Equity in health - Red light districts of Uganda

Growing up in a suburb next to a red light district granted me the opportunity of bearing and understanding prostitution with a much keener eye and mind. I knew what happened behind curtains and the societal gaps that needed to be filled in challenging the status quo. “Harriet, I felt so sorry and guilty watching my mother fade away because we could not access health care. Finally death was her only option,” were the heart breaking words that came out of her mouth with tears standing in her eyes after the burial of her mother, their family bread winner. Resty is a childhood friend that I had known closely for such a long time, her mother was a popular sex worker who had done this business for many years that when she contracted HIV/AIDS, the entire society blamed her for having caused this to herself especially the health centres that denied her attention and medication, at times.

I think we need to re-define some terms since their meaning and gradually fading away. Equity in health includes concepts of fairness and justice. It implies that everyone should have a fair opportunity to attain their full health potential , and that the primary determinant in access to health inputs should be health needs, and not factors such as status, gender, ethnicity, work, insurance, housing and disability. Access to health care is equitable if there are no information, financial, or supply barriers that prevent access to a reasonable level of health care.

Uganda has endorsed a number of both international and national instruments affecting public health, but their provisions are not fully included. These cases demonstrate the usefulness of international and regional instruments in the protecting health rights, even outside national legal systems. There is a possible bias against poor and vulnerable populations in the benefit from these provisions as they may find it difficult to take cases to regional and international levels. The International Covenant on Economic, Social and Cultural Rights (1966) ratified in January 1987. The Constitution sets out the state’s duty to ensure all Ugandans enjoy access to health services. I need someone to blow it right in my face that “Sex Workers in Uganda are not Ugandans” because this is what denial of their health care by the national health system comes to. If all Ugandans are entitled to an affordable and better health care, then why not sex workers?

According to Regional Network on Equity in Health in Southern Africa (EQUINET), The Discussion paper 63 carried out in East and Southern Africa, the public health law in Kenya, Uganda and Tanzania, Equity in health implies addressing differences in health status that are unnecessary, avoidable and unfair, to ensure the redistribution of societal resources towards these outcomes and to promote the power and means people have to influence this redistribution.

I can still close my eyes and envision the many “Resty’s mothers” out there that are dying out simply because the health system is not inclusive. Are we going to sit and watch while day by day people are fading away while we shamelessly blame them for the rapid increase and spread of HIV/AIDS?

The sex workers have only been listed as the minority groups in the prevention and treatment of HIV/AIDS and amazingly major efforts have been given to prevention rather than treatment, but remember treatment of an HIV patient bears the same or even more results as prevention. No wonder one sex worker in Kabalagala (the biggest red light area in Uganda) told me while conducting a baseline survey that “If we are not safe, then no one is safe” and it didn’t make sense to me at that moment but after a number of several reflections I now realize if the sex workers are not given priority in the medical care accessibility then Uganda is not safe due to the fact that they attend to a number of clients from different walks of life.

This stigmatization and discrimination does not only affect the sex workers but their families too. It is sad that the children witness what their mothers face, as a daughter of a sex worker told me, “I will do anything to take care of my mother because I have seen how she is abused, mistreated and looked down upon both in the hospitals and entire community.”

In Uganda, prostitution is judged as one of the worst sins. Approximately 90% of all sex workers are forced into this business. But regardless of the reasons why they are into the sex work business, they are humans like any other human being, they have a right to health and that right SHOULD be observed and respected.