By Alex Ababio
In 2017 and 2018, HIV and AIDS activities in Ghana saw a total expenditure of around US$92,573,993 and US$67,413,057, respectively. The bulk of these funds, 63%, came from external sources, while government allocations accounted for 51%, making up the most substantial segments of the expenditure in both years.
Felix Asante, the lead researcher of a comprehensive study on the matter shared this financial data .
The financial data underscore the importance of initiatives like “A Beacon of Hope: Felicia’s Journey to HIV Prevention.”
Deep within the heart of Ghana, nestled among the captivating landscapes of Obuase Tutuka in the Ashanti region, we find Felicia, a 28-year-old woman who’s faced life’s complexities as a sex worker.
Felicia’s story is an expressive example of strength which gives much volume on the crucial need to bolster HIV/AIDS services, especially for those on society’s fringes.
Felicia’s life, like many in her profession, has been marked by society’s judgment and personal hardships.
“I didn’t plan to go down this path, but economic struggles and limited opportunities pushed me into the world of sex work.” For years, she navigated this risky path, dealing with the dangers, judgment, and the constant threat of HIV infection.
“I’m always scared of being attacked and killed by strangers. This line of work is very risky. I’ve seen as many as five of my colleagues killed by unknown men under the pretense of spending time with them.
It is even riskier when it comes to HIV infections. Many of my colleagues have HIV.”
In her attempt to Navigate through the heart of her struggles, Felicia heard about Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP).
According to her, hearing the PrEP first time was a glimmer of hope amidst her harsh reality.
She admitted, “Honestly, I had never heard of it before, but if it can protect me from getting HIV, I’m willing to learn more and consider using it.”
This new found hope, a potential shield against HIV’s relentless threat, sparked curiosity within Felicia.
“As a sex worker, I’m highly exposed to HIV.
Therefore , i consider that as i have gotten information about it is my best weapon for my future.
Nowadays, there’s hardly any discussion about the disease, and the organizations that used to educate us have disappeared. Occasionally, an NGO visits to educate us about the disease.”
I asked her if she was aware of Anti-Retroviral Therapy (ART), and she confirmed, “Yes, many of my friends with HIV use it. They look healthy and don’t appear to have HIV.”
“I once accompanied a colleague to the district hospital, and I noticed there’s no privacy during their treatment. Multiple doctors and nurses attend to patients in the same room,” she noted.
With determination to make a difference in her attempt to find a lasting solutions to her difficulties , she began to seek for healthcare professionals who could provide insights into this groundbreaking treatment.
“Unfortunately, the nurses at the hospital told me they don’t provide PrEP and PEP.”
Felicia’s willingness to understand PrEP and PEP faced challenges. The lack of information in Ghana’s remote mining areas left her feeling isolated.
Despite her difficulties she was determined and stayed strong. Felicia, therefore, searched her community and began to engage with peers and advocates alike.
“Most of my fellow female sex workers are unaware of PrEP and PEP and wish they had access to prevent HIV infections.”
As she learned about PrEP and PEP, Felicia gathered others like her, hungry for better healthcare, and educated them about these treatments.
With their united voices , and they began to advocate for change.
As Felicia became a beacon of hope for her fellow sex workers, she offered not only her unwavering resilience but also her newfound knowledge.
“As their leader, I will continue seeking education on these medications to ensure all my colleagues are informed for our protection.”
Felicia also expressed concern about the high cost and occasional shortages of condoms.
“These days, condoms are so expensive, and sometimes we have to go without them in the community.”
In the backdrop of Obuase Tutuka, Felicia’s journey reflects the broader struggle of female sex workers across Ghana.
As Ghana continues to fight this epidemic ,the call to strengthen HIV/AIDS services becomes essentially indispensable, particularly the provision of PrEP and PEP which echoes in both urban and rural areas, especially in mining communities.
The story of Felicia is not peculiar to. It proves to be relevant testament to the resilience of those often left in the shadows to suffer stigmatization and lack of proper treatment . It throws light on how a pressing need should be adhered in providing essential healthcare services and information to marginalized communities.
With her journey as a sex worker , the hope of Felicia is that her story will pave the way for a brighter, healthier future for sex workers across Ghana.
Since it emergence ,the HIV epidemic has brought significant changes to Ghana’s society and economy, and it’s still affecting the country’s growth.
Despite a substantive amount of investment on extensive research on topics like HIV and sexually transmitted infections (STIs) among female sex workers, a notable gap remains in our understanding of their broader health challenges.
A crucial aspect that deserves attention is the mental health of sex workers in Ghana.
