Interview: Daisy Nakato fights for sex workers' rights

KAMPALA, UGANDA — Daisy Nakato is  the founder and executive director of the Women’s Organisation Network for Human Rights Advocacy (WONETHA), a non-governmental organization dedicated to protecting the rights of sex workers in Uganda. The interview has been edited for length and clarity.

EG: I saw on the WONETHA website, there was a quote that said, “unless all women are free, no woman is free.” So, I’m wondering if to start you could just talk about the importance of sex worker’s rights in Uganda?

Daisy: In Uganda, we first used it on Women’s Day. There was the national event where women were celebrating, but is there anything a sex worker has to celebrate? We are not free, we are not happy. The working environment, the violations that are happening, you know? So we say we are not free.

And so we went to one of the police posts around and we renovated the women’s cell, where they always imprison our people. It was very dirty, very messy, with a lot of insects. The men’s cell was clean and the female one was very dirty. So everywhere, wherever you go, you will find women being oppressed and having the bad things. So we said we have to renovate. We painted it and we did the floor. We’re like, okay, at least even if someone is in prison, let them be in a clean place, it doesn’t matter what kind of crime you’ve committed, you still have a right to be in a clean place.

So no woman is free until we are all free, because there are those who believe they are high class. There are those who believe they have all the rights in the world. I think some of us, because of the work that we do or because of the class or because of the level of education, we are still left behind.

So we say, however much other women celebrate, there is nothing to celebrate. You cannot celebrate when your fellow women are not happy. And we were actually calling them upon to come and to leave the celebrations and come and join us so that we walk the journey with all women until we all achieve.

EG: What are the biggest obstacles facing sex workers right now in Uganda?

Daisy Nakato sits in her office at WONETHA, an NGO that works to promote sexual education, economic empowerment and social change for female sex workers in Uganda. Nakato founded the organization in 2008 along with Catherine Namagembe and Macklean Kyomya. (Nicole McPheeters – The Media School).

Daisy: Well, one, our work is criminal. Our work is not accepted as work. That brings about the discrimination within the community, within where we live, where health services discriminate against you because you’re doing an illegal job. They see you as a criminal person. That brings in self-stigma among the sex workers.

Much of the work that we try to do is to empower our women to know that they’re doing the right thing by putting food on their table whichever way they get money. They’re supporting their children, so they shouldn’t be ashamed of the work that they do. They have to be strong, and then look up to the future.

But the community sees us as criminals, sees us as bad women, women who refuse to get married, women who go to school, who dropped out of school, and so we are doing something that is not allowed by the society.

The health worker, because they are from the same society, so that’s the same perspective that they have about the sex workers. And then the violations that happen because of the criminality of our work. The clients will get out of paying you, they’ll beat you up, the police are arresting you for no good reason and detaining you, and because the work you’re doing is illegal and you have no say.

EG: When women who are in sex work seek medical care, especially related to reproductive care, what do they encounter?

Daisy: Well, in most of the health settings, especially those that we [WONTHA] have not sensitized, the reception is not always good. Because if it’s an STI [sexually transmitted infection] or HIV [the virus that causes AIDS], they have the perception that you called for it. Why did you do a risky job that was going to leave you infected? They put the blame on the sex worker without attending to them or listening to them. Some workers try to go to pharmacies and use medication without going through that humiliation of being asked so many questions. And so one method is to sensitize the health workers and have a dialogue with them and tell them what sex work is and we share our own stories why we joined sex work and let them accept us.

These health workers, when they are doing their training, they are not trained to treat any particular group of people. They’re supposed to treat everyone with respect. And so it doesn’t matter what kind of job that I do as long as I come to you for treatment, you offer me quality treatment and respect me and what I do. We normally have sessions where we bring the health workers, we bring in the sex workers, and we have a dialogue. We tell them the dos and the don’ts.

The idea is to ensure that everyone goes to the hospital for treatment, especially now that the government is working hard on ensuring that we keep the 90-90-90 goals. And they cannot do this without us because we are very active in sex, we have so many clients, and so if they leave us out they aren’t going to achieve. And actually that’s one achievement that we’ve had to work with the government.  And so health workers have to ensure that they make the health centers as friendly as possible, as accessible as possible, to ensure that people come. And if people just go away without coming for treatment, then the government is not going to achieve.

EG: Can you tell me about the work you’ve been doing with the government?

