Continuum of HIV Services Affected by Violence Against Key Populations: Case of Female Sex Workers in Kenya

An immersion exercise to understand the sexual lives of Female Sex Workers (FSW) divulged a pattern of confessed non-condom use, client metamorphosis from first-time to regular, and symbiotic relationship that amalgamates FSWs to short-term husbands dubbed ‘sponsors.’

The research exercise aimed to explore the potential of social and behavior change communication (SBCC) strategies to enhance key populations (KPs) programming at Drop-In Centers (DIC) (a shared room for sex workers to access HIV/AIDS differentiated care and treatment from trained personnel in the health sector, that is, in Narok, Naivasha, Salgaa, and Nakuru), a total of 56 FSWs were trailed and later engaged in interactive group and one-on-one sessions to talk about their sexual lifestyle. The qualitative sessions offered a platform to: (i) understand behavioral issues affecting FSWs, and (ii) enabled participants (FSWs) learn from one another as they built on one another's views making the process an enriching encounter.

Inconsistent condom skipped HIV testing due to fear of turning positive, and poor violence reportage emerging themes that created barriers to healthy living by sex workers; and subsequently, building to systemic blockade in achieving the continuum of care for HIV services among key populations. Despite repeated sessions on consistency in use of condoms with paying clients, FSWs confided in the qualitative research team, that they have at one point or another had not used condoms with home-based husbands dubbed ‘sponsor’ (in Naivasha and Nakuru), ‘Kaplainer’ (in Narok), or ‘baba ’ (in Salgaa). About a third of FSWs present at the interactive group session cited the evolution of one-time clients (married men) who transition to becoming regular clients and finally ‘husbands’ with on-and-off relationships. Regardless of the knowledge by the ‘sponsor’ that the lady he is with is a sex worker, he (Kaplainer – from the word plain, meaning having sex minus a condom) insists on unprotected sex.  

“I really don’t know how to say no to his sexual advances. I am a woman, and when I need emotional support, my Kaplainer provides it,” said in Narok, “typically, the sponsor is a savior when business is low,” she added.

“Seasons can go as high as USD 50 and drop to USD1 per shot. During the bad times, I must get a man who will take care of my children at night when I am on duty, cater for their school fees, and deal with unruly clients who don’t want to pay. He is my Sponsor,” said in Naivasha.

The discussants indicated that most FSWs do not know the HIV status of their Sponsor/Kaplainer. when they confront them (Sponsors/ ) about their HIV status, the men use proxy indicators such as their wives at home have never tested positive.

“My sponsor responds to my query in a rather non-serious manner. He associates his status to that of his wife. He says, when his wife was expectant, she underwent several HIV tests before and after delivery, of which she tested negative. So, I should not have any doubts,” said a low spirited FSW based in Nakuru. 

In Salgaa region, sex workers reported immediate self-relocation of Sponsors who turn positive – making the FSWs go slow in persuading them to test for fear of losing their socio-cultural and economic ‘pillar.’ 

Besides sexual and financial responsibilities, the research team discovered that Sponsors/ have been entrusted by FSWs to act like ‘legal’ husbands during cultural functions (such as weddings, funerals) where the presence of extended family members is traditionally expected. This scenario has been fueled by the stigma associated with sex work; every FSW upon returning to their native homes, wish to be identified with a man, thus, justifying their non-involvement in sex work.

“I prefer married men. They are easy to deal with. They understand household needs and they tend to safeguard me as a ‘wife,’ that way I feel special. In return, I offer him sex without the use of a condom,” said a 22-year-old HIV positive FSW in Salgaa. 

Coupled with such a lifestyle, FSWs indicated that fear of testing arose from the fact that they had been potentially exposed through unprotected sex with a Sponsor whose HIV status they did not know. In further spreading the fear, there is a growing culture of rotational (seasonal sharing) ‘Sponsorship’ among FSWs.

Female Sex Workers narrated scenarios where they had been violated but did they report the incidences at the DIC or to the police. On average, data at DICs visited showed an average of four (4) cases per month – possibly way too low compared to the eventualities narrated by sex workers. Incidences of violence involving physical fights, abuses, and even deaths as being higher among sex workers who harbored sponsors. 

“As the low season nears its end, ideally it is time to kick the sponsor out of your life. This is when violence begins because he wants to stay and I need my space,” said in Naivasha. “The sponsor wishes to stay on, making the whole scenario move from peace to quarrels which trigger to a full fight,” narrated a 31-year-old mother of two and victim of abuse.“I don’t know how best to report, because I have always presented my sponsor as a husband. The police always advice we go back home and sort out our domestic issues amicably. I cannot say I am a sex worker, I fear arrest. To get him off my house, I am only left with on tactic, show disinterest until he pursues another woman,” she added. 

FSWs fear protracted court cases could expose them to public scrutiny and judgment; something they do not want to subject their families who do not know they are sex workers.

End>>>