Hope, pain and patience: HIV and sex workers

A year after the UN adopted a declaration in which member states committed to creating “enabling legal, social and policy frameworks in each national context …to eliminate stigma, discrimination and violence related to HIV” . Nada Mustafa Ali reports on the situation in South Sudan

Nada Mustafa Ali
22 July 2012

In 2008, Kira, 27, traveled to Juba, capital of South Sudan, to work as a cook for an NGO, so she could afford food and school fees for her children in war-ravaged Eastern Democratic Republic of Congo (DRC). Instead, she ended up a sex worker in Juba, facing constant threats of violence, forced sex, and other abuses, especially when she insists on condom use. “Clients threaten us, …beat us, and a client can even remove a pistol”, Kira told me in 2010. She was reluctant to report sexual abuse to the police because sex work is criminalized in South Sudan.

Although she received a positive HIV test result in Uganda, Kira said she never used healthcare facilities in Juba ─ including when she had sexually transmitted infections (STIs), which could increase the risk of transmission of HIV ─ because of fear of stigma.

Kira’s experience is not unique. Many sex workers in Juba live in poor conditions and face immense challenges and rights violations, including sexual violence, stigma and discrimination, and lack of access to HIV prevention and treatment services. The government responded to the expansion of sex work in Juba by demolishing some of the markets that hosted the brothels in Juba. These factors, along with criminalization of sex work, can contribute to the spread of HIV among the general population in South Sudan.

HIV prevalence in South Sudan is three percent. Prevalence rates vary between states, ranging from as low as one percent and as high as 7.5 percent in states that border high-prevalence countries, such as Uganda. Although there are no statistics on the HIV prevalence among sex workers in South Sudan, it is likely that HIV is high among this group. A study in Juba estimated HIV prevalence among the general population as 3 %, among commercial female sex workers as 16%, and among male clients of sex workers between 1985-1995 as 13.5%.

The majority of sex workers are women from neighboring countries including the DRC, Ethiopia, Kenya, and Uganda. There are also increasing numbers of local sex workers: young girls with minimal knowledge of HIV who, according to Veldwijk and Groendijk, turned to sex work because of poverty and unemployment and to escape forced marriages.

Gender-based violence is endemic in post-independence, militarized South Sudan, which increases sex workers’ vulnerability to violence and affects their ability to address its consequences. Small arms are abundant, and five decades of conflict and marginalisation at the hands of successive governments in Sudan have debilitated the healthcare infrastructure. Violence at the hands of clients, especially soldiers, is a constant fear and experience for sex workers in Juba, especially those who insist on condom use. Sally, 34, who came to Juba from the DRC in 2008, said

“I want to use condoms but most condoms burst because of the way clients use them. Some clients tell me they do not want to use condoms, and when I insist, they go. Others will agree because…I ask for more money if I do not use a condom. Sometimes clients beat me up when I insist on condom use. Some are very bad. They agree to use condoms and when they reach the room they will refuse and threaten me or take out their pistol. I agree to have unprotected sex because I fear.”

The legal system offers little protection or redress for sex workers. Sex workers said in a focus group discussion that when they reported beatings to the police, “nothing happened”. Sex workers interviewed said clients at times reported sex workers who refused sex to the police and that, at the time of research, one of their peers was serving one year in prison “because she refused to go with a man” and he reported her to the police.

Civil society organizations and UN agencies have worked with the government to introduce programs to address the protection and healthcare needs of victims and survivors of gender-based violence, including sex workers. Nonetheless, services for them are still limited. Sex workers, especially those from neighboring countries, also lack access to healthcare services. Sex workers told me although they suffered “sicknesses and microbes other than HIV” such as “back pain”, “stomach ache”, “malaria” and sexually transmitted infections “like syphilis,” they never used healthcare facilities and instead bought non-prescription painkillers because of stigma and discrimination, including that perpetrated by healthcare workers.

According to UNAIDS, HIV among sex workers and their clients plays a key role in the spread of HIV in the general population in sub-Saharan Africa, with clients being “a potential epidemiological bridge to other populations,” especially married women. According to Dr Lul Riek, then Director-General of South Sudan’s HIV/AIDS Directorate at the Ministry of Health, this is particularly a problem because of social and cultural expectations that married women should be “available” to their husbands, regardless of a husband’s sexual behavior.

As South Sudan was preparing for independence, the UN General Assembly adopted a political declaration in which member states committed to strengthening national efforts to eliminate all forms of violence against women, and to creating “enabling legal, social and policy frameworks in each national context …to eliminate stigma, discrimination and violence related to HIV.” While the meeting was male-dominated and involved limited references to gender and women, implementing commitments in the political declaration and promoting gender equality and women’s human rights enshrined in international human rights conventions would not only enhance South Sudan’s standing in the community of nations, it could contribute to ‘turning the tide’ on HIV and to saving lives.

This is one of a series of articles that openDemocracy 50.50 is publishing on AIDS gender and human rights in the run up to, and during, the AIDS 2012 conference in Washington DC, July 22-27.

The names of interviewees have been changed to protect their privacy. This article stems from a longer article published in Bubenzer, F. and Stern, O. Hope, Pain and Patience: The Lives of Women in South Sudan. Johannesburg: Jacana Media,


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