Daisy: Well, the research shows that HIV is high among the sex workers. And of course if HIV is high, we all know sex work is criminalized, but the government has no ways of stopping everyone from selling sex. Even when they arrest, the day you come out you just come back to the street. So the government has not put programs in place to ensure that these economic empowerment for all the women, for them to stop going to the streets. So they have partly accepted that these women are there and we have to work with them. And so, for the government to work with the sex workers, they have to work with them through WONETHA.

And so, we have actually opened doors for us within the government facilities, health facilities, they have allowed us to train them, to talk to the health workers and see how we can build that rapport, ensuring that our members go and get treatment. They have even opened up clinics, stand-alone clinics, like the MAPI clinic in Mulago and others in other regions where sex workers go and feel safe and respected. The condoms we are getting, we are getting them through the Ministry of Health, they know they are coming to the sex workers.

WONETHA is getting huge amounts of condoms. Sex is very cheap. Men pay 2,000, 3,000 [Ugandan shillings] for sex, so you don’t expect a sex worker to take 1,000 out of 2,000 and buy a condom when she has children in school, she has children who need food, she has rent to pay, she would rather take a risk. [One thousand shillings is worth 28 cents.] And then there are those men who come promising to pay more money for unprotected sex. And sex workers don’t have information. There’s no way we’re going to provide information when we don’t have the condoms to provide. So you give us the condoms, we’ll go and talk to the sex workers, tell them to use the condoms when we have the condoms to give them. We need to be sure that every corner where sex workers are can have access to free condoms. We don’t care how mu
ch people sell sex. As long as they’re going to use a condom, it’s very safe. They’ll not get unwanted pregnancies, they’ll not get any infection, no HIV, they’ll be safe. Just leave the work of promoting the condom use to us.

EG: Could you talk about the condom education and the sex education that you help to provide?

Daisy: We do the condom education because what is written on the condom is in English, and even if it was in the local language, still not everyone knows how to read. So, we go to where our members are and we bring in groups and we have demonstrations. We have a female vagina, then we have a penis. So we practically show them how you put a condom on. It’s one thing to have a condom, it’s the other using it. So we train them on how they use it and the storage, the expiry date, and then how you open it, how you put it on, everything. And if they ask questions, we ensure that they know.

We also train the peer educators to support us if a new member comes in. We have now 46 peer educators and those 46 sites. And we also have the rooms, after we distribute condoms we keep the boxes in the peer educators’ rooms. So if a new sex worker came in, they give them that information and they give them the condoms to start using. Some women, some come from marriages where they’ve never used a condom before. Some are from their boyfriends, and they even have that fear, a lot of myths about the condoms. So we try to fight the myths and we told them how good a condom is, we try to share our own stories, how condoms have helped us.

EG: So you see a lot of benefits from peer-to-peer education versus having health officials come in?

Daisy: You know, health workers have a problem. They cannot stand before people and tell them, this is a penis, this is a vagina. They don’t use that language. And actually, we’ve been hearing stories where health workers go to demonstrate condom use and use a banana or use a cucumber or something, and say, when after, you know putting a condom, and then you put, their language, they’re not direct. So we go to health workers and they train us the right way. And we did not care their language because we were getting the right information on how to use it. And then we started doing it ourselves.

EG: Why do they use such indirect language?

Daisy: It’s culture. It’s good women and good girls from very good families, you know, they went to high school and went, did their degree, they have never been exposed, they have never gone through what we go through. They don’t want to hear such words. But here, we are talking about a penis and a vagina and you have to be direct about it.

So once you start and you’re talking about people who do not have enough information, people need to know exactly what you’re talking about. Don’t say “if a man is ready, then put the condom on,” say, “if the penis is erect then put the condom on.” Let them understand, make the language be direct.

We have seen a lot of improvement. We used to have cases of women getting pregnant and then wanting to abort because they did not use a condom correctly and they don’t know the man that got them pregnant. You definitely don’t want to have a child if you don’t even know their father. And so, there are so many cases, and so many cases of STIs. But they have reduced. They have some confidence now.

EG: Do you believe that having the education makes it easier for the women to negotiate?

Daisy: We emphasize that so much. That’s why we tell them, you need to have as many condoms as possible, keep some in your room, some in your house, some in your purse, so wherever you are you have condoms. You never run out of condoms. And then we tell them how to negotiate. Because WONETHA is for and managed by sex workers, we are all sex workers here, we have gone through so many challenges and so many experiences that when we share them, we can help other people to do their work better.

