Commercial Sex Workers Educate At-Risk Populations About HIV in Uganda

Bugiri is a bustling outpost along a highly trafficked trade route that runs east-west, connecting Uganda to neighboring Kenya. Commerce in Bugiri is conducted on the roadway where crowds of vendors compete to sell sodas and snacks to road-weary taxi and truck drivers. Brightly painted storefronts along the highway advertise goods and services, such as pre-paid wireless data and mobile money transfer, for people on-the-go.

At the edge of town, a large, sunbaked parking lot offers truckers a place to take a break from countless hours of driving, and to socialize at Bugiri’s few bars and video halls. The transient trucking population also drives the commercial sex industry in Bugiri. It is a dangerous vocation; women risk violence, abuse, and theft with every transaction, for which they on average earn less than a dollar. The risk of contracting HIV and other STIs, moreover, is an ever-present threat. Despite the danger, hard circumstances and lack of opportunity lead many women into the profession.

Tabitha lost both of her parents to HIV when she was a girl, causing her to drop out of school to fend for herself. She became a commercial sex worker when she was in her teens, after she gave birth to her son, and struggled to earn enough money to support them both. Margaret lost her husband to HIV several years ago and, with little education and no experience in the workforce, turned to the commercial sex trade to provide for her children. Both women are living with HIV, but receive ARV treatment through the STAR-EC-supported health center in Bugiri.

They are also peer educators, “mentor buddies,” trained by STAR-EC to teach fellow sex-workers about HIV prevention and treatment. Tabitha and Margaret connected with STAR-EC staff at the Naluwerere Knowledge Room, a project-supported resource center located at the periphery of the truck stop lot.

The Knowledge Room is staffed by health workers and village health team members (VHTs) and offers information on HIV prevention and treatment, and provides a space for healthy recreational activities, like playing pool or watching soccer matches on TV. VHTs are trained to promote healthy behavior among people in their communities and provide information on HIV and TB testing and treatment services.

A VHT volunteer sits in on a card game outside

Mentor buddies, Tabitha and Margaret lead group discussions with sex workers to provide information about male and female condoms and how to negotiate their use with reluctant clients. “We teach women to protect themselves,” explained Margaret. “We tell them that there is no way to tell if a person has HIV just by looking at him, and that they should always insist on using condoms with their clients every time, even if the client is offering more money not to use one.”

Tabitha and Margaret also encourage women to get tested regularly for HIV and to go on ARV if they test positive, so that they can stay healthy and reduce their risk of transmitting the virus to others. They keep tabs on the women they meet at the Knowledge Room and elsewhere, seeking them out to make sure they know about the resources available to them, offering guidance and support.

“I like helping other women,” explained Tabitha. “Especially the very young women [who have just entered commercial sex work]. I want to encourage them to stay healthy and not give up on themselves. I also want to show women who test positive for HIV that they can get treatment and be okay, like me.”

JSI has implemented the USAID-funded Strengthening Tuberculosis and HIV & AIDS Responses in East Central Uganda (STAR-EC) project since 2009. The project is focused on increasing access to and utilization of quality comprehensive HIV/TB prevention, care, and treatment services within district health facilities and their respective communities.