Surviving on hope: Sex workers face HIV resurgence as ARVs, condoms vanish
Busia Survivors Clinic has provided sex workers with HIV treatment, condoms, peer support, and dignity for years. Now, the withdrawal of USAid funding threatens to erase this progress, pushing this vulnerable cohort back into the shadows.
What you need to know:
- Sex workers face a devastating healthcare crisis as specialised HIV clinics like Busia Survivors, which served 4,000 vulnerable women, close due to US funding cuts.
- Many sex workers like Hope, who relied on these facilities for free ARVs, condoms, and confidential care, now fear being forced into government clinics where they risk exposure of their profession to family members.
As a young girl, Hope, whose name has been changed to protect her identity, would watch veteran journalist Catherine Kasavuli with unwavering admiration, imagining herself one day stepping into those same shoes with equal poise and authority.
The glow of the television screen illuminated her childhood dreams, painting fantasies of a bright future.
"I could recite her sign-off lines perfectly," Hope recalls, a rare smile crossing her face. "I practised in front of our small television until my siblings would beg me to stop."
But fate had charted a different course for Hope—one marked by successive waves of loss, each one eroding her aspirations until nothing remained but the fight to survive on the streets.
Hope was midway through Form Two when HIV claimed both her parents. At just the age of 16, the classroom was suddenly replaced by a household where five younger siblings looked to Hope for guidance, protection, and their next meal.
"One day I was worrying about exams, and the next I was worrying about how to keep everyone fed," she says, her voice steady but her eyes reflecting the weight of that abrupt transition. "School became a luxury we couldn't afford."
With her education abandoned, Hope's broadcast journalism dreams faded. The responsibility of parenthood had arrived too early, forcing her to navigate adulthood without preparation or support.
No time to grieve
When marriage came, it seemed like salvation. Her husband embraced not just Hope but all her siblings, providing the stability they desperately needed. For six years, Hope experienced what family support could feel like, until her husband's sudden death plunged her back into crisis. "When he died, it felt like the universe was playing a cruel joke," Hope says. "I had to provide for my five siblings and three children of my own. There was no time to grieve."
Facing destitution and with limited education and employment prospects, Hope made a desperate calculation: survival required sacrifice. She turned to sex work. "Nobody dreams of this life," Hope states plainly. "But hunger is a powerful motivator, and dignity becomes a luxury when children are asking for food."
For nearly two decades, Hope navigated the dangerous night-time economy of street-based sex work. Alcohol became both an emotional aesthetic and professional tool, helping her endure encounters with men who often treated her as an object.
"I would drink to numb myself," she explains. "When you're intoxicated, you can detach from what's happening. But that same intoxication leaves you vulnerable."
The vulnerability manifested in horrific ways. Hope recounts incidents of violence that still haunt her: "One night, a client drove me to his home, then locked me in a room with his dog as he watched, laughing. I survived, but pieces of you disappear after such an experience."
With no negotiating power, she frequently engaged in unprotected sex, a decision made in moments of desperation or coercion, rather than choice.
"When I started this job, people would have unprotected sex with me, and because I was drunk, I would be so helpless," she says. "Violence wasn't the exception, it was almost expected. We accept risks most people would consider unthinkable, simply to survive another day."
Hope's trajectory changed when peer educators from a local health organisation approached her, inviting her to a health awareness session. For the first time in years, she spent a day sober, surrounded by women with similar experiences, learning about health rights and safety practices.
The connection and empowerment she felt that day came with a devastating revelation: a HIV test revealed she was positive.
"When I read two red lines on the HIV test kit that had a sample of my blood, my world collapsed again," Hope says. "I was transported back to my parents' deathbeds. I thought about my children becoming orphans, just as I had been."
For women like Hope, the path forward remains challenging.
Adhering to her treatment was not easy, especially because she had also enrolled on tuberculosis treatment after she was diagnosed with the disease. But through a support group, she pulled through.
Since 2016 when she learned about her HIV status, she has been receiving her antiretroviral drugs at Busia Survivors Clinic. The facility is funded by USAid Dumisha Afya as its implementing partner in the provision of HIV prevention, care and treatment for its members, like Hope, within the entire Busia County.
During the interview with Healthy Nation, Hope had a letter indicating that she would no longer receive antiretroviral drugs from this facility. Although she was consulted on her choice of a government facility within the county where she would prefer to continue receiving the drugs before she was given the letter, she says it was a tough decision.
“I took my last ARV package on February 28, and I need to go for the next one after three months. I have a transfer-out letter stating that from April, Busia Survivors will not be operating. I will now have to go to government hospitals, but I am not comfortable. It is like I have been forced to start going to the government clinics,” says Hope.
Apart from her treatment, Hope says the facility offers her condoms at no cost. She is afraid that she might not get them at a government hospital without being stigmatised. “When we tell clients to buy condoms, they deduct from our money. I have been going for condoms at Busia Survivors that serves me for a whole month for free,” says Hope.
This is the same facility that gives commercial sex workers who are not HIV positive the pre-exposure prophylaxis (PrEP) drugs for free, but now, after being transferred to public health facilities, they are not able to access them. “We are all exposed,” says Hope.
Since 2000, Busia Survivors has been offering different health services and commodities to sex workers within Busia County after research revealed that HIV transmission was high among this group at the time.
“Even though I am living positively, protecting myself is still very important because even if the client is also positive, our viral loads might be different. I must use protection. Also, the client might be having Sexually Transmitted Infections and finally, my family planning method is a condom, which I use consistently,” Hopes says.
With the US government funding freeze order, Hope fears that the treatment progress she has made now that the HIV virus is no longer detectable in her blood sample might change; and that her health might deteriorate, leading to her getting other infections like tuberculosis.
