steeped in stigma, discrimination and rights abuses and also have unintended consequences.

“It’s like they deployed an entire barracks at the border for us,” Namiiro says of Uganda’s targeting of sex workers. “The police find us, they beat us,” says Louisa Pedro, about her experience as a sex worker in Mozambique during the crisis.
“We invested 35 years in dealing with HIV. But now we’ve been locked out”
Some activists and health workers are surprised that African governments didn’t learn and borrow from the more humane approaches they have developed for other pandemics like HIV.

“We have invested the last 35 years in dealing with the HIV pandemic. We have experience and expertise on how to manage a response through a gender and human rights lens,” says Lillian Mworeko, a regional director for the International Community of Women Living with HIV (ICWEA) in East Africa.

“But, we have been locked out and cannot contribute meaningfully,” she says of the national Covid-19 responses in East Africa.

The tactics used to reach the most-at-risk groups for HIV – including truckers and sex workers – are established and successful. Namiiro, for example, is part of a country-wide network of peer educators who work with officials and encourage voluntary testing and treatment.

But for Covid-19, these practices seem to have been dropped in favour of lockdowns, bans, compulsory testing and other top-down approaches.

Confirmed coronavirus cases in Africa stand at under 165,000 (as of June 4) but the continent is home to more than 25.8 million people living with HIV and Aids, and sees about 950,000 deaths and more than 2.2 million new infections each according to WHO data from 2018.

At this point, what is controlling the newer pandemic appears to be worsening the older one.

Additional reporting by Arya Karijo, Estacio Valoi and Stephanie Ohumu

This is an edited version of an article first published by openDemocracy’s Tracking the Backlash project