We enter a large community centre in Nairobi that is packed with over 400 sex workers sitting in white plastic chairs. It’s loud, chaotic and friendly. A few children are in their mother’s arms. A handful of women are falling asleep, having worked all night yet staying up to come to the meeting. These are research subjects in a UM study on whether aspirin can aid in the prevention of HIV. The women are here for a semi-annual research update. Keith Fowke [BSc(Hons)/88, PhD/95], head of UM’s Medical Microbiology and Infectious Disease Department and the principal investigator in this study, leads our UM group up the center aisle to the front stage. He is a kind-hearted Winnipegger who is smiley, humble and has been travelling to Kenya for almost 40 years, since he was a PhD student at UM.

Keith receives a rock star’s welcome! The women cheer, clap, and wave at Keith as he steps on stage. They know Keith. These women live with intense stigma, so they know a true friend when they see one. All are equals—the University of Manitoba and the University of Nairobi, the researchers and study participants. It is a beautiful moment created through collaboration and community, trust and equality. At the end of the meeting, the women sing and dance their thanks to UM, as is their custom. It was jubilant and unforgettable. So touching there are tears in my eyes.

Joyce, a sex worker who is HIV-positive, led the community in song as a thank you to the research team.

Health equity, integrity, partnership, empowerment, destigmatization, trust. These words, I quickly learned during my February trip, aptly describe UM’s world-renowned research in Kenya. I had the pinnacle experience as Chancellor of visiting for a week. (I paid my own way!) This work comes out of the University of Manitoba’s decades-long partnership with the University of Nairobi studying communities in Nairobi who are vulnerable to HIV and other infectious diseases.

Keith Fowke’s studies have shown that aspirin—an affordable, globally available drug—reduced the number of HIV target cells in the female genital tract by 35 per cent.

Keith Fowke is not a boastful kind of guy. But he proudly told me that UM is number one in the world for the volume of research publications on sex worker health to date. Not only is it highly respected research, but it is carried out with kindness, compassion and passion. It was Fowke who, as a student under mentor Frank Plummer [MD/76], discovered that this population of women were somehow immune to HIV, despite being exposed to the virus hundreds of times. This finding greatly advanced the world’s understanding of potential treatments.

We’re in the core of the Majengo slums, visiting the 40-year-old SWOP (Sex Workers Outreach Program) Clinic, one of 10 clinics that serve 40,000 sex workers. Clients receive HIV and STI testing, prevention and treatment, support and programming. They come for the condoms but stay for the health services and supports. There is a condom shortage in Kenya. While here, these women are invited to participate in UM/UN research studies on infectious diseases. They will receive clinic support regardless of their research participation. Three thousand peer educators are the backbone of this and the other nine clinics’ model, spreading the word to other sex workers. Peer educators have also been key in achieving a 98 per cent adherence rate among participants when it comes to taking their drugs and keeping their appointments for the research study. This model was created in 1984 and has been promoted the world over by UNAIDS and the World Health Organization as best practice for how to work with populations at high risk of getting HIV.

The SWOP Majengo Clinic

Gladys is a “Clinic Champion” and client since 2001. A Champion is a sex worker who welcomes each new client, sharing her life, making her feel safe, and supporting the integrity of the clinic. Gladys met our van, shaking hands and smiling warmly. She hugged me and kissed my hand. I felt fully welcomed, and instantly experienced the difference a greeting from Gladys can make.

I got to know Joyce, who has been HIV positive for 24 years, but her viral load is undetectable due to the free meds she receives at the clinic. She doesn’t mince words: “It’s a privilege to work with UM and SWOP, because if not, some of us would be dead.” Joyce is a sex worker, community leader, peer educator, outreach worker, and co-researcher on a study with UM. She has spoken in front of the European Parliament. In her early 50s, broad shouldered and with a round and open face, Joyce looks like anyone’s favourite auntie. Over coffee, she tells me SWOP gives her and her community healthcare, capacity building, empowerment and confidence. I can’t help but wonder if the clinic also brings healing through its non-judgemental approach.

UM scientist Julie Lajoie [PhD/2013] is excited to show us what looks like a huge, old propane tank for your barbecue. We have entered her research lab at the University of Nairobi. It is small and full of machinery for analyzing blood samples. She explains this tank stores the irreplaceable frozen blood specimens of women from the 1980s. This blood can be thawed and studied today. The idea for Julie’s latest study came from Nairobi’s aging sex workers. They wanted to know about the impact of aging and menopause when living with HIV or not. Julie is also studying how an injectable, hormonal contraceptive may increase the risk of HIV infection. Julie’s PhD student is the fifth generation of UM researchers in Nairobi, dating back to UM’s Allan Ronald [MD/61, BSc(Med)/61, DSc/11] and his first visit in 1979.