“Not being able to get my ARVs at Busia Survivor means death ahead. Nobody follows you up in a government facility. Even when we lack food, nobody will think about us. There was a time I was very sick — I had not gone for my drugs for a whole week and peer educators looked for me manually. Who’ll do that for you in a government clinic?”
Hope represents thousands of women whose lives remain in limbo after the withdrawal of the US government funding, and they are only hoping that things will get better so they can get their lives back.
According to Busia Survivors Executive Director Caroline Kemunto, the facility has two drop-in centres located in Busia and Malaba that provide friendly services to 4,000 sex workers in the region. The clinics have 17 staff members consisting of clinicians, nurses, and HIV testing counsellors.
There are also trained 68 peer educators who are all supported by the USAid Dumisha Afya. “As we speak, yesterday we had a call with our partner and we were told that the contract is being reinstated, but that what will change is the mode of operation. Like they said, they want to fit into what the government wants to see, and our government wants to see all key population programming or activities incorporated into its programmes,” Caroline told Healthy Nation on March 21, during the interview.
She notes that their partner wants them to stop being a stand-alone facility and instead transfer their members across the county to the nearest clinics that they want to call Key Population Facilities. While they have identified facilities for their members, where the 68 peer educators will also be stationed, Caroline still has more unanswered questions.
“We know that key populations are a criminalised population in our country. Our business is still illegal in Kenya, and we are always stigmatised and discriminated against. We are asking ourselves and thinking out loud, how is this going to work?” Caroline questions.
Spread of HIV
Caroline further notes that most government health facilities have health providers who are relatives to sex workers like Hope, who have never revealed to their families the type of job they do. She is concerned that seeking commodities like condoms, Pre-Exposure Prophylaxis or going for sexually transmitted infection screening in these facilities might not be possible for them, and that would lead to the spread of HIV in the region among sex workers.
“If I transfer our members to those facilities, how do I protect their privacy? We’ve always used unique identifier codes to shield their identities. Now we’re expected to move these vulnerable individuals into a system that isn’t prepared to handle their specific needs. We’re deeply concerned that after transferring our members, believing they’ll receive proper care, they might instead face stigma and discrimination, causing us to lose contact with them altogether,” Caroline says.
Since January 20, when US president Donald Trump initiated a 90-day suspension of the US foreign aid, Caroline and her team have been writing proposals seeking other partners to support them. However, none has been fruitful. As the clock keeps ticking, she is left with no option but to oblige. She will now play the oversight role over their beneficiaries in the respective government facilities. Her biggest fear is the lack of privacy in the government facilities, which might make it impossible for sex workers to seek HIV treatment and protection commodities.
Kenya has been a major partner of the US President’s Emergency Plan for Aids Relief (Pepfar) and a beneficiary of the USAid grant that has been supporting HIV and tuberculosis response.
According to a statement to the media by the Kenya Communities and Civil Society working in Kenya’s health sector released on February 13, the US government funding freeze at the time had resulted in the closure of over 150 clinics, adversely affecting more than 72,000 people who rely on antiretroviral therapy.
“Drop-in centres for key populations including sex workers and people who use drugs have shut down, along with HIV prevention services for adolescent girls and young women.
Communities most at risk are paying the price. People living with HIV and key populations such as sex workers are facing increased persecutions in many PEPFAR-supported countries as governments chose the funding freeze as cover to crack down on human rights,” Faith Ndung’u, advocacy manager at Health NGOs network told the media.
The joint statement further reported that approximately 35,000 healthcare workers, including peer educators, outreach workers, doctors, nurses, and health care workers, as at February 13, had been placed on unpaid leave, leaving no one to provide crucial health care services and exposing millions of Kenyans to new infections and possible deaths.
“The destruction is increasing the risks of untreated illnesses, preventable deaths and overburdening the health system, particularly in areas like HIV/TB care, maternal health and emergency services. The impact of funding cuts is poised to be devastating,” Ms Ndung’u added.
The network further made an urgent appeal to the US government "to reverse the Stop-Work-Order, and adhere to basic global health governance principles, which build on cooperation, equality, and inclusivity”.
It also made an appeal to the Kenyan government.
“We strongly urge national and county governments in Kenya to step up and treat the current crisis as an emergency. Proactive urgent action should be taken to respond and mitigate the impact of the suspension. The country should not wait for lives to be lost before responding. We call for urgent action to be taken, including through a supplementary budget for the financial year 2025/2026,” Ms Ndung’u read part of the statement.
Senior Regional Manager for Implementation Advocacy for Aids Vaccine Advocacy Coalition Richard Ochanda says with the US government funding freeze, countries will not achieve the 2030 targets. The three targets are to have zero new HIV infections, zero number of people not having treatment and zero number of people infected being virally suppressed by 2030.
“It means that by 2030, instead of seeing the infections plateauing, we will be seeing them going up if at all both the county and national governments do not act and also if the international solidarity does not come in. What we have in front of us is an epidemic of very big proportions that will need everybody to step up on it,” says Mr Ochanda. He adds that clinic closures don’t just interrupt treatment—they manufacture time bombs. When ARVs run out, viral loads spike within weeks.
“Unlike when she got into sex work, Hope says that over time she has been empowered to prioritise her health, thanks to Busia Survivors. However, she is now becoming hopeless as the facility closes.
Clutching her last bottle of ARVs, Hope counts the remaining antiretroviral pills like precious stones. Just a few left. “When USAid removes the key population from the system, it means it is giving us poison that is killing us slowly. Instead of doing so, why not give us one lethal dose and let us die fast? At least then we wouldn’t infect the living.
“USAid is taking us back to the 1980s, where we will become skeletons.”
