Sandy* walks into the small room quietly, her gentle smile revealing a softness that contrasts with the life she has lived. The 22-year-old greets us politely before taking her seat, appearing calm, almost shy.
But behind that youthful face is a story marked by resilience. She was just 17 when pregnancy changed the course of her life. Her older boyfriend had gotten her pregnant, and when her mother discovered this, she was cast out from home.
“I moved to Kariobangi to live with him,” she recalls. What should have been a new beginning became another nightmare. After she gave birth, the beatings began. The man who had promised her a future became someone she feared.
With no other options, Sandy made the difficult decision to take her child back to her mother and leave. She arrived in Nairobi with nothing except a friend who offered her a place to stay in an informal settlement. Their home was a mabati house in Kariobangi.
It was this friend who introduced her to the only work she could find at the time – sex work.
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Sandy has survived violence at the hands of both men and women. For the past five years, sex work has been her only source of income. On a good day, she sees around five clients, a routine she has come to rely on for her livelihood.
Navigating risk and safety
Yet the work comes with risks she has learned to navigate; violence remains a constant shadow. She remembers offering a condom to a client, something meant to keep her safe, only for him to rape her.
“I did not report it to anyone,” Sandy says. In that moment of trauma, she felt utterly alone. But she was not. Other women in the trade, women who understood what she was going through, reached out. They took her to a drop-in clinic, a safe space where she could finally speak about what had happened.
There, Sandy received post-exposure prophylaxis (PEP) to prevent HIV transmission and was put on pre-exposure prophylaxis (PrEP) for ongoing protection. More importantly, she found something she had not had since leaving home: community and support without judgment.
Cindy* is vibrant and chatty. The 24-year-old has been in sex work for the past three years, seeing at least five clients in a good week, along with a few regulars who return often. But behind her cheerful demeanour lies a reality shaped by constant negotiation and risk.
In this line of work, protection, both physical and sexual, is essential. Cindy says she learned this the hard way. Whether dealing with a regular or a first-time client, her rule is simple: when a client refuses to comply with safer sex practices, she does not offer the service.
Even so, this boundary has not shielded her from harm. She recalls moments when offering a condom was met with anger, and in some cases, outright violence.
She also encourages clients to use self-test kits before any encounter, but this suggestion is often poorly received. “Most don’t respond well when you mention testing,” she says.
Her journey into sex work has been anything but easy. “I have been harassed by clients. On my first day on the job, I was beaten. I was also bullied by fellow sex workers,” she recalls.
The most traumatic moment, she says, was losing a close friend who died during work after leaving with a client. “In this work, we always carry condoms when going to the hotspots,” she explains. “But the challenge comes when you try to negotiate with clients.”
For Cindy, insisting on safer sex is not just a conversation; it is a daily balancing act between protecting her health and navigating the unpredictable reactions of the men she depends on for income.
She is not alone. Cindy and Sandy are among ten female sex workers in the capital city who told The Nairobian that negotiating for safer sex often exposes them to violence, intimidation, and humiliation.
These experiences have pushed many of them to find new strategies to protect themselves, earn a living, and maintain some control over their sexual health.
Across Kenya and globally, female sex workers are often treated as disease carriers, judged harshly, and blamed for public health concerns. Many report being despised, verbally abused, or physically assaulted by clients the moment they mention condom use or safer sex.
Despite being equal participants in the transaction, clients often feel entitled to dictate terms, including demanding unprotected sex.
A 2024 systematic review in The Open Public Health Journal highlights that stigma, criminalisation, violence, and persistent human rights violations restrict sex workers’ access to healthcare and significantly elevate their risk of HIV and other sexually transmitted infections (STIs). These realities mirror Kenya’s own landscape.
Recent national estimates show the scale and vulnerability of key populations. A mapping exercise by the National AIDS and STI Control Programme (NASCOP), the Key Population Consortium of Kenya, and Partners for Health and Development in Africa places the number of female sex workers at more than 167,000, with about 32,000 Kenyans identified as men who have sex with men (MSM).
A more recent 2024 United Nations Population Fund (UNFPA) report suggests the numbers may be even higher, estimating approximately 200,000 sex workers in Kenya, with Nairobi alone accounting for more than 40,000.
Experience of long-term workers
In a typical week, Trixie* sees about 28 clients, including several regulars. The 34-year-old has been a sex worker for 18 years. She insists on condom use with both new and returning clients. Trixie says she is HIV-negative, having taken her last test three months ago.
“When I leave the house for my hotspot, I carry both male and female condoms. I have to go prepared because it is hard to convince some men that protection is necessary. A few agree, but most refuse,” she explains.
According to her, the negotiation is often delicate and unpredictable. Some clients resist any discussion around protection, forcing sex workers to find creative ways to stay safe. “We try to persuade them, but some still say no. Sometimes we have to be tactful because many men just don’t like condoms,” she says, adding that younger men tend to be more resistant than older clients.
For Trixie, payment comes first before any service, a rule she has adopted over the years. Even so, she has endured various forms of gender-based violence, from verbal threats to physical intimidation, especially when she insists on safer sex.
One of the most alarming challenges she faces is deliberate interference with condoms. She recounts incidents where some clients tamper with them, poking holes and tearing them with their nails.
According to the World Health Organisation (WHO), sex workers globally face extreme physical violence.
In response, sex workers have built informal networks for safety, sharing strategies for negotiating condom use, screening clients, and providing community support to continue earning an income while protecting their health.
Support systems and clinics
At a drop-in centre run under the Bar Hostess Empowerment and Support Programme (BHESP) in Kariobangi, an organisation serving vulnerable populations, the site manager, a clinician who requested anonymity, witnesses these painful realities every day. “The girls try to protect themselves. They want to use condoms. They try to negotiate safe sex. But the problem is the clients they meet, men who are often violent,” she says.
