“The only thing I have acquired from commercial sex work is HIV,” Elenia told me.
Elenia works in an isolated spot along the border crossing from Uganda into Rwanda. She is one of thousands of women in Uganda who are driven by poverty and political instability to provide sexual services to truckers, boda cyclists and taxi drivers who travel across the country’s major transportation routes.
I have come to the border town of Katuna, Uganda to observe the work of Katuna MARPS, a community-based organization that is providing most-at-risk individuals like Elenia with medical care and psychosocial support. As the research and documentation officer for the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) in Uganda, my job is to record best practices and lessons learned through the programs and partners that we support – like Katuna MARPS, an EGPAF sub-grantee.
Since I began this work in July 2014 – through the Global Health Corps fellowship program – I have interviewed, photographed and connected with countless people reached through the programs and services provided by EGPAF and its partners.
Elenia is one who stands out.
UNAIDS reports that more than 1.6 million Ugandans are living with HIV. The prevalence rate of adults aged 15 to 49 with HIV is a staggering 7.4 percent – up from 6.4 percent in 2005 [1]. More than one-third of commercial sex workers are living with HIV.
As a commercial sex worker, Elenia falls into the category of most-at-risk populations (MARPS) – a classification she shares with the mobile populations that traverse the highways and the people living in the communities near transit hubs.
“The inconvenient truth is that highways that carry the materials and goods we all depend on also transport the high impact diseases that are decimating African communities and economies,”[2] reports the North Star Alliance, a nonprofit that brings health services to transient populations.
Impacted by political instability, poverty, stigma and poor access to health care, many at-risk individuals suffer in silence. But this is changing. With an influx of knowledge about the spread of disease among mobile populations, EGPAF is collaborating with community-based partners to prevent the spread of HIV among most-at-risk populations.
Road Side Assistance
To reduce high risk behavior in Katuna – a major entrance point to Rwanda – Katuna MARPS specifically targets commercial sex workers, long distance truck drivers, discordant couples, youth and uniformed personnel. Working with village health trainers, peer educators, religious leaders and other community-based organizations, Katuna MARPS is able to provide at-risk individuals with referral services and access to health and community programs.
For example, village health trainers conduct monthly community forums on HIV testing and counseling, antenatal care, tuberculosis, family planning and condom usage and prevention of mother-to-child transmission of HIV (PMTCT) [3].
Katuna MARPS also engages in moonlight activities – health outreach conducted at night along the roads where truckers and sex workers congregate. These programs aim to reach nocturnal populations and provide on-site, stigma-free HIV counseling and testing.
Because of poverty, many commercial sex workers have difficulty resisting the demands by clients for “live sex” – intercourse without a condom – which pays significantly more. In response, the Katuna MARPS financial cooperative is working to provide the women with enough stability that they can resist requests for high risk behavior.
Elenia Finds Support
While conducting interviews one day, I was instantly drawn to Elenia out of the group of nine commercial sex workers. Elenia is vocal about her HIV-positive status and the conditions in which she lives and works.
“I started [commercial sex work] after the death of both of my birth parents,” Elenia told me. “I do not have immediate relatives. They all perished in the Rwandan genocide.”
“If I had a way out, I would completely abandon [commercial sex work],” she added. “I have no other work.”
Elenia is receiving lifesaving antiretroviral therapy through linkages provided by Katuna MARPS. She is also a member of a financial cooperative that Katuna MARPS sponsors. She contributes a set monetary amount each week and meets with other workers every Thursday to talk through issues, receive health information and access services.
Hope for an Unborn Child
Elenia disclosed to me that she is pregnant as a result of a live sex encounter four months ago. I advised her to immediately enroll in the prevention of mother-to-child transmission (PMTCT) program at a local health center to reduce the risk that her child will be born with HIV.
Heading back to the hotel that evening, I couldn’t stop thinking of Elenia, wondering if she would heed my advice.
The next morning, I returned to Katuna MARPS to interview male clients who cross borders frequently and often seek out commercial sex. Afterward, I made an unplanned stop with the rest of the EGPAF team to Kamuganguzi Health Center III, where I noticed Elenia enrolling in PMTCT services, accompanied by the peer leader from Katuna MARPS.
Elenia smiled at me and said, “I want my child to be healthy.”
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Through organizations like Katuna MARPS – funded and supported by the Elizabeth Glaser Pediatric AIDS Foundation, USAID/STAR-SW – women like Elenia who work in the commercial sex industry, as well as the men who purchase sex at transit hubs, are receiving vital education, health care and support, improving their ability to act as agents for their own bodies.
From the period of October 2013 to September 2014, the programs offered by Katuna MARPS, made possible by the funding of EGPAF, STAR-SW/USAID, have reached 907 commercial sex workers, 732 long distance truck drivers and 307 members of other vulnerable groups, including boda cyclist and uniformed men in the Kabale District.
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This article has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the United States Agency for International Development (USAID) under the terms of funding provided to the Elizabeth Glaser Pediatric Aids Foundation in the implementation of the USAID Strengthening TB and HIV AIDS response in the South Western Region of Uganda (STAR-SW project). The contents are the responsibility of the Elizabeth Glaser Pediatric AIDS Foundation and do not necessarily reflect the views of USAID or the United States government.
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[1] “UNAIDS Uganda.” UNAIDS. Web. 4 Sept. 2014. http://www.unaids.org/en/regionscountries/countries/uganda/
[2] “Building Healthy Supply Chains in East Africa.” North Star Alliance. Web. 4 Sept. 2014. PDF File.
[3] Strengthening Tuberculosis and HIV and AIDS Response in South Western Uganda. N.d. Work prepared by machine. Katuna MARPS: Kamaganguzi Bakyara Tukorerehamew Group (KBTG).