Female sex workers (FSWs), Adolescent girls surviving in sex work settings especially those with compounded and intersecting vulnerabilities in Uganda bear a disproportionate burden of HIV and Sexual Reproductive Health challenges. This is compounded by the existence of little evidence on the barriers that impede their access to HIV/AIDs and SRH related services. According to Wabwire- Mengen, Sempiira and Kwesiga (2019) as cited by Mukwaya & Kyomya (2021), it is important to note that, an estimated 130,359 FSWs in Uganda operate in a criminalized environment and this environment has exposed FSWs to increased risks of HIV infection leading to extreme stigma, discrimination and denial of access to health services in health facilities.
The Alliance of women advocating for change as an umbrella network of grass-root female sex workers (FSW) led-organizations in Uganda has promoted and advocated for human rights and access to affordable, acceptable, responsive and quality health and socio-economic services among female sex workers and other minoritized women and girls in Uganda. In a bid to enhance access to integrated universal health care services among female sex workers, AWAC established models such as the Drop-In Centre, Community Health and Livelihood Enhancement Groups (CHLEGs), Outreaches and stepping stone out of the need to plummet the rate of HIV/AIDS spread among female sex workers in Uganda. Through AWAC clinic days (Wednesday and Thursday) at the DiCs, our members have been provided with integrated Universal Health care services – these include HIV screening and testing, counselling, refills for clients on ART and PrEP, mental health, psychosocial support for GBV survivors, SRH commodities for FSWs, other minoritized women and girls at our DiC safe space.
In 2021, AWAC initiated 287 clients on ART and 2957 clients on PrEP. AWAC has further donated emergency food relief to 121 of her members to ensure their ART and PrEP adherence is not compromised by malnutrition due to a shortage in food during this extraordinarily challenging period. It is worth to note that, prevention of HIV is one of the core focus areas of our service delivery programs. Besides PrEP, this has been enhanced through distribution of sexual reproductive health commodities and services such as family planning to 3089 female sex workers and other minoritized women as a tandem to promote health equity and UHC as an integral focus area of 2030 SDG agenda.
We have continued to empower and mentor 294 FSWs and adolescent girls on sexual reproductive health, relationships and behavioral change through stepping stone workshop series. Most notable of this economic empowerment program has been on integration of an intersectional focus through economically empowering 40 adolescent girls and young women (including 13 of these with disability) in tailoring and design skills to strengthen their economic risk resilience and tide over the immediate impact of COVID-19 on their livelihood sources. This has improved adherence for 13 minoritized AGYWs on ART and increased uptake of PrEP for 27 HIV negative AGYWs benefiting from the “Make Me Visible” Project. Further to note, through our empowerment programs and models such as Community Health and Livelihood Enhancement Groups model, our community members have been able to establish 11 saving groups from Masaka region, 5 from Kampala including a savings group for AGYW with hearing impairments and 1 from Wakiso. This has been an enabler to our groups to save money and further invest into their jointly owned economic ventures.
AWAC introduced MALAIKA toll-free line 0800-333-177 which operates for 24hours. Through this toll-free line, over 1025 FSWs have shared their experiences, provided with psychosocial support, sexual reproductive health commodities and services and food relief to improve their ART and PrEP adherence.
Much as AWAC continues to spearhead the resilience of the FSWs movement to demand equitable health services and a free environment from discrimination and stigma of FSWs and marginalized/PLWHIV in Uganda, the government should be at the forefront in the fight against inaccessible health services, and discrimination and stigma against FSWs and other minoritized women/PLWHIV. Since the COVID-19 outbreak, the government has diverted most of its attention to COVID-19 yet HIV is still an epidemic in Uganda. The government should put in place inclusive responsive policies to address the needs of FSWs and other women/PLWHIV at the society periphery such as the inclusion of FSWs and other minoritized women and their children in social protection programs and national health insurance scheme –such that they can access adequately health services without being discriminated and stigmatized in health facilities.
Mukwaya, R. and Kyomya, M. 2021 (Advocacy issues Brief, Decriminalizing Sex work and enhancing equitable access to Health, Justice and Social Protection by Female sex workers in Uganda .