GHD's Comms Officer, Winnie, reflects on the experiences of women who live at the intersection of two challenging and marginalised identities in Kenya
“It’s hard enough to go to the clinic and be given reproductive health service as a sex worker,” says Mary*, a commercial sex worker in Kitengela, Kenya, “but being a sex worker and disabled, makes it almost impossible!”
Mary has been working in Kitengela for the past 6 years. Kitengela is a hotspot for sex work, as it is a transit point for truck drivers from Mombasa to the rest of Kenya and other East African countries. According to a UNICEF report 2015, 12% of people living with HIV/AIDS in Kenya are residents in Kitengela, mlolongo, Athi River and its environs, while 25% are truck drivers. In 2016, UNAIDS reported that an estimate of 36.7 million people were living with HIV/AIDS globally, with Kenya having the fourth biggest HIV epidemic in the world with an estimated 1.6million people living positively. The National AIDS Control Council in Kenya reports that there is a high prevalence of HIV among sex workers, who contribute to up to 15% of new infections.
“Sex workers with physical disability are at a higher risk of contracting HIV,” says Mary, who had her legs amputated at the age of seven because of polio. “It’s difficult for a sex worker to negotiate for safe sex with a client. It’s even harder if you’re a person with disabilities. The client automatically feels like they have an upper hand.” A contributing factor to the high risk of sex workers, especially disabled sex workers, contacting sexually transmitted infections is the fact that they are in a tougher position when it comes to negotiating for safer sex. They are often at the mercy of their clients. Sex workers frequently form alliances to look out for each other in such situations, where they can raise an alarm and be rescued. However, disabled sex workers often face discrimination from their colleagues, who according to Mary, feel like having a person with a physical disability in their group as an “extra burden.” Mary has had to come up with her own methods of defending herself. She always carries a small wooden club she can hide in her wheelchair to defend herself.
Sex workers also face the risk of experiencing violence from their clients and the police. The Kenyan national law criminalizes the involvement of third parties in sex work. County by-laws outlaw “loitering for the purpose of prostitution,” “importuning” for the purpose of prostitution and “indecent exposure,” criminalizing sex work itself for all intents and purposes. This criminalization of sex work aggravates the risks sex workers face, with disabled sex workers at a higher risk of exposure to violence as they are seen as an easier target. A report by the World health Organization released in 2012 revealed that there is a clear relationship between sexual violence and infection with sexually transmitted infections among sex workers. 25% of these infections could be avoided by reducing physical and sexual violence.
Discrimination and stigma is something that she has had to learn to deal with. “You need to have tough skin if you are to survive in this industry,” she says. Accessing health services (particularly reproductive health) has been a challenge to Mary. The health centers are not friendly for people with disabilities. The lack of proper physical structures that are friendly to people with physical disability is one of the factors that creates a challenge in accessing these health services. Structures such ramps for people on wheelchairs, hand rails that can guide those who have visual impairment and using door handles rather than door knobs could make it significantly easier to access services. Toilets that are spacious enough to allow movement from the wheelchair to the toilet should be available.
Proper physical structures alone will not ensure effective service delivery. It is vital for the personnel to have the capacity to also deliver services to persons with disabilities. For example, a health center should have someone who’s capable of communicating using sign language. Lastly, the government and non-governmental organizations that initiate reproductive health programs that are either aimed at reducing sexually transmitted infections such as HIV or for family planning should be inclusive and considerate of people with disabilities. Sex workers with disabilities such as Mary feel left out. “We the disabled people are excluded in almost everything. For example, all these HIV programs that are usually launched by the government and other NGOs do not consider the disabled person. A person who is blind for example, cannot read those fliers they distribute,” Inclusivity in programming will be a great first step to motivate and allow for more sex workers with disabilities to access the much demanded for reproductive health services.
* Names changed to respect privacy