For many of the women, she explains, condom negotiation remains one of the biggest triggers of gender-based violence. “Some clients accept, some refuse, and when the girls try to defend themselves, they are blamed for it. We see all forms of violence: verbal, emotional, physical, even harassment, and about 60 per cent of the cases we see are linked to condom negotiation.”
The drop-in centre, which handles over 100 women a day, was established to provide what mainstream hospitals often fail to offer – privacy, respect, and non-discriminatory care. Here, sex workers can walk in freely for HIV testing, STI screening, cervical cancer screening, GBV support, family planning, and health education.
The manager explains that public facilities, although mandated to serve everyone, still struggle with stigma. “When they go to normal hospitals, many feel judged because of their work. That’s why they prefer coming here. They find their peers, a safe space, Wi-Fi, health talks – everything. Here they can open up. In public facilities, they hesitate.”
Peer educators who are themselves sex workers play a central role in mobilisation and follow-ups. They distribute condoms weekly, offer health education at hotspots, and encourage women to visit the clinic for quarterly testing. The centre currently supports a cohort of over 10,000 female sex workers, most of whom remain HIV-negative. “Our aim is to maintain them as negative,” she says. “We haven’t recorded seroconversions in the existing cohort. The positive cases we see are usually new enrolments – women who come from new hotspots and are tested for the first time.”
Despite this, national statistics continue to report that sex workers contribute significantly to Kenya’s HIV burden figures – a reality the manager believes must be interpreted carefully.
“I don’t think the numbers tell the whole story. Many of our women are negative and working hard to stay that way. But some may not disclose their status publicly because of stigma. And remember, as long as someone has multiple sexual partners in transactional sex, they are considered high-risk even if they’re HIV-negative,” she notes.
Systemic challenges
Recent data paints a stark picture of the risks female sex workers continue to face. The 2025 National Syndemic Disease Control Council (NSDCC) report, released by the Ministry of Health, shows HIV prevalence among female sex workers at 27 per cent, higher than the 18 per cent among men who have sex with men.
A 2024 PLOS Global Public Health study puts Nairobi’s prevalence among female sex workers at 28 per cent, with national estimates at 29.3 per cent, compared to 4.3 per cent in the general population.
According to Dr Emily Mukomunene, a Health Rights and Advocacy Champion, female sex workers in Kenya face a heightened burden of HIV and other sexually transmitted infections largely because their negotiation power is extremely low. “They are dealing with male clients who are strangers to them, and because sex work is their source of income, they often cannot assert their terms beyond payment,” she explains.
Cultural beliefs, male chauvinism, and the widespread perception among men that condoms reduce pleasure further weaken sex workers’ ability to negotiate safer sex.
According to Dr Mukomunene, clients range from low-income men to politicians and businessmen, who sometimes use threats of arrest or humiliation to force unprotected sex.“Some even use abusive language or become physically aggressive when condoms are mentioned. Many sex workers simply withdraw out of fear,” she says.
She adds that the risks are higher during menstruation, when women are more biologically vulnerable. The psychological toll, too, is severe: “They know they are risking their lives, but they need the income,” she says.
Despite sex workers’ efforts to carry condoms, use PrEP, and attend testing, client resistance undermines their precautions. Some men tear condoms or throw them away.
As a result, forced unprotected sex exposes them to HIV, STIs, HPV, and other infections, particularly during menstruation, when vaginal tissues are more vulnerable. “The psychological trauma is just as serious. They know they are risking their lives, but they need the income,” Dr Mukomunene notes.
She identifies several systemic gaps that leave sex workers exposed, including criminalisation, stigma, discrimination by law enforcers, weak justice systems, and lack of social support.
“A sex worker who reports violence is often asked, ‘What were you doing there?’ This discourages them from seeking help.”
However, not all is lost; peer-led interventions have helped through peer education, moral support, and arbitration groups that help sex workers pursue unpaid dues or seek justice.
Legal reforms and advocacy
To reduce violence and improve access to respectful healthcare, Dr Mukomunene is advocating for legal reforms. “We need decriminalisation or a clear legal framework that protects sex workers. Counties should stop classifying them as loiterers, and we need safe zones where they can work without harassment,” she says, accusing police and county askaris of extortion and abuse.
She also urges policymakers to stop framing sex workers as the drivers of HIV infections while ignoring the role of clients. “Sex work is a willing-buyer, willing-seller trade. You cannot criminalise the seller and leave the buyer untouched. Without demand, sex work would not exist,” she asserts.
Along the Mombasa Road highway, Cathrine Kilonzo, chairlady of the Tupendane Sisters, a group working closely with female sex workers in Mtito wa Ndei, reveals that her community faces similar struggles. “Our girls face a lot of challenges. Despite giving them a lot of condoms, both male and female, many clients – especially truck drivers – resist using condoms or force lower prices when the women insist on protection,” she says.
Lobbyists, such as the Kenya Sex Workers Alliance (Keswa) continue to push for the decriminalisation of sex work.
Advocate Eugene Owade explains that although Kenya refers to prostitution under Sections 153 and 154 of the Penal Code, these charges rarely result in conviction. Instead, most arrests are based on county by-laws that are vague and easily abused. “The main challenge has been the immoralisation of sex work,” he says. “Everyone has a right to life, livelihood and dignity no matter what vocation we use to earn an income.”
The National Committee on Criminal Justice Reforms (NCCJR) proposed a bill in late 2023 (the Penal Code (Amendment) Bill, 2023) to delete the sections of the Penal Code that criminalise living off the earnings of prostitution.