No Turning Back: Examining Sex Worker-Led Programs That Protect Health & Rights

In the late 1990s, a group of women working in Nairobi’s bars came together to protest. They were disillusioned by the “corruption, tribalism, and poor leadership” in Kenya, that “translated to extreme poverty, violence, and desperation” and prompted many women to work and sell sex in bars.

When the HIV pandemic hit, “homes were wiped out, and almost the entire country was losing loved ones.” As Peninah Mwangi, a former bar hostess, recalls, “We spoke of HIV/AIDS in whispers and with fear. Everybody suspected themselves and each other as having the then ‘death virus.”

While researchers studied sex work, and posters were produced warning men to stay away, there was no funding for programs to protect bar hostesses and sex workers from HIV infection, or provide those who tested positive with treatment and care.

At the same time, women working in bars faced rampant harassment and violence from bar owners, clients, and the general public. Bar owners demanded sex in exchange for employment, while members of the public beat, raped, robbed, and even killed them with impunity. Police were equally abusive, arresting sex workers on unfounded charges, performing strip-searches, and demanding sex or money in exchange for release.

Peninah remembers a “lean constable” named Jimmy, who routinely physically and sexually assaulted the bar hostesses where she worked and refused to pay his bills. When a bar hostess was docked part of her salary because of his debts and confronted him, Jimmy’s response was swift.

He blackened her eye, threw her screaming into his trunk, and arrested her for robbery-outraging the other bar hostesses. They reacted en masse, closing the bar, marching to the police station, and demanding to speak to the commander.

Disgusted by the abuses the bar hostesses described, the commander made Jimmy and five others pay every bill they owed. Buoyed by this success, Peninah floated the idea to her peers to form their own organization, and Bar Hostess Empowerment and Support Programme (BHESP) was born.

Peninah remembers the early hurdles. When she went to register BHESP as a non-governmental organization, she felt “ashamed, small, and inadequate,” and could not afford the $50 dollar registration fee.

She reached out to academics, international organizations, and businesses to seek advice and funding, but few responded. In the end, it was Kenya Breweries, the main supplier of alcohol for local bars, who provided money for BHESP to hold its first meeting.

In 1998, 100 sex workers and bar hostesses gathered and agreed to work together to fight AIDS, stop violence, and lobby for increased pay. They went to Kenya’s National AIDS Control Council to describe how AIDS was impacting their community, and the Council helped them write a proposal, register as a community-based organization, and secure funding to start teaching bar hostesses and sex workers in Nairobi’s bars about HIV.

Peninah says BHESP missed opportunities in its early years due to lack of structures and focus. It had no strategic plan, and much of the organizational knowledge and responsibility sat with Peninah who was swamped with day-to-day administration and had little time to step back from the work and think about strategy.

BHESP had no policies, so “employed who [it] wished, when [it] wished, and how [it] wished, putting [it] at risk of lawsuits and poor performance of staff.”

When it became clear BHESP did not have the capacity to undertake a project funded by the Open Society Foundations in 2008, the donor agreed it could use the money to work with an organizational development firm to rethink its structure, develop job descriptions for staff, and prepare manuals outlining policies and procedures. Peninah says these steps were critical, enabling it to strengthen and expand its work.

Small Groups, Peer Education, and Home-Based Care

For its first several years, BHESP remained primarily focused on HIV. In 2005, it was selected as a partner for the Global Fund to Fight AIDS, Tuberculosis and Malaria. This allowed it to reach more of Nairobi’s estimated 27,620 female sex workers and expand to other towns, distributing condoms and hosting small group meetings to talk about safer sex.

In the meetings, BHESP would ask participants if they were interested in working together to address local needs. This process helped establish 42 sex worker groups in four counties, ranging in size from 25 to 200 plus members.

Thirty of the groups have since registered as community-based organizations, and some are now mentoring others. These groups have become the foundation of BHESP’s work. BHESP went on to train many of the group leaders who emerged as peer educators.

Each of its 48 peer educators is responsible for bringing together 25 sex workers per quarter for a series of meetings to discuss work safety and health. The rationale is that, after three months, participants will be comfortable accessing services on their own and may even wish to form new permanent groups. Peninah says, “That simple act of reaching out really changes the lives of many of those 25.”

Some go on to be peer educators themselves, or get into activism, or go back to school. This was true for Mary Mugure who remembers that her struggle to find condoms first brought her to BHESP, and that she became a peer educator soon after.

BHESP has three drop-in centers where the peer educators can host meetings. They are modest rooms with little more than chairs and a table, but BHESP says their “safe and caring atmosphere” helps “dispel [sex workers’ ] sense of isolation and promote solidarity.

BHESP also runs a home-based care program to improve the health and quality of life of people who are sick as a result of AIDS-related illnesses. Its 104 community health workers live with HIV themselves, and care for approximately 20 patients each, providing medicines and first aid for AIDS-related conditions.

They offer counselling to patients and families, connect them to support groups, and help with daily chores. The community health workers also help to identify pregnant women in the community to refer them to health services and ensure those living with HIV get the care they need to avoid transmission to their babies.


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