Kenya’s national HIV prevalence rate of 5.6 percent is driven by subgroups within the general population that engage in high-risk sexual and drug-related HIV risk behaviour (KAIS 2012). These include sex workers and their clients, men who have sex with men, prisoners, and injecting drug users. People who inject drugs, men who have sex with men and those who give or receive money or favours for sex are at highest risk of HIV infection (KAIS 2012).
Kenya experiences a mixed epidemic (both generalized and concentrated). As of 2012, about 1,200,000 million people between the ages of 15 and 64 were living with HIV and the national HIV prevalence rate was 5.6 percent (KAIS Preliminary report 2012). The generalized epidemic is driven by serodiscordance, unprotected sex, multiple or concurrent partnerships, low male circumcision (MC) rates among some cultural groups, and unawareness of HIV status. The concentrated epidemic is driven by subgroups that engage in high risk sexual behaviour, such as unprotected anal or vaginal sex, and drug-related HIV risk behaviour, such as unsafe injection practices. These subgroups include SWs and their clients,men who have sex with men (MSM), prisoners, and injecting drug users (IDUs).
It has been estimated that nearly half of all new infections in 2008 were transmitted through heterosexual sex in the context of steady relationships, and 20 per cent during casual heterosexual sex. Moreover, high HIV prevalence among some most at risk populations, including sex workers, injecting drug users (IDUs), and men who have sex with men (MSM), have been found. Altogether, these groups are estimated to have contributed a third of all new HIV infections in Kenya in 2008 (National AIDS Control Council [NACC], 2009). However, this may be an under-estimate, as it does not take into account upstream sources of infection among those in steady relationships. Other groups considered to be most at risk of HIV infection in Kenya include truck drivers and cross-border mobile populations.
Among KPs, female SWs and their clients account for 14 percent of new HIV infections in Kenya. Female SWs’ high incidence of HIV is as a result of their high-risk sexual behaviour (unprotected sex, frequency and number of sexual clients, anal intercourse, dry sex, and substance use). Sex workers in general not only have a higher risk of transmitting and acquiring HIV and STIs than the general population, but also are hard-to-reach members of society. Factors that increase SWs’ vulnerability to HIV and STIs and that make it difficult for SWs to access services include the following:
- Stigmatization and marginalization by health and program staff create barriers for SWs to access health and social services.
- Punitive and restrictive legislation and policies hinder the ability of SWs to access voluntary and confidential health information and services.
- SWs often lack resources and economic opportunities.
- Gender, economic, and power inequalities limit the ability of SWs to negotiate safer sexual practices (such as condom use) and encourage SWs to engage in unsafe sexual behaviours (such as unprotected vaginal sex).
- High geographic mobility interrupts SWs’ access to health care and increases the number of sexual networks per SW, which might also increase the rate of HIV transmission within the country.
- Health care services are generally not addressed, acceptable, accessible, or affordable to male and female SWs.9. 10, 11
Programs for the prevention, care, and treatment of HIV and STIs need to be developed (and existing programs need to be tailored) to reach and address the particular needs of these KPs effectively. As members of society, SWs must have access to the same health care services as other members of society, in accordance with their rights as human beings. For these programs to be effective, program management, planning, and implementation must be a participatory process – that is, SWs must be involved. A participatory process builds consensus and ownership of the programs and empowers SWs to seek services and to advocate for their health care and human rights. Their involvement also helps sustain the programs, because it gives SWs a vested interest in the success of the programs.