Health
Surviving Against All Odds: A Female Sex Worker’s Fight with HIV and Stigma
In Uganda, both sex workers and youth face significant risks of HIV infection, aggravated by stigma, discrimination, and limited access to healthcare services. According to the 2023 Fact Sheet on HIV/AIDS, there were approximately 130,000 female sex workers (FSWs) in Uganda, with an HIV prevalence of 12.7%. While 88% of this group had access to testing, only 65% were on antiretroviral therapy. These women are also disproportionately affected by gender-based violence.
In 2015, the World Health Organization (WHO) recommended oral pre-exposure prophylaxis (PrEP) for groups at substantial risk of HIV infection, including FSWs. Sub-Saharan African countries, including Uganda, have since implemented PrEP programs targeting high-risk groups. The Uganda Ministry of Health has continued to advocate for PrEP as an effective biomedical intervention, and studies have shown high uptake among FSWs.
In 2015, a 14-year-old girl named Nantumbwe arrived in Kampala from Kyotera district, hoping to build a better life for herself and her mother. What followed was a devastating journey.
On her first night in Kampala, she hoped to get help from local council offices in Katwe but was taken in by a man, old enough to be her father, who promised her shelter and assistance. She trusted him and followed him to his house, only to be defiled. The next morning, he sent her away to fend for herself.
Through sheer luck, Nantumbwe found work as a housemaid. However, weeks later, she started experiencing symptoms that led her to seek medical attention. At Kisenyi Health Centre IV, her life was shattered when she learned she was not only pregnant but also HIV-positive.
“I was shocked. I just wanted to die,” she recalls. “I couldn’t tell my family or anyone. It felt like my burden alone to bear.”
Unable to cope, her mental health deteriorated, and she lost her job. Desperate and pregnant, she sought out the man who had defiled her. Instead of offering support, he married her, though he neglected her and their child. To survive, she plucked wings off grasshoppers for small earnings, barely enough to buy food.
In her despair, she was introduced to AWAC (The Alliance of Women Advocating for Change), a feminist organization supporting FSWs’ sexual and reproductive health and mental well-being. Through AWAC, Nantumbwe received counselling, HIV treatment, and support that helped her through her pregnancy. She returned to Kyotera to give birth, though financial struggles continued to haunt her.
Today, 23-year-old Nantumbwe is a mother of three, with her eldest two children living with her mother and the youngest with their paternal family. Driven by economic hardship, she works as a housemaid by day and engages in sex work by night, earning just enough to scrape by.
“School fees and basic needs are overwhelming,” she explains. “My salary of Shillings 100,000 a month isn’t enough, so I started sex work in 2020. It saved me during the COVID-19 lockdown when I had nothing and even thought of ending my life and my children’s lives.”
The stigma of her HIV status looms large, both socially and within healthcare settings. She recalls being humiliated by a health worker when collecting her antiretroviral medication. Despite the hardships, she remains resilient, drawing strength from the counselling and support provided by AWAC.
Dr. Jacqueline Kanywa Balungi, an expert in adolescent HIV care at Mulago, highlights the challenges faced by young people like Nantumbwe. “Drug fatigue, stigma, and the fear of being seen at an HIV clinic drive many to stop treatment,” she explains. “Joblessness adds to their struggles, making them question why they should keep living.”
Dr. Balungi also emphasizes the need for a comprehensive approach to care, including mental health support and life skills training. While once-daily HIV pills remain the most effective treatment in Uganda, she expresses hope that injectables, already available in Europe, could ease the burden for many.
Preventative measures such as sex education, PrEP, voluntary male circumcision, and post-exposure prophylaxis are critical tools in combating HIV. Yet poverty and legal barriers, including Uganda’s AHA law, make implementation difficult. Dr. Balungi calls on the media and society to challenge stigma, urging everyone to support those living with HIV.
“Ending HIV starts with empathy,” she says. “We must build safe spaces, foster understanding, and ensure no one feels isolated. Together, we can dream of a future where HIV is no longer a threat.”
With organizations like AWAC ( https://awacuganda.org/ ), Sexual Reproductive Health and Rights (SRHR) Alliance Uganda, doctors like Balungi and initiatives like DREAMS, the fight against HIV among Uganda’s vulnerable populations continues.
Despite the odds, individuals like Nantumbwe embody resilience and hope, paving the way for a brighter future.
