Responding To The Challenge Of Sex Work In Ghana

Sex work by definition is any transaction in which sex is exchanged for money or gifts. The consistent and persistent focus by the Ghana AIDS Commission (GAC) and its partners on high impact HIV interventions for sex workers in Ghana over the years is gradually paying off. In 2006, HIV sero-prevalence among sex workers was 38 per cent and this reduced to 25 per cent in 2008 and in 2011, it has further reduced to just a little over 11 per cent.

Listening to an Accra based radio program, many callers were of the opinion that the problem of sex work is limited to 'university girls'. In fact, tertiary ladies are in the minority (of under 5 per cent) in almost all the behavior surveillance studies conducted by the GAC and its partners on sex workers.

In terms of Female Sex Workers (FSW) population size estimates in Ghana, the GAC estimated that there were about 60,000 in 2011 and projected that this number may tip over 100,000 by 2015.

There are two main types of sex workers in Ghana. These are the 'seaters' who are mainly brothel-based and usually have an average age of about 35 years with very high HIV prevalence and then the 'roamers' who line up on our street corners, beer-bars, discos, hotels and are usually young with an average age of about 24 years. However, there are some non self identifying groups who exchange sex for money and gifts but do not see that as sex work. Having several 'sugar daddies' who pick up the bills for school fees, phone credits, rent, utilities etc is not seen as sex work but in fact is by definition sex work pure and simple. There are reports of hotels in Ghana that have the pictures and telephone numbers of ladies who are called by their clients and are specially escorted to facilitate the transaction. I will call all these types as the 'non-classified' sex workers.

Some people also think that majority of FSW are not Ghanaians and are rather from the neighbouring countries. This is a fallacy because the facts are that more than 90 per cent of FSW surveyed in the several studies are Ghanaians. What is intriguing is that close to 70 per cent of the latest survey were ladies who had no education or had up to Junior High School (JHS) education. This is particularly worrying because for several years we have heard that only 50 per cent of the JHS pupils pass their examination and my concern is that all these drop-outs may find their way into the sex trade. Have we as a nation bothered to find out what happens to these children when they fail their basic examination?

Feedback from some of these girls also show that social pressures push them into early marriages which soon lead to separation and divorce largely because of economic reasons.

The public health challenge of sex work is that if it is not addressed comprehensively it makes everyone unsafe from crime, drugs and ultimately diseases like HIV, Hepatitis B and C, Syphilis and many others.

Comprehensive response to sex work requires a full understanding of 'what the push and pull factors are'. Apart from some studies which show that some women are into sex work because they simply love sex, majority of our ladies are on the street for economic and at times social reasons. This means that we need social and economic safety nets for such vulnerable ladies.

The Ministry of Gender and Social Protection has a big role to play in targeting programs at these vulnerable women. The next area is with the Ministry of Education. It's important that we focus on our children in school because studies show that the longer girls stay in school, the better opportunities they have to excel and build the needed foundation to compete in life. Parents, religious bodies and society in general all have their different unique roles to play to keep the family bond together, to have the needed social cohesion for development.

The next level of the comprehensive response relates to ladies who are already into the sex trade. From history we know that police raids have never solved the problem of sex work and never will simply because it is a criminal offense. Such vulnerable groups actually need protection from the police and society as a whole. In fact, police partnership with FSW and organizations working to improve the lot of sex workers can actually lead to better intelligence gathering on the criminal gangs who traffic children and girls into the sex industry.

Currently, we all know that there is serious human trafficking of girls across the West African sub-region mostly with the promise of getting them to Europe and the Americas. The FSW need protection so that they are not abused by their clients who either rape them at gun or knife point and physically assault them or even have sex with them without paying. The public health implications of not providing comprehensive information through peer-education on the dangers of the sex trade and how sex workers can protect themselves from being infected with HIV and other diseases cannot be over emphasized.

We have to continue to invest in gathering strategic information on sex work, map out the key hotspots and use the data generated to inform policy and programming for sex workers. At this point, I want to recognize the leadership of the GAC on the work they are doing with sex workers in the country and especially the generous financial support from the Global Fund and the United States Government to ensure that almost all major cities and towns in Ghana have Civil Society Organizations working through peer-educators, most of whom have been sex workers before and are now out of the trade but use their new knowledge to help their comrades. Now most sex workers are knowledgeable about HIV and are empowered to have protected sex with condoms and lubricants correctly and consistently and do not accept to have unprotected sex for a higher fee. They go for regular screening in hospitals and clinics and also at the drop-in centers. The push for a near 100 per cent condom use by sex workers in Ghana is laudable and should be sustained.

Organizations like FHI 360, WAPCAS and ADRA are the major suppliers of high impact interventions for sex workers in Ghana. Through them, more than 60 per cent of the sex workers in the Ghana Survey in 2011 had had an HIV test done one year before the survey. This is very high compared to just under 10 per cent of Ghanaians who had an HIV test one year prior to the Demographic and Health survey in 2008. The FSW who test HIV positive are referred for care and treatment. I must add that almost 14 per cent of FSW surveyed who knew they were HIV positive were still on the street selling sex and that is why all those who buy sex should always and every time  use a condom. Your health just like the health of the sex worker and most especially your wives (if married) is important.

In the area of rights and social protection, organizations like Human Rights Advocacy Centre (HRAC), The Gender Centre and Commission on Human Rights and Administrative Justice (CHRAJ) have done a lot to ensure that Gender-based violence is not perpetrated on the FSWs. CHRAJ in partnership with GAC and USAID with technical assistance from Future Group is currently setting up a tracking system for documenting human rights of key populations and persons living with HIV. This will be complimented by the early response mechanisms designed by Civil Society Organizations in partnership with some Human Rights lawyers to rapidly address the safety and legal needs of key populations.

The final level of the comprehensive response requires that we focus on these vulnerable women and girls in the sex trade and provide them with alternative livelihoods. Even though the evidence on this is mixed, identifying appropriate alternatives is critical for social acceptance so that these alternative livelihoods can become beneficial and sustainable for FSWs. Such interventions have failed in some countries because they were not well implemented, not adequately financed or targeted, based on felt needs. The GAC and WAPCAS with the support of the German Government (via GIZ) and the Danish Government (via DANIDA) have supported some of these vulnerable women and girls in Ashaiman and Kumasi to go through vocational training. Majority of these have completed the training and are now on their own and engaging other young girls to learn from them.

There is the need to equip young people with employable skills. Therefore all the social mitigation packages to generate employment for the youth should not be partisan but target the vulnerable and at-risk youths especially women and girls so they do not fall prey to the easy option of selling sex on the street.

Sex work in Ghana is driven by socio-economic determinants therefore Government policies need to be coherent and targeted at the development needs of the people. Education is key and we also need to benefit from the fruit of democracy with development guided by our current middle income status else the public health consequences of sex work will end up costing the country more than it would have, if we had invested in preventing, protecting and empowering sex workers to get them out of the industry.

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