Economic dependence exposes sex workers to stigma & health risks

By Erica Gibson & Victor Grössling

KAMPALA, UGANDA — Sex is easy to buy in Uganda.

Although prostitution is illegal, the Ugandan government estimates that at least 54,000 women engage in sex work in Kampala alone. Women work in every neighborhood, catering to a variety of clients.

Sex work is a negotiation for livable wages, safety and survival. It exists at all socioeconomic tiers. The price and outcomes may differ, but the diseases and health consequences are the same everywhere.

In Kampala’s Kisenyi slum, women work day and night in a crowded brothel where rooms are divided by hanging sheets. Downtown, sex workers pace the grounds of Rock Bar across from the Kampala Sheraton, dancing to American pop music in expensive dresses. These are the parallel worlds of Betty* and Sonia**.

Betty is a 45-year-old mother of four. She has worked in the Kisenyi brothel for 15 years.

Betty spends four hours a day, five days a week in a brothel in the Kisenyi slum. On a good day, she makes 50,000 shillings or about $14. (Victor Grössling | The Media School)

Dirt and sweat and weigh down the dense air of her room.  She coughs frequently into a white handkerchief. Across from her, women nap facing each other head to toe on a twin-size mattress. Betty is barefoot, and wears a loose button-down shirt with fading colors. She will work all afternoon before returning home to her children for dinner.

When Betty finishes her work today, Sonia will begin her night of work across town at Rock Bar.

Sonia is a 25-year-old Rwandan. She moved to Uganda three years ago to escape strict government laws in her home country, including a 10 p.m. curfew that makes her line of work difficult.

She has a full face of cleanly applied makeup: mascara, penciled eyebrows and light lipstick. Her hair is short, black and styled in twists. She wears a black and white sleeveless shirt, long red skirt and black patent heels with a peep toe.

Sonia owns a restaurant near Makerere University in Kampala, but money is scarce when students return home for the summer. She started working the Rock Bar in 2015 to support her six-year-old son.

“I have to look other places to get some money for my child,” Sonia says.

Both Betty and Sonia say many sex workers are also mothers.

Betty started sex work when her husband left her family in 2002. She had no formal education, but needed to pay for her children’s schooling.

Betty’s oldest child is a medical student at Makerere University in Kampala. She hopes he will provide for the family when he graduates so she can retire. He and his siblings do not know their mother is a sex worker.

“Most women who are doing it have many problems,” Sonia says. “They have children to take care of, they come from a poor family or they didn’t go to school. That’s how most women come to be prostitutes. Even my friend who went to school doesn’t have a job. She came here to look for money.”

Seeing one client a night can earn Sonia as much as 700,000 Ugandan shillings ($194). The man will meet her at the bar, buy her a drink and get for a room in a nearby hotel before paying her for sex.

In contrast, Betty pays 20,000 Ugandan shillings a day for the room she uses in the brothel ($5.50). She works five days a week for four hours at a time. On good days, she makes 50,000 Ugandan shillings ($14). Other days she breaks even or loses money and so cannot afford to pay the day’s rent.

“They chase you out if you cannot pay,” Betty says.

She cannot return until she has the money.

The entrance to a brothel in the Kisenyi slum. The brothel hosts 80 women sex workers. (Victor Grössling | The Media School)

No matter what rate a sex worker charges for her time, men are always willing to pay more for sex without a condom.

“Sometimes you can go with someone who is bad and doesn’t want to pay you,” Sonia says. “You can go with someone who tries to fuck you without a condom. Maybe he has HIV or another disease I don’t know about. And you try to fight it.”

In Uganda, 37 percent of sex workers are HIV-positive, the highest prevalence rate of any of the country’s high-risk groups. The Ugandan Ministry of Health identifies sex workers a “key population,” meaning their medical treatment is instrumental to curbing the epidemic. But despite its illegal status, sex work still accounts for 16 percent of the country’s new infections.

Betty says the 80 women in the brothel prefer to use condoms, though men can become violent when women negotiate condom use. Betty uses a stick to cane men if they become aggressive when she rejects them. She cannot turn to the police if a client becomes aggressive without risking arrest or extortion.

Health workers from the Most At-Risk Population Initiative (MAPI) at Mulago Hospital in Kampala visit the brothel every three months. Betty says MAPI tests her for HIV every visit and remains negative after 15 years of sex work. She says she must remain healthy for her children. Betty is in charge of giving the other women the condoms MAPI leaves for her and the others.

“I will fight the men who do not want to use condoms,” she says. “I chase them out.”

In more affluent settings like Rock Bar, men are willing to pay for immediate HIV testing so they can have unprotected sex. Sonia takes them to a 24-hour clinic where they are tested for HIV and other sexually transmitted infections. She does not disclose her HIV status.

Sonia feels stigmatized as a sex worker. She says that people will jeer and openly ridicule those who are known or suspected to be sex workers.

Only one close friend knows about her work. Sonia says if people found out, they would tell her children and treat her poorly. People are suspicious when they see her going out certain nights dressed up. She keeps her secret.

“They think that we are there just to fuck, that we’re not human beings,” Sonia says. They think “we don’t have plans for our lives; for our children. They think that we can’t fall in love. But it’s not true.”

[*Betty and **Sonia are not their real names. Their identities are being concealed so they can avoid discrimination and harassment.]