“Sex workers are growing,” said Frank Chimbandwira, head of HIV at the Ministry of Health in Malawi. Other countries are witnessing the same trend. In Kampala, prostitutes line the streets near the Speke Hotel and sell sex for as little as 3,000 Ugandan shillings (75 pence). There are an estimated 45,000 sex workers in Nairobi and as the numbers have increased the price of sex has fallen. Prostitution is a feature of every city in the world, but in Africa it has exploded in the last decade, driven by a growing economy and the power imbalance between men and women. It was an impressive demonstration of safe sex– and a world away from the brothels of Kasensero. The women appeared leading their clients – one a bald man leaning on a crutch – calling to Wilfred as they passed, who handed each two condoms and a piece of tissue, before they disappeared into the bolted cubicles beyond. “Muzungu (white man),” she yelled, cackling with laughter.Īs we stood chatting to Wilfred, the manager, a chewed matchstick between his lips, there was a sudden flurry of business. A tall elegant woman descending from an upper floor grabbed my crotch as she passed. But it was quicker than Uganda to recognise that generalised behaviour change campaigns were failing and it was essential to tackle the disease in key groups such as sex workers, fishermen, truckers, men who have sex with men and injecting drug users.Īt the top of a flight of stone steps, five women in short skirts and tight trousers sat on a row of chairs, waiting for customers. Kenya, which had a tourist industry to protect, was slow to acknowledge the epidemic in the 1980s and slower still to act. But in recent years his enthusiasm has waned, some say under the influence of his evangelical Christian wife, Janet Museveni, who preaches abstinence. The president, Yoweri Museveni, marking his 28th year in power, was the most outspoken leader on Aids in the 1980s, as he watched it decimate his troops. Uganda was the first country that achieved results – it may be the first where we see a rebound, and others follow.” “As one commentator said, what have they been smoking? People are not looking at the complexity of the epidemic. “I am very concerned there is complacency,” said Peter Piot, director of the London School of Hygiene and Tropical Medicine and former director of Unaids. The recent resurgence of the virus in the country has aroused fears that it may signal a new continent-wide reversal, putting paid to heady talk in the West about the end of Aids. They, not truckers, may be the crucible of the African epidemic. Serotyping shows fishermen spread the virus into the general population when they return to their home villages.
A recent survey found more than half of fishermen said they had had more than one partner in the previous three months.
“These are very isolated communities with very basic services”, said Asiki Gershim, project leader at the UK Medical Research Council in Masaka, 80km from Kalensero. By comparison with the risk of going out on the lake, the risk of HIV is remote. Drownings are common and alcohol cheap and ubiquitous. They are young men, with plenty of cash, living in communities with few families, few older people and no constraints. Fishermen move from place to place, wherever the catch is good. Fishing, by its nature, is uncertain and risky. The customers don’t have enough education for safe sex.”Īll along the shores of Lake Victoria, the story is the same. Her three children are looked after elsewhere by their grandmother. She was diagnosed HIV positive a year ago. Bottles of Beckam Gin and Royal Vodka stood on the dusty shelf above her. The customers are attracted by the women,” she said, indicating her friends. Wearing a long blue dress, she sat in the gloom with two friends, both in revealing low cut tops.
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