EG: What do you think are the biggest misconceptions people have about sex workers and HIV?

Daisy: People see us as disease carriers. They believe every sex worker is HIV-positive. And they believe that we are there to spread the virus. But it’s not true. That’s why we really emphasize for all sex workers to know their HIV status so that it’s easier for them to protect themselves or protect their clients.

We mobilize, and then we invite them to come and test, and then we refer and do follow ups. We want to ensure that even if you are HIV positive, it’s not the end of the world. You can still be healthy, you can still do sex work without even passing it on to any other person, as long as you take your medication well, your viral load is suppressed, you take good care of yourself, and you use a condom, you cannot infect anyone. And that is scientifically proven.

It’s a normal thing now, HIV. It’s not scary, it’s not like you’ve signed your death sentence because you’ve tested positive. So people are strong, and because of the experiences and the stories they hear from their peer educators about living with HIV and still managing to work and achieving a lot and have babies who are HIV-free even when they are positive. So all these stories encourage them to live a positive life.

EG: What do sex workers need to reach UNAIDS’ 90-90-90 goal?

Daisy: The biggest step to improving things is involvement, involving sex workers in programs that are going to happen. Consulting us. When we’re involved we feel we have to work together, it’s a team. We are working as a team and not working as sex workers.

Another thing would be condoms and lubricants. The government is still skeptical about lubricants. Some people feel it’s for the gay men, that they’re the ones who need the lubricant, but it’s for everyone, even married women. Because not every day you will be prepared for sex, so if you’re not and your man wants, you definitely need a lubricant so that the condom doesn’t break. It applies everywhere. The lubricants are not totally for gay men, they are for everyone. We really, really need them.

So, it’s lubricants and condoms and ensuring that every sex worker has the information. You know information is very important, if someone has information, they will make informed choices. Let people know where health facilities are, what is provided there, where are condoms, where can you go for testing, and then they will make informed choices. But people make a lot of mistakes because they don’t have information.

EG: What kind of programs do you run to help educate sex workers?

Daisy: What we have here is the functional adult literacy program, where teach our members to read and write English, have the basic skills in life that can even support them when they are outside sex work. The training is about their self-esteem, improving their confidence, negotiation skills. It’s a three month training, and then they graduate and go on to another level.

So we have others who graduated last year, they are now doing computer learning. We like to hire women from the classes. So they go from reading and writing to computer, and then when we send out a call, they apply and join us. And then we have the field work, the condom distribution. Because of the budget limitations, we try to give as much as we can to a site so we don’t frequent there.

EG: Can you talk more about the clinics you work with that are trained to treat sex workers?

Daisy: Yes, for example, the one that is in the Ministry of Health, MAPI, Most At-risk Population Initiative, which only works on key populations. So it’s for the sex workers, the LGBTI community. We refer most of members there. And then there’s some in government facilities where we have identified partners and sensitized them. And we’ve created a referral system so when they get there, they know this person is from WONETHA and they’ll know this person is a sex worker, and they don’t even let them queue up for long.

Most of our member work during the day, so to spend their entire day in a hospital queuing up and being
asked so many questions, they don’t feel comfortable. So these health workers that we talk to, that we sensitize, they know what questions to ask. They may not ask, “when did you last have sex, how many sex partners have you had?” Because in reality, in a busy day, you cannot even know how many clients you have. Or you’re going for a test and they ask you to bring your partner, if it’s a person handling a sex worker they’ll know this is irrelevant. So, they feel safe there, they don’t feel offended.

If sex workers are very comfortable going there, they’ll even tell their fellow sex workers. They even ask for numbers, and if that worker is not there, they will not go there. And that is one of the challenges we face, because these government health workers, they keep on being transferred, so the next time you go, the person who is friendly is not there.

What we’ve started doing is ensuring that we’ve not only sensitized one or two, because we used to have workshops where we’d bring a few, so we go to that health facility now and make sure that all of them sit. They ask funny questions and we explain to them.

So all the questions they would have asked a client in the room, let them ask us. “Oh, why did you choose to go into sex work, why don’t you get married?”

We have all the answers because we’ve been through this. So you ask me now, and when you get to that room, please treat. Don’t ask questions. Don’t judge. Your work is to ensure the person gets treatment.