“PrEP keeps me safe from contracting HIV…”
These are the words echoed by a 40-year-old Mulena* who does sex work for a living.
It is widely acknowledged that Key Populations (KPs) including sex workers, men who have sex with men and transgendered individuals are the most vulnerable to HIV. According to UNAIDS, Key Populations and their sexual partners accounted for 65 percent of HIV infections globally with 39 percent of new HIV infections recorded in sub-Saharan Africa, in 2020.
Mulena was linked to an HIV prevention method of Pre-Exposure Prophylaxis (PrEP) in 2020 through interventions of the USAID-funded Key Populations - Strengthening Technical Assistance and Response for Sustainable HIV Prevention and Treatment (KP-STAR) project. The goal of the project is to strengthen HIV prevention for KPs and other HIV KP programs while scaling-up innovative, evidence-based approaches to reduce the incidence and mitigate the impact of HIV.
PrEP is an antiretroviral drug which helps HIV negative people more at risk of HIV infection stay negative. Proposing PrEP to people, like Mulena, who are at substantial risk of acquiring HIV can be beneficial because of the inability to consistently use other prevention methods, such as condoms.
Due to her line of work, she finds herself in, Mulena says PrEP keeps her safe from contracting HIV during her sexual encounters with different clients.
“Clients pay less when we ask them to use condoms. Sometimes I agree to have sex without a condom because I must feed my children. It is a risk that could get me infected with HIV which is why I prefer PrEP. In incidents where a client refuses to use a condom, I know that I am on the safe side,” she says.
To be effective, it is required that PrEP is taken daily and correctly. Mulena says she has been taking PrEP consistently.
“I make sure that I take my PrEP every night because I want to stay healthy. I am not happy doing sex work, it is a risk that I am taking to take care of my children,” she says.
Adhering to PrEP is also a decision 31-year-old Chuma*, who started sex work at the age of 17, made.
“I do not miss taking my tablets. My children know that I am taking PrEP, so they always remind me whenever I forget because I drink too much alcohol,” Chuma says, adding that PrEP protects her from HIV as in most cases she engages in sexual activities while under the influence of alcohol.
Encouraging peers to use PrEP
It is, however, a different case with Mulena who chooses to keep her usage of PrEP from her family. Nevertheless, she does not hold back encouraging her peers to consider taking PrEP.
“I do not want my family to know that I am using PrEP because they might find out that I am doing this kind of business, but I always tell my friends to use PrEP especially when clients are refusing to use condoms. Condoms are good but some men tear them, and some refuse to use them,” she says.
Chuma on the other hand goes the extra mile of linking her friends to KP-STAR Peer Educators for HIV services including PrEP.
“I always tell my friends that I am using PrEP to prevent myself from contracting HIV, I even bring clients to Peer Educators,” says Chuma.
KP-STAR Regional Site Coordinator for Zambezi region, Ophelia Samunzala, says clients who are on case management receive routine screening on HIV, pregnancy, and sexual transmitted infections when they go for follow up.
*Not her real name.
The KP-STAR project is being implemented by a consortium of partners, including IntraHealth Namibia, in 10 Priority Geographic Areas (PGAs) namely Gobabis, Swakopmund, Walvis Bay, Oshakati, Rundu, Katima Mulilo, Oshikango, Keetmanshoop and Otjiwarongo and targets Female Sex Workers, MSM and Transgender.