In-depth: ART on the frontline

DRC: Sex workers in Bukavu run the HIV/AIDS gauntlet

Photo: Olu Sarr/IRIN

bukavu, 20 October 2006 (IRIN) - Conflict in the Democratic Republic of Congo's (DRC) eastern province of South Kivu is forcing thousands of women to sell sex in exchange for food and other basic necessities.

Girls aged as young as 12 work the streets of the provincial capital, Bukavu, where higher tariffs for sex unprotected by a condom often pushes them to take risks they know could have life-threatening consequences.

"Women sell sex for the simple reason of poverty. Perhaps the husband has died or doesn't work, or his salary hasn't been paid," said Marie-Louise Ruhamya, a counsellor at the nongovernmental health organisation, Population Services International (PSI). "Whatever the reason, it is left to the wife to provide for the family with whatever means she has."

A decade of fighting between foreign-backed rebel movements, Congolese militia groups and the national army in the country's volatile eastern provinces caused widespread murder among civilians, the rape of women and children, and left many villages looted.

The violence displaced hundreds of thousands of people from rural areas to major towns. Bukavu's population has swelled to over half a million, with crowded, unhygienic slums covering the surrounding hills. Unemployment is high and prostitution is rife.

Displaced people, many of them single women and unaccompanied children in acute need of food and other basic necessities, are particularly vulnerable to being raped or coerced into sex.

"Poverty is a clear factor in the number of sex workers. The population in Bukavu and the surrounding villages has swollen, people are sleeping rough, there's no access to clean drinking water and food is scarce," said Damien Du Nia, a senior officer at the National Programme for the Fight Against AIDS (PNLS).

In the impoverished, unstable environment of a conflict zone it is common for the number of commercial sex workers to rise, as women feel they have no other means of keeping their families alive. It is a story that has been told across the continent, from the DRC to Sierra Leone to northern Uganda.

Justine, 28, was forced into prostitution at the age of 13 after her parents died, leaving her to fend for her siblings. "I had to find a way to earn money. I had no other choice other than to start selling my body. It wasn't what I wanted to do, of course not, but what else was there for me?"

Justine's story is a familiar one among hundreds of sex workers who have received counselling from the local nongovernmental organisation (NGO), Femmes Actives Pour Le Development Integral au Sud Kivu (FADI). Sitting next to Justine in FADI's office, among boxes containing over half a million condoms, a group of destitute women aged 18 to 50 talked openly about the sex trade in Bukavu.

CAUGHT IN A CATCH-22

The going rate for sex is as little as 100 francs (US $0.23); without a condom it doubles. Often, the choice is not theirs to make.

"There are clients who will pay more for sex without a condom. Each time I concede, though, I do so in fear that this may be the one who infects me," said Bora, 28, who works in the red-light district of Essence.

She was wholly ignorant before FADI's director, Aimee Muzurikwabo, confronted her in the street three years ago. "I never used to use a condom because I knew nothing about HIV/AIDS and the other sexually transmitted diseases," she said. "Now I understand what the virus is and how it is transmitted, and what the dangers of unprotected sex are."

But knowledge is often no competition for desperation. At 100 francs a client, Bora has to sleep with five men to earn $1 - enough for flour, oil and a few vegetables.

"If a client arrives and refuses to use a condom, I may try and negotiate, even explain to him the risk he is taking, but invariably they never listen. Some even turn violent," she said. "If ... I have no money, what can I do but sleep with him without a condom, even though I know the risk."

Those working with sex workers in Bukavu recognise the futility of trying to deter them, and instead focus on the importance of condom use. "Our main aim is not to persuade them to leave prostitution. If you say that, they will say, 'what then?' so we focus on ensuring that they use contraception with each client and go for regular counselling and testing," Muzurikwabo said.

PSI distributes condoms on behalf of the Multi-Sector National Programme for the Fight Against Aids (PNMLS) to high-risk groups, including sex workers, truck-drivers and the military. According to Médard Mpinda, the acting coordinator, over three and a half million condoms were distributed in the last year.

The contraceptives are not free; a pack of three costs 50 francs ($0.12). "We noticed that free distribution doesn't solve the problem. When a person buys a condom it means he really needs it. Someone who is given a free condom doesn't necessarily need it, so it's a waste," Mpinda said.

HIV is still widely misunderstood in South Kivu, most noticeably in rural areas, where aid agencies can only guess how many women are engaging in commercial sex. Ruhamya said those attending PSI workshops believed HIV/AIDS was synonymous with death.

"Often they arrive with the belief that VCT [voluntary counselling and testing] is tantamount to casting a spell of death over yourself. That attitude changes with counselling," she said.

On average, 50 of the 80 sex workers who attend PSI workshops each month agree to take an HIV blood test. The latest figures show a prevalence rate of 2.7 percent. In 2001, the rate among sex workers was 4.4 percent.

ART on the frontline

October 2006
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Links & References

IASC Guidelines for HIV/AIDS interventions in an emergency setting
ART in a conflict setting: Lessons learned from Bukavu DRC
HIV/AIDS as a security issue: Lessons from Uganda

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