Kenyan Prostitute of six years offers unprotected sex to many clients, remains HIV negative

In Kenya 1,5 million people are living with HIV, and
there are about 100 000 new infections every year.
Despite this, some sex workers are having
unprotected sex — and taking anti-retroviral drugs
afterwards to cut the infection risk.
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“Let me tell you the truth about why many of us don’t
use condoms. We don’t have money and when you
meet a client who offers to give you more money than
you usually get, you have sex without protection even
when you don’t know his HIV status,” Sheila who has
been a prostitute in Nairobi’s Korogocho slum for six
years says.

Sheila says she and other prostitutes can go to a clinic
the next morning to get emergency anti-retrovirals
drugs which suppress the virus if taken within 72
hours of infection and in many cases stop its
progression.

“We use this medicine like condoms,” she says.
The type of anti-retroviral in question is known as
post-exposure prophylaxis, or PEP.

It is intended to be used in emergencies. For example,
it is given to victims of rape if their attacker is thought
to be HIV-positive, or to medics who have been
pricked by a potentially infected needle.

There are no definitive figures to show how well PEP
works. It’s far better, experts say, to prevent exposure
to the virus in the first place by using condoms.
Some clinics will only give clients one course of PEP a
year. They worry that if they hand the drugs out too
freely, prostitutes will stop using condoms altogether.
This hasn’t stopped 24-year-old sex worker Pamela
using PEP four times in the past year.

“I had unprotected sex when I was very drunk one
night and the following morning I didn’t go to the
same clinic where I got the first PEP tablets . . . I went
to a different clinic where they don’t have my records
and lied that I was forced into unprotected sex,” she
says.

She didn’t finish the full course because of the side-
effects.
“You feel bad, like vomiting, dizziness and generally
you just feel sick. So I stopped taking them,” she
says.

Peter Godfrey-Faussett, senior science adviser with
UNAIDS, says there is a place for anti-retrovirals
among sex workers, but only when used in the right
way.

“We know that despite fairly high rates of condom use
in many sex-work communities, we still have very high
rates of HIV so we need additional tools as well as
what’s already happening,” he says.

However, emergency use of PEP is not the best way
to go about it, he says. Instead it would be better for
prostitutes to take a type of anti-retroviral designed to
be taken before exposure to HIV — known as Pre-
exposure prophylaxis (PrEP).

These are taken daily and contain fewer drugs than
PEP so there are fewer side effects. But Godfrey-
Faussett stresses that they must be used as part of a
wider package, including regular HIV testing to make
sure that the patient is on the correct medication.

There are plans to run a pilot programme with sex
workers in Kenya to see if it could be practical for
them to use PrEP as an extra layer of defence.
The drugs are not cheap, though.

In the United States, PrEP costs around $14,000 (£8
700) a year at the full price, although people on low
incomes can get it much cheaper, or even free.
In developing countries, where generic copies of the
drugs are used, the cost may be about $150 (£93) a
year.

Godfrey-Faussett stresses that the cheapest line of
defence is, in this case, the strongest.
“Condoms are the single most effective way of
preventing HIV, sexually transmitted infections and
pregnancy,” he says. “PrEP is not a silver bullet that
will suddenly take away all those other issues.”