Sex workers, local leaders, health workers including the CHAIN MNCH group all attended the dialogue.
This happened at the end of August (25 August 2011) in a commercial sex workers’ meeting about maternal health and HIV/AIDS, organized by Community Health and Information Network (CHAIN) at Kisenyi 3 Community Health Workers’ Association in Mengo, a highly populated slum area in Uganda.
Mr. Kalanzi Edirisa, who worked as a youth chairman for 15 years and is now on the village health team (VHT), said the area has an estimated 30,000 people, which includes many sex workers.
He went on to say that the area has high abortion rates and drug abuse problems, particularly with young people smoking marijuana.
Kisenyi 1, 2 and 3 in Mengo parish all have high populations but can only access free health services at one city council health center, which has few doctors and inadequate facilities.
Edirisa says the hospital closes at 2pm but he would like services to be available all the time. Another problem is that there is no ambulance at the center. One that comes around is from Mulago referral hospital and the City Council Railway Health Center (CCRHC) and people have to pay as much as 20,000 and 30,000 Uganda shillings for its services.
Mama Dorah, who owns a clinic in Kisenyi 3, is known for the maternity services she offers and one of the sex workers said the CCRHC refers pregnant women to her.
The government health unit offers free TB medication but the one of the sex workers said other drugs like antiretrovirals (ARVs) must be brought at 2,000 Uganda shillings. She went on to say she had heard reports of young mothers being abused by medical staff.
Mubiru Musa, from Kingston Youth Association for Development, also work on the VHT. Musa said the VHT is currently unable to got out to villages to teach about maternal health, HIV and AIDS because they lack financial facilitation. He went on to say there is no maternity clinic at the CCRHC as it used to be at city hall.
He also talked about two known traditional birth attendants, Jajja Mutono and Jajja Mariam, where most pregnant women go to give birth and get treatment from sexually transmitted infections (STIs).
Without such sessions the sex workers said it was hard for them to know about maternal health, HIV and AIDS. Nanyonga Shamim said it was her first time seeing such a dialogue.
Herbert Kimbugwe, a health researcher on the CHAIN team, says the campaign aims to see enough requirements in hospitals, plus responsible fathers, mothers, government and doctors. He said these are the things that need to be in place to stop 16 women in Uganda dying everyday during childbirth.
Mr Kimbugwe added that seemingly minor issues can be the things that kill these women. He gives an example of a Mityana mother who died because she lacked a glove. He said gloves are bought at 1,000 Uganda shillings. If she had prepared gloves she wouldn’t be dead. He also said that a mama kit is important, but women go to hospital without it and doctors refuse to attend to them, which can lead to their death.
Sex workers were asked how they would know if they were pregnant. Answers included: when you no longer get periods, after three days, when I eat soil, dozing every time and having constant fights with partners. They were also asked when a woman should start going to hospital after suspecting she is pregnant. Among the answers they gave were after three months, after four months, after six months, village women don’t go and as soon as you suspect you are pregnant. Herbert said the answer given by Kisenyi 3 youth leader was the best answer - go for check up as soon as you suspect you are pregnant, the doctor will give you details.
When asked about the importance of going for antenatal care, sex workers said it was important to go to be tested for HIV. Other answers included: you are taught producing procedures, you learn what food you are supposed to eat and you get to know antenatal attendance days.
“Enjawulo etukolera nyo,” said one woman to the question why they didn’t want to go with their husbands for antenatal care (“We need a bargain on the money given to us by men, an extra shilling to save.”) Others said they did not go to antenatal care with partners as they feared finding out having a different HIV status and because they had multiples partners.
Sex workers were asked whether a father or a mother owned a child, and answers were mixed. Herbert said that a child can belong to a mother or a father. He added that this was another reason as to why CHAIN was holding the dialogue - to tell them that a child belonged to both partners and both are responsible for it.
Herbert said the first 40 days before and after giving birth are very risky to a mother. He then asked how long the woman waited to have sex again after producing. Answers ranged from two weeks to 9 months, although the majority said two weeks. Herbert replied to this by telling the women they must make their partners wait for at least six weeks before having sex, even if he has high sexual urges, and if he refused they should consider leaving him. One traditional norm was referred to by a sex workers. She said that after birth a woman is advised to go to her family until she is in good health but there was always a fear with this of the man cheating during their absence.
Masitula emphasized that the women should put away the fear of HIV testing so they can know their status and this will help them live longer and protect their babies from getting infected. She also advised that, if partners are HIV positive, they should go for a check up to see whether they can have babies.
“Tuyambeko abasawo”, said Namatta Regina, CHAIN country manager. (“Women should work in hand with doctors.”) She went on to say some women lie to doctors about the number of children they have had and this complicates the doctor’s work.
Herbert demonstrated condom use to the sex workers and also gave out condoms to the sex workers.
The participants told Regina they would appreciate if CHAIN had come and supplied ARVS. They asked for more sessions like these and also for HIV testing services. Women also emphasized that men should be told about their responsibilities through such dialogues.
