Throughout the learning exchanges, it became evident that it is of critical importance that we find ways to discuss sexuality. This is especially so because sex is viewed as a taboo subject in most of Africa. Indeed, on many occasions East Africans felt that their counterparts in the Greater Mekong region had achieved much in opening possibilities for discussing sexual life.
There was a strong feeling that East Africans can learn from Asia the strategies for de-stigmatizing condom use. The Art for Action on HIV/AIDS Festival held in Nairobi and which brought together partners from the Greater Mekong region and East Africa focused on stigma and allowed AAI participants to explore ways in which condom use can be de-stigmatized. In this phase of the InterAction there will be more targeted approach to positive sexual life with particular attention to pleasure, respect, and caring among sex workers. We will draw on indigenous knowledge systems on sexuality to open up the discussions in the media, electronic and print in Kenya.
Through the AAI we learnt that interventions in sex work settings work and as such;
Successful prevention in commercial sex networks can avert multiple secondary infections and slow transmission through bridging populations into the general population.
Where highly targeted interventions have been implemented with sex workers and clients on a large scale (for example in Thailand and Cambodia) increased condom use and declining HIV and STI trends among high risk and general population groups is documented.
A number of activities are highly effective in preventing HIV transmission in commercial sex networks. These include several of the same activities – outreach, peer support, education and advocacy – that work for other vulnerable populations, as well as more specific interventions – condom promotion and STI control – that specifically address occupational risks
Availability of treatment provides an important incentive for people to make contact with HIV services. If, through integrating prevention and treatment, this leads to increased uptake and coverage of harm reduction services where HIV is spreading fastest, maximum impact on developing HIV epidemics can be achieved.
Over 75% of new HIV infections occur through sexual contact. Factors that increase the rate and efficiency of heterosexual HIV transmission include high rates of sexual partner change and the presence of other sexually transmitted infections (STIs). In many countries, sex workers are frequently exposed to HIV and other STIs. HIV prevalence as high as 60-90% are found in some places where sex workers have poor access to HIV prevention services. In commercial sex settings where condom use is inconsistent and access to effective STI treatment limited, half to two-thirds of women working as sex workers typically have a curable STI at any one time.
Only 16% of sex workers are estimated to have access to HIV prevention services. Regardless of the region, poor access to services correlates with high STI and HIV prevalence. Early in epidemics, HIV and STI prevalence frequently rises rapidly among sex workers and their clients, especially where condom use is low and access to health care services poor. In the absence of effective interventions, clients transmit infection both to sex workers and to their regular partners, extending transmission into the general population. In the absence of effective interventions, high rates of transmission in commercial sex and drug injecting networks continue to drive HIV epidemics even after HIV has spread more widely in generalized epidemics.