By Joseph Magoola
It is more than 20 years since HIV/AIDS was discovered in Uganda. The efforts to combat the spread of HIV/AIDS have enabled Uganda to realise a drop in prevalence from 18% in 1992 to 6.4% in 2010. Because of this, Uganda is internationally known for its success in the fight against the disease.
Although Uganda has been hailed for the success it registered in the fight against HIV/AIDS, there is now cause for alarm as the prevalence has began to rise. The key risk factors include people having multiple concurrent sexual partners, discordance and non-disclosure among couples, lack of condom use, transactional sex and cross-generational sex.
The modes of transmission study projected for the year 2008 that 43% of new HIV infections would be among mutual monogamous sexual relationships, while 46% would be among persons involved in multiple sexual partnerships. Commercial sex contributed 22%, while heterosexual casual sex contributed 14%.
Sex workers are, therefore, a high risk population. So, interventions against HIV/AIDS should also focus on those engaged in transactional sex (the sex workers). Sex workers have sex with many people and the reality is that they do not always use condoms. Sometimes, it is because the sex workers do not have access to condoms, while others are not sensitised about the importance of using condoms.
In other incidences, the sex workers are simply powerless and they cannot negotiate for condom use with their clients. Sometimes, clients may refuse to pay for sex if they are asked to use a condom and use intimidation or violence to force the sex workers into unprotected sex.
The clients might also offer the sex workers more money for unprotected sex â€” a proposal that a sex worker, who is desperate for the money, might find very hard to refuse.
Every Ugandan has a fundamental right to health regardless of tribe, religion or occupation. Rather than criminalising sex workers or ignoring them, we need to bring them on board and encourage them to protect themselves.
Protecting sex workers from HIV/AIDS does not mean promoting the trade. Sex workers can be protected while a more acceptable money-making venture is being formulated for them.
Involving sex workers in HIV prevention campaigns will raise their self-esteem and empower them, thereby encouraging them to look after their health and to access services that could help them protect themselves, such as condom use. Denying them a platform to address their issues forces them to go underground, which will increase the HIV/AIDS incidence.
So, instead of pretending that the sex workers do not exist and, therefore, marginalising them, we need to design interventions that can curb the escalating HIV/AIDS incidence among them while we seek alternatives to lure them away from the trade.