Revealed: How married women compete with sex workers for condoms

Condoms at display at Afrika Mashariki awards take 5 campaign [File. Standard]. "I have a husband but have to do this to fend for my children. He works as a stone mason and what he earns barely gets us through," confesses Grace, not her real name. "From Monday to Friday, I prepare my two children for school, ensure that I drop them off, and then leave for downtown Nairobi. I don't consider myself a sex worker as such, but just someone out to earn a living," says Grace, a married woman living in the slums of Mathare and engaged in sex work. "I have been married for six years now and I am not the only one; we are quite many," adds Grace, who operates only at daytime at a popular joint along River Road, downtown Nairobi. In a shocking revelation, the National Syndemic Disease Control Council (NSDCC) has raised alarm over married women increasingly competing with female sex workers for free condoms at distribution points, amid dwindling supplies. Dr Douglas Bosire, the council's acting Chief Executive Officer (CEO) says the challenge stems from many women like Grace who engage in transactional sex without registering formally as sex workers, making it hard to accurately estimate demand. "Our projections rely on data from registered sex workers. But when women in transactional sex don't identify as such, it skews planning and disrupts supply chains, leaving the public vulnerable to HIV and other infections," Dr. Bosire warned. Kenya has 285, 505 female sex workers, according to population size estimated by the Ministry of Health conducted last year, numbers that are underestimated. "Buying condoms is a bit expensive, and therefore I largely rely on the free condoms. We simply find them in the toilets at the club where I operate from, but these days they are not as available as in the past," says Grace. "Most clients come knowing that we always have the free condoms with us, and so because of the shortage, sometimes I have to buy, but the client will have to pay an extra amount," she adds. "After all, I show them that the kind of condoms I have are not the free type," observes Grace. "I have to insist on using a condom because I have a husband. I need to protect him, as he doesn't know that I engage in this business," says Grace. It is emerging therefore that inaccurate data is disrupting Kenya's ability to plan for HIV prevention commodities like condoms and Pre-Exposure Prophylaxis (PrEP). "So you find yourself planning for fewer people, yet in reality, the demand is much higher. In Nairobi, for instance, we are seeing a growing trend of married women leaving home in the morning to engage in commercial sex work, only to return home in the evening. Just like you and I go to work. But do they identify as sex workers? No. And there are many of them," says Bosire. Unregistered women dealing in transactional sex are not only in Nairobi but in respective urban centers across the country, notes Bosire. Adding to the strain is the growing issue of condom hoarding. "We're also seeing people hoarding condoms," said Bosire. "Whenever there's a rumour of a shortage, some individuals collect far more than they need. If someone should take 40 condoms, they pick 100, disrupting the supply and leaving nothing for the next person." Kenya requires at least 450 million condoms annually, but currently, the country depends on Global Fund, well wishers and Non-Governmental Organisations. Every man requires about 40 condoms annually, but current supply levels fall short. Due to the limited stock, free condom distribution is now targeted primarily at key populations such as sex workers, people living with HIV, and discordant couples. The commodities are available at designated drop-in centres and moonlight outreach points. Bosire emphasises that female sex workers remain among the key populations at highest risk of contracting HIV, alongside men who have sex with men, people who inject drugs, and transgender individuals. The high prevalence of HIV in these groups is a growing concern as Kenya works toward its goal of ending new infections. According to the latest data from NSDCC, HIV prevalence among female sex workers stands at 29.3 percent, nearly ten times higher than the national average of 3.3 percent. "This is a serious public health concern," warns Bosire "The high prevalence in key populations can spill over to the general population, especially since many of these individuals have families and spouses." New cases of HIV infections are already being reported among sex workers, risking a spill to the general population. Elizabeth Siama, an official of Coast Sex Workers Alliance (COSWA), has raised alarm over a growing HIV risk in Mombasa due to a crippling shortage of