During my conversation with Dr. Akwasi Osei, the former Chief Executive Officer of the Mental Health Authority and current Chairman of the Faculty of Psychiatrists at the West African College of Physicians, in Kumasi, pointed out, “Many female sex workers turn to drug use, which can often trigger trauma and lead to severe mental health complications.”
Taking into consideration regarding understanding of the issue , a comprehensive approach becomes even clearer.
Focusing solely on HIV prevention and STI management is not sufficient; we must also address the mental well-being of these sex workers.
“ I want to say that we need to rethink our decision to know that aside from policies which will help improve healthcare access we should strive to stick to a thorough assessment of mental health diagnoses among female sex workers in the country . Furthermore, We should acknowledge that this approach could undoubtedly help foster broader efforts in frighting against HIV whiles promoting overall health within this vulnerable population.,” Dr. Osei suggested
According to Felix Asante, the lead researcher in a study, the combined expenditure on HIV and AIDS activities in Ghana amounted to approximately US$92,573,993 in 2017 and US$67,413,057 in 2018. The majority of these funds were sourced from external contributions (63%) and government allocations (51%), constituting the largest portions of the expenditure in both 2017 and 2018.
As the Ghana AIDS Commission (GAC) reported in 2022, around 9,357 people died because of illnesses linked to HIV/AIDS.
In 2020, about 14,000 people passed away because of HIV/AIDS in Ghana. This was a bit less than the numbers from two years earlier. But it’s a big drop from the numbers in 2001 and 2003, when 28,000 and 30,000 people lost their lives due to these illnesses.
GAC’s 2022 report tells us there are currently 230,317 children who lost their parents because of HIV/AIDS.
A report from UNAIDS indicated that in 2022, 39 million people around the world were living with HIV.
86% of them knew they had HIV. 76% of those, which is about 29.8 million people, were getting antiretroviral treatment (ART) to help them.
In 2022, 1.3 million people still got HIV. 630,000 people died from AIDS-related sicknesses in that same year. About 4,000 young girls and women got HIV.
Especially in sub-Saharan Africa, a big part of new HIV cases were in women and girls – they made up 63% of them.
In Ghana, Dr. Kyeremeh Atuahene, the Director General of the Ghana AIDS Commission, GAC, stressed the importance of having enough money to fight new HIV infections and achieve elimination by 2030.
Right now, they have $45.2 million from donors like PEPFAR, the Global Fund, and UNAIDS. But this falls way short of what’s needed – they’re missing over $86 million.
“If we don’t find a way to fill this big money gap, we might lose the progress we’ve worked so hard for.
In its 2022 National HIV Prevalence, Estimates, and Projections report, the Ghana AIDS Commission indicated that there are more than 100,000 people in Ghana who have HIV but don’t even know it because they didn’t take the test.
“More than 28% of people with HIV don’t even know it because they didn’t get tested. That’s around 100,000 people. Sadly, they’re unknowingly spreading the virus, which is really bad.”
The population of Female Sex Workers in Ghana.
According to data from the Ghana Statistical Service (GSS), there are approximately 60,049 women engaged in female sex work (FSW) in Ghana. Among these FSWs, 93% are classified as roamers, while the remaining 7% are categorized as sitters.
Among the majority group, which comprises about 93%, there are roughly 55,686 FSWs. When we analyze the geographical distribution, Greater Accra boasts the highest number of roamers, with 19,081, followed by the Western Region with 11,535, Ashanti with 5,561, Eastern with 4,753, and Central with 4,061.
To sum it up , the estimated count of stationary FSWs stands at 4,363.
When considering the sum total, there are approximately 60,049 FSWs in Ghana.
Most of these female sex workers are quite young, with an average age of around 26 years old. Significantly, over 90% of them are younger than 35.
As reported by the Ghana AIDS Commission (GAC) in 2022, around 4.6% of FSWs in Ghana tested positive for HIV.
Therefore, the number shows a decline from the 7.0% rate recorded in 2015 and the 11.0% rate in 2011. It is recorded that the following regions have the highest HIV prevalence and these are Upper East (7.8%) and Upper West (7.7%).
According to the report the regions are followed immediately by Bono East (6.6%), Western (6.4%), and Western North (6.0%).
While overall HIV rates have seen a reduction since 2015, some regions, notably Upper East, Upper West, and Western, have experienced a noteworthy increase.
The recent 2022 report from the Ghana AIDS Commission shows that in the general HIV population, there are about 354,927 individuals living with HIV, making up around 1.66% infection rate .
According to the report the rate among FSWs is much higher which stands at 4.6%, more than twice the rate of the general population.
However, It’s important to understand these numbers so as pave the way for better strategies in the fight against HIV in Ghana.
The alarming figure in HIV calls for prevention strategies such as condom usage, Anti Retroviral Therapy (ART), Pre-Exposure Prophylaxis (PReP), and Post-Exposure Prophylaxis (PEP), particularly for vulnerable groups like female sex workers.
