KIGALI, Rwanda: As the coronavirus spreads in Africa, it threatens in multiple ways those who earn their living on the streets — people like Mignonne, a 25-year-old sex worker with HIV, foreign media reported.
The lockdown in Rwanda has kept many of her customers away, she said, so she has less money to buy food. And when she doesn’t eat, the antiviral drugs she takes for HIV can bring on pain, weakness and nausea, or even make her pass out.
“Yet it’s equally dangerous when you don’t take the drug,” Mignonne said in an interview. “You will die.”
Similar challenges exist elsewhere in Africa, which has the world’s highest burden of HIV.
Studies have shown that food insecurity is a barrier to taking the drugs daily and can decrease their efficacy, affecting not only sex workers but anyone where food — or the money to buy it — is scarce.
Among sex workers in Zimbabwe’s capital, Harare, “most who are living hand-to-mouth have been lamenting that it’s making it difficult to adhere to treatment,” said Talent Jumo, director of the Katswe Sistahood, an organisation for sexual and reproductive health.
That’s a danger as many sex workers around the world are excluded from countries’ social protection programmes during the COVID-19 pandemic, researchers from the London School of Hygiene & Tropical Medicine and
elsewhere wrote in a new commentary for The Lancet.
“Sex workers are among the most marginalised groups,” they wrote, adding that “it is crucial that disruption to health services does not further reduce access to HIV treatment.”
Rwanda, which offers free antiretroviral therapy to all, has been widely praised for its progress in controlling HIV. The country has kept HIV prevalence at 3% for more than a decade and the number of new infections has dropped.
But sex workers and health experts warn that those gains could be lost.
More than 45% of the estimated 12,000 sex workers in the East African country live with HIV. Not taking the antiretroviral therapy risks spreading the virus, said Aflodis Kagaba, a medical doctor and executive director of Health Development Initiative, a local organisation that promotes better access to health care. The organisation has been giving some sex workers food, hand sanitiser and hygiene materials and is talking with the government about budgeting aid for sex workers.
“Sex workers are part of the society and they deserve to live a healthy life,” Kagaba said.
In Migina, an entertainment area in the capital, Kigali, Mignonne acts as a leader of 60 sex workers, reminding colleagues with HIV to take their antiretroviral therapy and visit health centers every month.