condoms, lubricants, and PrEP. "For six months now, condoms have been completely out of stock. We have also not seen lubricants over a year now" Siama tells The Standard in an interview. "This is a disaster in the making." With no free supplies, sex workers are forced to buy condoms at exorbitant prices ranging from Sh50 to Sh1,000 depending on the brand. This, Siama says, is driving many into risky, unprotected sex. COSWA, supported by the Stawisha Pwani program, has been at the frontline of HIV prevention through testing, distributing HIV prevention commodities, and encouraging the use of PrEP. But for the past two months, even PrEP has been inaccessible. "Health workers tell us it's reserved for pregnant and breastfeeding women. But we need it too because condoms can burst," says worried sex worker. The erratic supply has sparked fear and frustration. "Some clinics offer nothing, others give just a week's supply. We are not sure if or when we' will get more. The inconsistency is causing more anxiety and fears," she observes. COSWA has been working with government facilities to ensure sex workers in hotspots get condoms, HIV testing, treatment, and are encouraged to take PrEP. But the outreach has stalled. "Only a few outreach programs have been done recently, and already, we've seen five new HIV infections. I'm sure it's because we didn't have PrEP," said Siama. The current shortage is threatening the health and livelihoods of over 3,290 registered sex workers in Mombasa, where nearly 20 per cent are already living with HIV. "When clients bring their own condoms, they often deduct the cost from our payment. That eats into our income. But what's worse is when there's no condom at all-we're left exposed," she said. Siama, pleads with the government, "We chose this work to survive. We are doing our part. The government must do its part too. Give us condoms. Give us PrEP. Test us. Protect us." Lulu* a 24-year-old sex worker based in Tudor, Mombasa, stands on the frontlines of survival while shouldering the cost of her own protection. Though she faithfully uses PrEP to prevent HIV, Lulu insists condoms are non-negotiable. "PrEP protects me from HIV, but condoms shield me from other infections like gonorrhoea, syphilis, and chlamydia, which can cause infertility by blocking fallopian tubes," she says. But with Kenya facing a widespread free condom shortage, Lulu is forced to buy them herself, passing the cost to her clients. "If I know the client's HIV status, we may skip condoms. But with new or unknown clients, I insist and charge extra, sometimes up to Sh1,000, to cover the cost," she tells The Standard. As a PrEP champion, Lulu not only uses the drug but also educates others. Still, access to PrEP is becoming harder. Initially, sex workers used to receive a supply of three months that has now been reduced to only one month at a time. Some reports being turned away entirely, with PrEP prioritised for pregnant and breastfeeding mothers, following Trump's order on waiver.s "The Stop Work Order by President Trump disrupted the supply of commodities like PrEP. I've been on it daily since 2018, but now stocks are tight. Even so, I won't compromise-I use condoms and negotiate with clients at the hotspot before any encounter," she adds. Lulu's journey into sex work began at just 16, while still in school. Back then, she hid in shame, but today, she captures her clients on streets, speaks out boldly, negotiating not just for money, but for her safety and dignity. Despite the limited supply of free condoms, NSDCC maintains that it is far more cost-effective to spend Sh50 or Sh1,000 on condoms than to contract HIV, which requires lifelong treatment. "Our adolescents and young adults will spend Sh500 or even Sh2,000 when going out, but when it comes to buying a condom for Sh50, it suddenly becomes the government's responsibility. This is not sustainable. A single unprotected sexual encounter can have life-changing consequences," warns Bosire. Currently, NSDCC is reporting increased cases of STIs in hospitals, indicating an increase in unprotected sexual activity. "This means people are engaging in unprotected sex. At worst, you could contract HIV. While infections like gonorrhoea and syphilis are treatable, HIV is not - it remains in the body for life and brings with it stigma and discrimination," says Bosire. He adds, "What we want Kenyans to understand is that just one episode of unprotected intercourse can result in infections like gonorrhoea, syphilis, or chlamydia - all of which are on the rise." Currently, the government spends at least Sh15,000 per year to keep one person on HIV treatment, amounting to a total of Sh25 billion annually for HIV-related commodities.

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