The 2022 National HIV Estimates and Projections Report by the Ghana AIDS Commission paints a vivid picture of prevention efforts. 36,209,782 condoms were distributed, including 35,184,689 male condoms and 25,093 female condoms.
According to the report 1,971,381 individuals received HIV Testing Services (HTS), comprising 404,105 males and 1,567,276 females. The reports indicates that among them, 46,764 tested positive, with 13,126 males and 33,638 females.
It brought to light the reach of HIV prevention interventions to 65,379 female sex workers (FSWs) as thus emphasizes the commitment to combating HIV’s spread.
Anti Retroviral Therapy (ART) reached 6.4% of people aged 15 and above. Prevention of Mother to Child Transmission had an impressive coverage of 84.8%.
The 95-95-95 strategy aimed for Testing to Know Your Status at 71.8%, while ART coverage achieved 87.4%, and the Virally Suppressed target reached 68.1%.
Significantly , the report didn’t include figures for Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP) coverage.
I spoke with several female sex workers across various cities in the country, such as Accra, Kumasi, Takoradi, Tamale, as well as in mining sites like Obuasi, Manso Atwere, and Konogo in the Ashanti region. My intention was to understand the level of awareness and popularity of this medication, especially among female sex workers.
Most of them informed me that they hadn’t even heard about it, except few .
Hannah, a 34-year-old sex worker from Konongo, shared her thoughts: “Honestly, I haven’t come across any information about it before, but if it can protect me from getting HIV, I’m willing to learn more and consider using it.”
Cynthia, a 25-year-old sex worker residing in Obuasi, expressed her surprise: “I’m quite amazed to hear about this drug for the first time. Could you please guide me on where I can go to access it? I’m definitely interested.”
When I spoke with Mrs. Olivia Graham, the Ashanti Regional Technical Coordinator of the Ghana AIDS Commission (GAC), about the availability and accessibility of PrEP and PEP in the region, she informed me that three health facilities are currently administering PrEP and PEP. These facilities include Tech Hospital and Suntreso Government Hospital .
She explained, “We have a group of people known as discordant couples, where one partner has HIV and the other doesn’t. Under this circumstances, the hospital authority makes an arrangement with the partner who is HIV-negative administer Pre-Exposure Prophylaxis (PrEP) to them to prevent them from contracting HIV.
Sex workers can also benefit from PrEP, but it’s not available to everyone.
In an interview , Dr. Thomas Agyarko Poku, the Medical Superintendent at Suntreso Government Hospital, told me, “We’ve initiated the Pre-Exposure Prophylaxis (PrEP) program in Ghana, and it’s currently being implemented.
We started with a pilot project in the Western region, and now we’re scaling it up.
Initially, it was confined to the Western region, but now we provide the drug wherever we offer HIV treatment.m
The scaling-up process is gradual. We need to be careful because if we bring in a lot of medication and it’s not used, it can expire. So, people are gradually becoming aware. When you come to Suntreso Hospital, we’ll have the drug available, but it’s not a straightforward process. We don’t give the drug to people who are already HIV positive; we conduct a test beforem providing the medication. If you’re willing to take the test, then we can put you on the medication.”.
At Komfo Anokye Teaching Hospital in.. Kumasi, Dr. Ruth Owusu Ofori, the Head of the Public Health Directorate, informed me, “We don’t currently have am Pre-Exposure Prophylaxis (PrEP) program at Komfo Anokye Teaching Hospital. While we’re not. offering PrEP at the hospital right now, I’m aware that there’s a pilot program being conducted in a few institutions across the nation.
Isaac Nsiah Foster, the Director responsible for Human Rights at the African Liberators Economic Institute (ALEI), a non-governmental organization located in Kumasi, shared his viewpoint regarding the administration of PrEP to prevent HIV in the country
“I believe that the Pre-Exposure Prophylaxis medication should be accessible, especially to people like female sex workers. However, the cost is currently too high.m Interestingly, even though this medication is essential in combating HIV, many individuals inm the country are unaware of it, particularly female sex workers in both urban and rural areas.
“Even I am uncertain about the locations where these drugs are administered. So, you can imagine how challenging it is for female sex workers who are often illiterate or have dropped out of school, and are financially disadvantaged in remote places like mining sites.
These individuals may struggle to find a healthcare facility that provides such medication for their protection.
“Moreover, if the government is genuinely committed to eradicating HIV in the country and preventing its spread, they should view Pre-Exposure Prophylaxis as a valuable alternative to condoms in combating HIV. Since not everyone is comfortable usingm condoms during sexual encounters, promotingm Pre-Exposure Prophylaxis could be particularly beneficial form. people like female sex workers in cities and mining areas across the country.
