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.
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 Uganda – SEX WORKERS.
Growing up in a suburb next to a red light district gave me the opportunity to witness prostitution in practice. To the extent that I knew what was happening behind closed doors (through my friends confiding in me). Equally, I had a sense then and now of how difficult it would be to challenge the status quo and change attitudes.
“Harriet, I felt so sorry and guilty watching my mother fade away because we could not access healthcare…death was her only option.” These are the heartbreaking words spoken by my friend, Resty. It was just after her mother’s funeral and she spoke these words in tears, conscious that her family would never be the same because they had lost their breadwinner.
Resty is a childhood friend. Her mother was a well-known sex worker in the area who had been in the business for many years. When she contracted HIV/AIDS, the whole community felt that she was responsible for her predicament because of her line of work. In fact, the local health centres often would deny her care and medication because of how strongly they felt she deserved to be in this situation.
This is unacceptable.
The meaning of equity in health includes the concepts of fairness and justice. It implies that everyone should have a fair opportunity to lead a healthy life and the primary determinant in access to healthcare should be health needs rather than status, gender, ethnicity, race, employment and insurance. Access to healthcare is equitable if there are no financial, information and supply barriers. Based on the Regional Network on Equity in Health in Southern Africa (EQUINET) and the Discussion paper 63 on public health law in Kenya, Uganda and Tanzania, equity in health means to lessen the differences in health status that are unnecessary, avoidable and unfair. Pursuant of this goal is to ensure the redistribution of societal resources and to promote the power and means people have to influence this redistribution.
Uganda has endorsed a number of international and national initiatives in relation to public health, but not all of the provisions included in these initiatives have been endorsed / implemented in full. Technically, international and regional bodies can be a great platform to unite and think through solutions for common human rights and socioeconomic problems, which are beyond the scope of individual countries. Nevertheless, the poor and vulnerable are unable to fully benefit from these supranational initiatives because they lack the information and the means to challenge their states in an international court.
The International Covenant on Economic, Social and Cultural Rights (1966) was ratified by Uganda in January 1987. According to the constitution, it is the state’s duty to ensure all Ugandans have access to healthcare services. If all Ugandans are entitled to healthcare services, what about sex workers? Can a claim be made that sex workers, born and living in Uganda, are not Ugandans? Of course not. This kind of thinking simply does not work. Sex workers are Ugandans who happen to be involved in sex work. Therefore, the current system based on exclusion and marginalisation should not be tolerated.
Unfortunately, the situation with Resty’s mother is the norm rather than the exception. Countless women are being sentenced to death because of lack of access to healthcare. They are being held responsible for the spread of HIV / Aids, which is seen as grounds for their exclusion from and non-priority status within the healthcare system. A catch-22 style situation emerges. Access to sexual health information and medication to treat sexual health-related conditions would mean that the women are less likely to be at risk of becoming infected and pose less risk to others if they are already infected. Denying them access actually perpetuates the spread of infection, which creates a dangerous cycle.
Most initiatives on HIV / Aids in Uganda have focused on prevention rather than treatment. It is wrong to prioritise one over the other as they are both equally important. In fact, treatment of HIV / Aids should be front and centre of any prevention strategy. For example, HIV-positive sex workers who are on the fringes of society – impoverished, marginalised and demoralised – are more likely to take risks and put themselves and others in danger. A sex worker in Kabalagala once told me: “If we are not safe, then no one is safe.” It did not make sense to me at the time but, upon reflection, I realised she was absolutely right. Attitudes towards sex work may be conservative but the reality is that sex workers have customers. Remove the customers from the equation and there will be no sex work – and the link between sex work and the spread of HIV would not exist.
Another important issue to consider is that sex workers have families. They are mothers, daughters and sisters. It is tough to be the daughter of a sex worker not least because you witness and experience the same struggles as your mother. A daughter of a sex worker once 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.” Moreover, the cycle of mother-to-daughter prostitution is very real. Daughters of sex workers are more likely to become involved in sex work.
To summarise, attitudes in Uganda are very conservative to the extent that prostitution is considered one of the worst sins. Yet, to put things into perspective, approximately 90% of all sex workers are forced into this line of work. Irrespective of the reasons why these women became involved in sex work, what is most important is that they are human beings and should have the same rights as everyone else: they have a right to healthcare which SHOULD be observed and respected.
By Harriet Kamashanyu
Founder of Rhythm of Life
Rhythm of Life acknowledges that containing the threat of the HIV / Aids virus requires the courage to tackle challenging social issues, the commitment to making long-term investments, and a preparedness to go beyond existing measures. As an organisation, we view HIV / Aids not only as a health problem, but also a product of — and exacerbated by — human rights violations. Since HIV / Aids disproportionately affects the poorest, least educated, and most marginalized groups, our aim is to eliminate stigma and to empower those living with the virus.
The daughters of sex workers are instrumental in our vision to bring about change in the red light districts and improve the life chances of a “forgotten and marginalized” group.
The Sexual Health and Rights Project (SHARP), an initiative from the Public Health Program of the Open Society Institute, argues that access to healthcare for vulnerable peoples should be a universal right.
This blog is intended to provide a snapshot of the lives of the women we engage with on a day to day basis. We hope that there are useful lessons to take from the work we are doing. Ultimately, we want to ask policymakers and donors around the world to increase their support for the health and rights groups working to improve the life chances of sex workers. With funding we can continue our work in education, service provision and advocacy. By increasing access to health and social care services and promoting good laws and policies, we want to bring an end to discrimination against sex workers and reduce the incidence of HIV and other sexually transmitted diseases. More importantly, we want to create a world that is just.
AUGUST 15, 2013, 2:39 PM
A Powerful Tool in the Doctor’s Toolkit
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.
View original post 934 more words
Welcome to our blog!
We are a small charity operating in Uganda. We are interested in helping the tiny fraction of the Ugandan population who have been discriminated against and denied access to the healthcare system – the sex workers in the red light districts.
Please take the time to look through our pages and posts to find out what we are about. Your feedback and comments will be greatly appreciate, as well as your support.
From ROL Family