UM researcher and physician Dr. Stephen Moses walks into the SAPTA Centre. In 2007 Moses co-led a study showing that circumcision reduced the risk of HIV infection by 50 to 60 per cent in men who had heterosexual sex. The discovery was named one of the biggest medical breakthroughs of the year by Time magazine.

The wounds heal but the scars remain. These are the words of another peer educator we meet, this time at SAPTA (Support for Addiction Prevention and Treatment in Africa). SAPTA is a safe space for 6,000 injection drug users who want a better life. With methadone, they taper off their need for drugs and start to see a new way forward. Peer Educators’ expertise is also essential to the success of this program, creating a safe bridge from the drug dens to the front door of SAPTA.

UM President Michael Benarroch is shown a clean needle kit, which peer educators hand out to drug users to help prevent the spread of HIV.

Our group sits in a conversation circle with 24 peer educators and clients. One by one each participant speaks candidly about their years on heroin and their life now they are clean. They share what motivated them to change (tired of street life, family rejection, suicidal thoughts) and what SAPTA means to them (home, mentorship, empathy). UM researchers Parinita Bhattacharjee and Souradet Shaw [BA/97, MSc/2009, PhD/2018] are partnering with SAPTA to study the barriers women face when seeking care. It appears to be related to cultural shame and other forms of stigma. SAPTA is meeting people where they are to support personal transformation. Love emanates from the community here.

Chancellor Anne Mahon with Daniel (left) and Levi

Listening to each other’s stories is therapy. This comes from Daniel, a client at HOYMAS (Health Options for Young Men on HIV/AIDS and STIs). HOYMAS, like it’s mother clinic SWOP, utilizes peer educators and offers all services under one roof, seeing 6,000 male sex workers each year. Walls in these small, humble offices are painted the colours of the rainbow—cheerful and inviting. Our group crowds into a brightly lit room with couches. On one wall is a huge white banner called “a talking wall,” covered with messages of encouragement from clinic clients and visitors.

Levi, a peer educator, shares what this room has meant to him. It was a safe space to sleep during the day after working all night, when he was living on the streets, rejected by his family. Those words on the wall served as messages to continue on and focus on the good in life.

Piles of packed binders spill over the small coffee table in the SWOP Ambassadors offices, where sex workers advocate for their community. These binders are filled with data documenting the assaults and often gruesome murders of sex workers. The four women we meet are a special group. Compassionate enough to face this work, and angry enough to have the strength to do it. Over and over again. Their work focuses on safety strategies, police sensitization and accountability, and mental health supports in a city where they say violence against women has been normalized.

Rosemary is a strong woman! She is the leader and the voice of this group. They have 12 paralegals who volunteer, meeting their peers in the police station, helping to navigate the discriminatory legal system. The ambassadors are planning an End Femicide Campaign focusing on the female violence and murders. Their work is hauntingly similar to Indigenous women in Canada raising their voices for the MMIWG2S. Later that night, I lie awake thinking about their unwavering commitment, despite feeling unseen by society.

Servant leaders. That’s how Kenyan and UM-trained Joshua Kimani describes the UM approach to working within these communities. I see it everywhere… in the co-created research ideas like Julie’s, in the connections, the deep respect, and the shared laughter. UM’s Institute for Global Public Health applies this same philosophy to its collaborative work in India to improve health systems and maternal health. Lifesaving changes made there are set to be applied in several African countries and Pakistan in the coming years, thanks to funding from the Bill and Melinda Gates Foundation. UM’s global public health experts receive more funding from this foundation than any other Canadian university.

In the office of the SWOP ambassadors

We laughed a lot this trip despite the sobering context to our visit. Our trip was the same week the Trump administration froze all international aid through PEPFAR and USAID. I witnessed the community in crisis. Joyce told me she could die without the free HIV meds she gets from the SWOP clinic. Free HIV medication resumed Feb. 6 because the US government deemed it essential. But if funding cuts continue past the 90-day freeze, all HIV prevention and treatment activities are vulnerable. Peer mentors will be unemployed. There would be no HIV testing, no community supports. The clinical foundation of all the UM research that I learned about this week could be eroded.

Back to that community meeting with the 400 sex workers. As it was wrapping up, advocate Rosemary spoke emotionally about the uncertainty and fear everyone is facing because of funding cuts announced by the American government.

She pleaded to our UM group, saying Remember us.

I will never forget you.

Read more on this topic: The Conversation // U.S. cuts to HIV/AIDS funding will be detrimental for vulnerable groups in Kenya

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