Access to healthcare – myth or 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.

dora

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.

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