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‘I sell sex, not bananas’

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PrEP IT ENCOURAGES INTERACTION — Katumba

To many, business is all about selling foodstuffs, household items, among many other things which are regarded to be ‘morally right’ to sell.

Even though she has received a lot of criticism, discrimination and, of course, questions such as “why can’t you sell bananas?” Scotchy (not her real name) is having none of it, as she proudly continues plying the trade of selling sex.

The 23 year old woman, who looks energetic, confident and sociable, is however taking all precautionary measures to ensure that she does not fall pregnant, contract HIV and other Sexually Transmitted Infections (STIs).

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She uses Depo-Provera (injectable) contraceptive and  prefers to use female condoms.

“I make sure that I go for STI screening whenever I meet clients who don’t understand. I’m sure that i’m safe on pregnancy and HIV infection so that’s why I go for regular STI screening. I want to be treated early if I have one,” Scotchy  tells.

She is in thick dreadlocks and has a good choice when it comes to her attire. One would not easily deduce her trade until you interact with her.

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According to Scotchy, she ventured into sex trade when she was only 14 years old.

“I grew up with my cousins. Some of them went to South Africa while others were in and out of jail. Others were dying of Aids and Tuberculosis… I couldn’t go to school because I didn’t have a birth certificate,” the Zimbabwean born Scotchy said.

She added: “I don’t know anything about my parents. What I saw were their graves at our rural home where I grew up.”

She narrated that from a young age, men would sleep with her in exchange for food and clothes. She started demanding money from them thereafter.

“Since that time, family friends would shout at me. They said we are a cursed family because my cousins are criminals while many others have died. But they never mentioned HIV…” she recalled.

Though they say every face tells a story, nobody would know or guess hers. She does not have any traits that would give an impression that she is into sex trade.

Her looks and portrayed personality have been shocking many delegates during HIV Prevention Symposium meetings on HIV Prevention Research, where she has made open declaration that “I sell sex. I’m not a sex worker but I sell sex”.

Each night, she has sex with four to eight men charging $5 (K3, 675) for short time and $20 (K14, 700) for the whole night.

Nevertheless, Scotchy is not the reckless kind as she has her health at heart. When she saw a flyer about a new research to be rolled out in her area back in her home country, Zimbabwe, she decided to be part of it.

She is one of the women in her line of trade that participated in a study to determine the effectiveness of Pre Exposure Prophylaxis (PrEP).

According to AIDS Vaccine Alliance Coalition – Avac Introductory factsheet published in November 2017, PrEP is an HIV prevention method which involves using antiretroviral medications (ARVs) to reduce the risk of infection in people who are HIV-negative.

It may either be taken orally, using an antiretroviral drug available for treatment of HIV infection (tenofovir plus emtricitabine), or topically as a vaginal gel containing tenofovir.

Scorchy was initiated on PrEP in June 2014:

“I saw myself to be at potential risk of contracting HIV because I sell sex. I’m taking PrEP because I don’t have other options. I have lots of issues when it comes to condom use. At times, I get clients who have money and are in total control. I can’t negotiate the use of condoms. Sometimes I meet very violent clients who sexually abuse me. With PrEP, I’m in total control. I was told about the side effects and what to expect as I take these drugs.”

She acknowledged that PrEP is just one tool for preventing HIV, which should be used together with other prevention methods since it does not protect conception or contracting other STIs.

“I feel each and everyone is at risk through his or her perception. If you look at me, look at the ABC (Abstinence, Being Faithful and use Condom) strategy.

“I’m at risk because I can’t abstain from sex. I’m already into sexual activities; I can’t be faithful to one partner because I’m sleeping with like four to eight men per day,” said Scotchy, who had a child at 14 years old but does not know who the father is.

She disclosed that she only experienced nausea and felt sleepy during the first weeks of taking the drug but was back to her normal self later on.

PrEP is an oral pill which is taken daily to protect HIV negative people from becoming infected with HIV.

Scotchy attests to the fact that this drug only works to one’s advantage if properly adhered to.

“One needs to take it seven days before engaging in any unprotected sex. Mind you, this is not a drug that one takes continuously but only takes for a particular time they feel they might be at risk. Before being initiated on PrEP, one undergoes an HIV test to check whether they are already HIV positive or not. If one is found to be positive even after they were previously on PrEP, they are initiated on ARV treatment immediately,” she explained.

Scotchy does not hide the fact that throughout the years she has been on PrEP, she has noticed a high discrimination pattern.

“At the beginning, many communities didn’t know about this pill so they thought it’s an ARV drug for HIV treatment. And personally, it’s not been easy to take this pill because it is big and it makes a lot of noise when in the bottle. Even when inside my bag,” she admitted.

Scotchy is also honest about how she is treated at health facilities, where there is high discrimination. She says health workers would somehow abandon their obligation and start asking her questions like, “Why can’t you stop selling sex and sell bananas instead?”

Much as it would appear easy and suitable for women who sell sex to use PrEP, she revealed that not all her colleagues are interested.

Programs Officer for Avac, Angelo Kaggwa- Katumba said nations have for long used ARVs as an HIV treatment but research revealed that it could be used for HIV prevention as well.

“This is true particularly tenofovir medications which people at high risk of HIV infection could be using, in addition to other prevention method tools that are already there such as Voluntary Medical Male Circumcision, Abstinence, Condom usage and being faithful to one sexual partner,” he said.

Katumba pointed out that Malawi has participated in a lot of biomedical HIV research, including the one to determine the effectiveness of PrEP but the drug is not yet available to everyone because the country is still working on the guidelines.

“ Adolescent girls, women, female sex workers , men who have sex with men and people that inject themselves drugs are at great risk of contracting HIV and this medicine would reduce their chances of acquiring HIV,” he said.

Katumba is calling on Malawi Government to consider adopting and investing in PrEP in order to reach the United Nations 90:90:90 targets.

The targets strive to have 90 per cent of all people living with HIV diagnosed; have 90 per cent of those diagnosed on treatment and 90 per cent of those on treatment having their viral load suppressed by year 2020.

“PrEP involves HIV testing which encourages one’s regular interaction with health workers who provide counseling from time to time,” he said, adding that it is important to take everyone on board in the fight against HIV, which includes key populations.

Katumba noted that many African countries’ moral beliefs discriminate against men who have sex with men (MSMs) and sex workers but the UNAIDS guidelines on HIV prevention and treatment are clear that no vacuum should be left out.

Ministry of Health officials said they are currently developing guidelines on the use of PrEP before rolling out.

“Daily oral PrEP is currently not approved for roll out. The ministry is supporting implementation research to gather more evidence that will guide future guideline revisions. We are not yet rolling out,” said the ministry’s spokesperson, Joshua Malango, adding that this should be considered as one of the HIV prevention interventions which the ministry is considering to implement.

It is likely that key populations such as the likes of Scotchy are excited with the introduction of PrEP as it empowers them to have safe sex. She is now an advocate working in one of the organisations (name withheld) that deals with women who sell sex. She is also studying at night school and will be writing Ordinary Level examinations this year.

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