"A lot of sex work occurs here because of the kind of social interaction that is there. It's beer and sex and money" - Kenyan official
NAIROBI (AlertNet) - Kenya opened its first free 24-hour health clinic on Friday, aimed at driving down the HIV rate among some of the country's most at-risk groups -- long distance truck drivers and sex workers.
Organisers said the clinic, set up in a trailer park on the outskirts of Busia town on Kenya's border with Uganda, would offer 'moonlight' testing and counselling, as well as free distribution of condoms.
Long days on the road means it is often difficult for truckers to visit conventional medical centres. Sex workers also slip through the net. Not only do they often face stigma in ordinary health clinics, but they also keep odd hours, working at night and sleeping through the day.
“We need to be innovative in how we provide the services,” said Greg Irving, health programme officer at the International Organisation for Migration (IOM), one of the groups funding the clinic, which is run by the Kenyan government.
“What this clinic does is make the services available in the right place, at the right time for the population.”
The HIV prevalence rate in Kenya is 6.3 percent but among sex workers, it rises to 27 percent.
Kenya’s National Aids Control Council (NACC) says truckers and sex workers are two groups with the greatest risk of contracting HIV/AIDS, along with injecting drug users and men who have sex with men. Together, the four groups account for 13 to 15 percent of new infections, the NACC says.
Border towns along the highway, which stretches from the Kenyan port of Mombasa through to Uganda, Rwanda, Burundi and South Sudan, are fuelling the HIV epidemic across the region, experts say.
There are also fears that as business booms in South Sudan -- with huge volumes of goods trucked northwards from Uganda and Kenya to its capital city, Juba -- it will bring increasing rates of HIV to the area which is due to become an independent state in July.
BEER, SEX AND MONEY
By day a dusty outpost, Busia comes to life at night. Parked trucks line the highway while bicycle taxis hustle for business. Music pounds out of the bars, alcohol flows freely and sex workers gather around seeking out clients.
"A lot of sex work occurs here because of the kind of social interaction that is there,” said Steven Oyugi, a NACC official.
“It’s beer and sex and money.”
“We stop to fill up on fuel and alcohol, and later buy girls,” 58-year-old trucker, Abdul Mwangale, told IOM in a report last year.
The married father of six had five to eight girlfriends in each town along the highway.
“When we are on the road, far away from home, it gets lonely. We need to have someone to talk to, entertain us… that’s why we get women,” he said.
The transport corridor accounts for between 3,200 and 4,148 HIV infections each year, or 2 to 4 percent of new infections in Kenya, according to a 2005 study.
“If we were to increase condom use [between sex workers and their clients along the corridor] from 77 percent up to 90 percent for all sex acts, we’d prevent two-thirds of the infections,” said Irving.
However, only 28 percent of sex workers’ clients are truckers. The remainder are other lonely migrants: businessmen, soldiers, police, immigration officers, teachers and health workers, according to a 2008 IOM report
Sex is readily available for as little as $3 or a few beers.
“It is dangerous to come to here if you are single. For those who are married, we must try and be mature. The problem is temptation,” one immigration officer told IOM.
When people have sex with concurrent multiple partners, the chances of contracting HIV are much higher. Through these sexual networks, HIV spreads from high-risk groups to the general population.
Half of the sexual relationships along the corridor are long-term partnerships, which increase the likelihood of HIV transmission, Irving said.
“These are people who know each other and love each other,” he said. “They are less apt to be using condoms in their sexual acts and because of that we see this as a potential significant driver of new infections.”
SUCCESS IN UGANDA
In 2010, IOM piloted its new ‘moonlight services’ approach to high-risk, hard-to-reach mobile populations with three clinics along the highway in Uganda. Opening hours were extended to midnight and health outreach workers were hired to encourage people to get tested.
The project was a success. IOM recorded a 32 percent increase in HIV testing among at risk populations while 62,000 condoms were distributed and 3,000 one-on-one discussions about behaviour change were held.
“The purpose of the counselling isn’t just to figure out if you have HIV or not,” Irving explained.
“The purpose of the counseling is to engage with the client and help them to process their own personal risk behaviour ... This has been shown, if it’s well done, to be one effective way to impact behavioural change.”
In addition to HIV counselling and testing, the new clinic in Busia offers free treatment for malaria, tuberculosis and HIV.
NACC plans to pepper the entire transport corridor with free health care clinics specifically designed for hard-to-reach populations.
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