Is access to healthcare for sex workers in Uganda a myth or a reality?

Rhythm of Life is a member of the global Network of Sex Workers Projects (NSWP). All members are united in our shared vision to “[Promote] health and human rights”. According to the 2013 World Bank report on HIV among sex workers, there are variations globally but the region with the highest prevalence is sub-Saharan Africa with 36.9%.

Some progress has been made globally in the adoption of USAID’s three-pronged strategy to HIV prevention. Yet significant policy and programming barriers still exist, especially in Africa. Sex workers in Africa do not have access to the health and well-being services they need: sexual and reproductive health services, unforced and anonymous HIV testing, counseling (HTC) and other support for mental health issues and drug addiction support and rehabilitation. Likewise, as a result of discrimination and stigma, sex workers are often excluded from the agendas, later programmes, set by governments to tackle HIV prevention and treatment.

What makes us different from other local charities with the same focus is our links with the red light districts, which means that we are focused on addressing the realities associated with life in these areas. Rhythm of Life was founded in February 2013 by Harriet Kamashanyu. It was her experience of growing up in the red light areas of Kabalagala that gave rise to the desire to help her community. However, it was the research that she carried out on the specific problems affecting HIV-positive sex workers and their daughters which gave rise to her activism in this field.

In January 2013, Harriet and a team of volunteers carried out an assessment of the prevalence of sex work in the Kampala district Makindye Division. They discovered that Kabalagala has the highest number of sex workers – 360 in total – and 70 per cent of these women were HIV positive. This is the area where we are currently focusing the core of our activities. Through monthly health outreaches in the red light districts, we partner with local health workers to provide voluntary HIV testing and counseling services and testing and treatment of sexually transmitted infections.

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Due to the connections we are making through the monthly outreaches, we were recently alerted by a peer counselor about one of our ladies (a sex worker) in Daido – Makindye who had kept herself locked up indoors for two (2) weeks. Dora had been infected with HIV/AIDs two years earlier and was receiving the antiretroviral therapy (ART) through a friend, who was working as a nurse at one of the local referral centres. Things changed when her friend left the job. Dora told us that she was mistreated when she went to the referral centre to receive her treatment. This is why she decided not to ever go back.

In those two weeks she had locked herself indoors, without food or medication or food, she had given up on life and was waiting to die. She hated everything and everyone around her. In fact, when we first made contact with Dora after we had been informed of her ordeal, she showed no interest in us. Fortunately, on that first visit, we were accompanied by a professional therapist who coaxed her into agreeing to speak to us during our visit the next day. This was a crucial first step because we had gained her trust. Since she had no money, we bought some food and drinks for her before we left.

When we met with Dora the next day, it was fantastic that she opened up to us about her health condition. The therapist took her through what she needed to do in order to keep up with her ART treatment. In time, we managed to secure her a referral to another treatment centre and access to a support group. In addition to financially supporting Dora, the biggest impact we could make was to show her that she was loved and valued regardless of her health status and occupation. We encouraged her not to give up on life and to show love to herself by following through with treatment.

We are happy to report that Dora is diligently managing her ART treatment and has found a new lease of life thanks to the people she’s in contact with. Through our referral card, she is being treated at a nearby centre and there has been no incidence like the one she reported to us. She is also part of a peer-to-peer support group.

Dora’s case is a call for action to fill the gap in healthcare left behind by inadequate policy. It demonstrates that there is a need for drop-in centres / health cafes especially for sex workers where they can access the services they need, from counselling through to HIV treatment. In essence, what we want to do is involve sex workers in designing, running and evaluating the health services that they use. This is the only way we can guarantee that the health system is inclusive and addresses their needs.

It actually does not take much but the first step is acknowledging that the health of sex workers matters too! Let’s come together to create a more health friendly environment for one of the most at risk populations in UgandaSEX WORKERS.

Equity in Health: Red light district of Kabalagala

Kabs

 

 

 

Growing up in a suburb next to a red light district granted me the opportunity of bearing and understanding prostitution with a much keener eye and mind. I knew what happened behind curtains and the societal gaps that needed to be filled in challenging the status quo. “Harriet, I felt so sorry and guilty watching my mother fade away because we could not access health care. Finally death was her only option,” were the heart breaking words that came out of her mouth with tears standing in her eyes after the burial of her mother, their family bread winner.  Resty is a childhood friend that I had known closely for such a long time, her mother was a popular sex worker who had done this business for many years that when she contracted HIV/AIDS, the entire society blamed her for having caused this to herself especially the health centres that denied her attention and medication, at times.