“Hence, my suggestion is that this medication should be made available and heavily subsidized by the government. This would ensure its accessibility for Ghanaians, especially female sex workers in the country.” ,he stressed
During my visits to different places, I had conversations with female sex workers. I engaged with them in areas like Accra (including Circle, Lapaz, Kantamanto, Awoshie, Kaasoa, Labadi, and Nungua), Takoradi’s Market Square, Sekondi, Kumasi (covering locations like Adum, Anloga, Tafo, Krofrom, Dichemso, Asafo, Bantama, and Ahodwo), Sunyani (including Area Three, Usbert, and Brekum), Tamale (particularly at Sawaba and the Main Lorry Station), Aflao (at the Lorry Park), and Cape Coast.
Apart from aforementioned places,I also visited mining centers where female sex workers operate.
For example, in Obuasi, I explored Penkwase, Tutuka, JJ (New Nsunta), Wawase, and places around the estate where mining officials live. In the Manso Area of the Ashanti region, I covered, Manso Atwere, Kumpese, Manso Kaneago, Watreso, Bontefufuo, among other communities.
In all these locations, sex workers raised concerns about condom shortages at times.
Juliana, a 24-year-old sex worker and resident of Obuasi, expressed her frustration, saying, “There are times when I can’t find condoms to buy, and now they are becoming more expensive.”
Comfort, 22, another sex worker residing in Kantamanto, Accra, shared a similar sentiment, “I sometimes have to search the town, going from one drug store to another, looking for condoms to buy, but I still can’t find any.”
Isaac Nsiah Foster from the African Liberators Economic Institute shared his experience on the matter:
“About two years ago, I personally encountered this situation when I visited various pharmacy shops and drug stores in search of condoms to buy. Unfortunately, I couldn’t find any due to shortages. It was then that I realized the concerns and rumors were indeed true. Over the years, I’ve observed that during public holidays, especially Christmas and Valentine’s Day, you won’t find condoms available in pharmacy shops and drug stores. They’ll inform you that there’s a shortage in their stock.
The issue is even more pervasive during Easter festivities and particularly rampant in places like Kwahu in the Eastern region.
The situation worsens during Christmas in cities like Accra and Kumasi.
“Just think about the scenario where condom shortages affect urban centers and cities such as Accra, Takoradi, Kumasi, Tamale, and Koforidua. When condoms become scarce in urban areas, it inevitably affects rural regions, particularly mining communities in the most remote parts of the country. Consequently, individuals engage in unprotected sex, particularly female commercial sex workers in mining communities,” he emphasized.
According to the Director HIV is spreading rapidly among female sex workers, particularly those who are roamers.
He explained, “It’s true that even though regular people in our communities have multiple sex partners, we often overlook them in terms of HIV prevention and condom use.
We should know that these people are actually contributing significantly to the spread of the disease because many young people, especially girls, avoid using condoms during sex.
Also, it’s a reality that some female sex workers, particularly roamers or ‘hook ups,’ often demand large sums of money for unprotected sex with clients.
In this regard , I want to implore the Ghana AIDS Commission and NGOs to focus on providing condoms to these young girls,” he emphasized.
Through my investigation conducted from May to June and continuing into August, I discovered that the Ghana AIDS Commission Office in the Ashanti region has been experiencing a shortage of condoms for distribution to vulnerable groups such as key populations and the general public.
In conversation with Mrs. Olivia Graham, she confirmed the shortage and clarified, “Yes, at the moment, our stock of condoms for distribution to the general population, particularly female sex workers, has been used up.
Nonetheless, we do have lubricants that we are distributing to these female sex workers and other targeted groups.”
Boosting HIV Testing Among Sex Workers:
Imagine spaces where sex workers feel safe to get tested and seek guidance without facing judgment.
When there is available spaces for them it will help break down the walls of stigma and discrimination, making it easier for them to reach out for help.
This might lead to more sex workers getting tested than before.
In a city called Vancouver in Canada, in 2013, the British Columbia Centre for Excellence in HIV/AIDS did a study.
They set up special clinics just for sex workers. Within just six months, the number of sex workers getting tested for HIV shot up by more than 50%!
According to a study conducted , sex workers dedicated to healthcare are more likely to get tested and improves their health overall.
Striving to Make a Difference with New Treatments:
There is the need for Ghana to embrace the positive impact of advanced treatments like PrEP, PEP, and ART on HIV prevention.
Just as it has proven to be efficacious, these medications is accepted to offer hope and control to various individuals which include sex workers, enabling them to take better care of their health.
This Feature Article was written by Alex Ababio and supported by the Internews Health Journalism Network
