At an increased risk of HIV and often unable to negotiate safe sex with clients, sex workers have been a major focus in HIV prevention and treatment.
However, away from the streets and brothels, their children have been largely ignored.
Now a small but growing body of research has suggested that the children of sex workers face a range of HIV risks including early sexual debut, low school enrolment, parental abandonment and psychological issues, including social marginalisation, related to their mothers’ work, according to Jennifer Beard, assistant Professor in the Department of International Health at the Boston University School of Public Health.
Beard published a review of the existing literature on the children of sex workers and other vulnerable population groups in the July 2010 Journal of the International Aids Society, and found that little research had been done on the issue.
“We don’t really know anything about children of most-at-risk population (MARPs). There’s a lot of good programmatic information that’s out there but it’s not really been put together and that’s a major untapped resource,” she told Irin/PlusNews.
“All of the programming we do with the children of MARPs, it’s almost like an afterthought because our funding streams are all focused on the adults.”
One of a handful of African organisations working with both sex workers and their children is Zambia’s Tasintha Programme.
Born in 1992 on the infamous Addis Ababa Drive, a hot spot for commercial sex work in the Zambian capital Lusaka, the Tasintha Programme took its name from the local Chichewa word for “change”, and has worked with women and their children for almost a decade.
It has found that supporting the children of female sex workers has been key to giving women options and breaking a cycle of HIV risk.
In Zambia, where HIV prevalence is about 14%, there have been no recent attempts to quantify HIV prevalence among sex workers.
However, data from 2005 showed that 65% of all sex workers in major urban areas were HIV-positive, an HIV prevalence more than four times that of the general population in the same year.
Beard’s review also found that in a number of cases, sex work became a family business, handed down from mother to child in the absence of other income-earning alternatives.
In Zambia, cases like this prompted Tasintha to expand its programming to include children of sex workers in 1998.
“We found that we’d have a whole family here; the grandmother was a sex worker, her daughters became sex workers, the grandchildren had become sex workers,” said programme founder Nkandu Luo.
“(Many organisations) don’t see this because they are seeing the individual, not the systems around this woman. The fact that she is a mother, because she doesn’t make enough money, means the children also join (her).”
Tasintha offers mothers skills development alongside HIV information, counselling and treatment support, but the programme knows that skills in areas such as brick-making and small business do not always put food on the table for families.
“It’s not easy. If she goes to sell sex, and she is lucky, she will make at least 300 000 Kwacha (US$64,5) a night,” said Clotilda Phiri, Tasintha programme coordinator. “
She comes to Tasintha, we give her skills and she has to use those skills to generate income that may only be 200 000 Kwacha ($43) a month so she has to weigh the situation.”
What may tip the scales for many mothers is whether they can feed and clothe their children and ease the financial pressures of often single parenthood.
Tasintha offers the children of its clients educational bursaries and has put many, including underage sex workers, back in school.
“If you support the mothers but are not able to support the children, the women will always have that pressure to go back to the streets to support them,” said Luo, who added that Lusaka’s largely street-based sex workers continue to face high levels of gender-based violence, including physical abuse, rape and even torture.
At 17 years old, Pricilla’s parents encouraged her to take up sex work to help meet the family’s needs.
After becoming HIV-positive, she accessed antiretrovirals (ARVs) with the help of Tasintha’s in-house clinic and is mother to a four-year-old son.
Although she has told her son what she used to do for money, she admitted it was a hard subject to broach but one she felt she had to when other children began teasing him about what his mother did for work.
“(The children) are scared to tell us if other people tease them,” said Priscilla, who has been laughed at and ridiculed by members of the community for having been a sex worker herself. “Some children understand, some don’t; I explained that this is what I do and when you hear people saying things, don’t pay attention to it because I feed you from this money.”
Priscilla added that when money was short, she’s also had to trade sex with her son’s teachers in lieu of the school fees she could not pay.
One way or another, children often find out and often feel a mixture of respect and responsibility for their mothers”, Phiri added.
“We had a problem with one of the schools where we took some of the children. The teachers know that the children are sponsored by the Tasintha programme,” she said.
“If they misbehaved, or came to school late, the teachers would shout at them: ‘After all you are just good for nothing, you are children of sex workers.’”
When the stigma becomes too much for children, Tasintha liaises with the nearby Chainama Hills Mental Hospital to bring in counsellors, a service most called on when mothers or children have to deal with a HIV-positive diagnosis.
Amid high HIV prevalence rates among sex workers and a struggling national prevention of mother-to-child HIV transmission programme (PMTCT) that reached just 29% of HIV-exposed babies with treatment in 2009, Tasintha works with the nearby mission-based Coptic Hospital to ensure that HIV-positive women in its programme access services to ensure their babies are born HIV-negative.
In the meantime, Tasintha continues to watch a generation of children born HIV-positive come of age.
Phiri described a recent case where a child became suicidal and had to be rushed to a child psychologist over her HIV status.
“This is a child that believes that the only way you can get HIV is through sex and she has never had sex with anybody, and then she is told she is HIV-positive. It becomes a very big problem to handle and we are handling a lot of such cases.”