I think we need to re-define some terms since their meaning and gradually fading away. Equity in health includesconcepts of fairness and justice. It implies that everyone should  have a fair opportunity to attain their full health potential , and that the primary determinant in access to health inputs should be health needs, and not factors such  as status, gender, ethnicity, work, insurance, housing and disability. Access to health care is equitable if there are no information, financial, or supply barriers that prevent access to a reasonable level of health care.

Uganda has endorsed a number of both international and national instruments affecting public health, but their provisions are not fully included. These cases demonstrate the usefulness of international and regional instruments in the protecting health rights, even outside national legal systems. There is a possible bias against poor and vulnerable populations in the benefit from these provisions as they may find it difficult to take cases to regional and international levels. TheInternational Covenant on Economic, Social and Cultural Rights (1966) ratified in January 1987. The Constitution sets out the state’s duty to ensure all Ugandans enjoy access to health services. I need someone to blow it right in my face that “Sex Workers in Uganda are not Ugandans” because this is what denial of their health care by the national health system comes to. If all Ugandans are entitled to an affordable and better health care, then why not sex workers?

According to Regional Network on Equity in Health in Southern Africa (EQUINET), The Discussion paper 63 carried out in East and Southern Africa, the public health law in Kenya, Uganda and Tanzania, Equity in health implies addressing differences in health status that are unnecessary, avoidable and unfair, to ensure the redistribution of societal resources towards these outcomes and to promote the power and means people have to influence this redistribution.

I can still close my eyes and envision the many “Resty’s mothers” out there that are dying out simply because the health system is not inclusive. Are we going to sit and watch while day by day people are fading away while we shamelessly blame them for the rapid increase and spread of HIV/AIDS?

The sex workers have only been listed as the minority groups in the prevention and treatment of HIV/AIDS and amazingly major efforts have been given to prevention rather than treatment, but remember treatment of an HIV patient bears the same or even more results as prevention. No wonder one sex worker in Kabalagala (the biggest red light area in Uganda) told me while conducting a baseline survey that “If we are not safe, then no one is safe” and it didn’t make sense to me at that moment but after a number of several reflections I now realize if the sex workers are not given priority in the medical care accessibility then Uganda is not safe due to the fact that they attend to a number of clients from different walks of life.

This stigmatization and discrimination does not only affect the sex workers but their families too. It is sad that the children witness what their mothers face, as a daughter of a sex worker told me, “I will do anything to take care of my mother because I have seen how she is abused, mistreated and looked down upon both in the hospitals and entire community.”

In Uganda, prostitution is judged as one of the worst sins. Approximately 90% of all sex workers are forced into this business. But regardless of the reasons why they are into the sex work business, they are humans like any other human being, they have a right to health and that right SHOULD be observed and respected.

They need education too.

Rhythm of Life acknowledges that changing the course of the global HIV/AIDS pandemic requires the courage to tackle challenging social issues, the commitment to sustain long-term investments and the determination to push the limits of existing responses. We view AIDS not simply as a health problem, but a product of — and exacerbated by — pervasive violations of human rights.  Because HIV/AIDS disproportionately affects the poor, least educated and most marginalized people, we have pioneered new approaches to eliminate the stigma of the disease and promote advocacy for those afflicted.

Daughters of sex workers from the red light districts are very instrumental in the positive transformation of the red light scenarios of “forgotten and marginalized groups” in Uganda.

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Their lives matter

 

The Sexual Health and Rights Project (SHARP), an initiative of the Public Health Program of the Open Society Institute, recognizes the incontrovertible link between health and rights. Policymakers and donors around the world should heed the lessons in these pages and generously support sex worker health and rights groups to continue their lifesaving education, service provision, and advocacy efforts. By increasing access to health and social care services and promoting laws, policies, and practices that end discrimination against sex workers, the brave people running these organizations not only reduce the incidence of HIV and other illnesses, they help create a more just world.

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A Powerful Tool in the Doctor’s Toolkit; How caregivers present and administer treatments has a powerful effect on clinical outcomes

Bamboo Innovator

AUGUST 15, 2013, 2:39 PM

A Powerful Tool in the Doctor’s Toolkit

By DANIELLE OFRI, M.D.

It was well past midnight and most of the patients had settled in. The hospital ward was quiet, except for “the howler.”

The howler was a patient in his 30s who earned his nickname for his nightly bouts of yelling. This was in the early 1990s, during the peak of the AIDS epidemic. I was a second-year medical resident at Bellevue Hospital, in charge of the sprawling AIDS ward that night. Admissions were rolling in, one after another, each more feverish and emaciated than the previous.

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