A female Sex worker (FSW) does not produce enough natural lubricant when having intercourse with her client because the intercourse is transactional and has very little to do with pleasure. Men having sex with men (MSM) also require the same since the anal sex they engage in also requires synthetic lubrication to reduce friction and possible chaffing and rapture of the condom during intercourse.
The above groups alongside drug users and transgender persons have been identified as Key populations and are said to bear the disproportionate burdens of HIV infections. In the 21st century it is not enough to preach the Abstinence, Faithfulness and the condomize verse since sex like all constants in life is evolving.
When presenting at the recently held PEPFAR Botswana and INK Centre for Investigative Journalism New Directions in Global Health Media Writing Workshop, Prevention Advisor from USAID Maina Kiranga explained that, ” These are persons for whom inclusion in HIV prevention, treatment, and care services are necessary to achieve epidemic control.”
In the classroom, the guidance and counseling teacher speaks to adolescents about sexual reproductive health demonstrating the safe use of condoms between a man and a woman in a relationship. A stone throw away; at the local clinic the nurse demonstrates at the clinic on the safe use various modes of contraception and the overall care and precautions when a man and a woman in a relationship engage in sexual intercourse. The reality however is that the conventional man and woman engagement in sexual intercourse has sized to exist as the most popular form of sexual interaction within our societies.
The risk factors faced by these key populations due to lack of provision of the necessary tools and training regarding their sexual reproductive health is immense and requires immediate attention to ensure their safety.
With respect to lubrication or the lack of it thereof presents risks such as; “Potential wounds giving direct avenue for virus into the blood stream,” (Sex and the Society Volume 1: Cavendish). It is further stated that it occurs mostly when people are coerced in to sex without the necessary stimulation the friction can break the skin. Therefore the lack of synthetic lubrication in public health facilities compromises people from key populations. These factors cannot be ignored because according to Kiranga the high unemployment rates in Botswana force people into engaging in commercial sex work.
The 2012 Biological Behavioral Surveillance Survey (BBSS) indicates that Female Sex Workers are the most affected sub population affected by HIV and AIDS followed by Men who have sex with Men. The FSW has a prevalence HIV rate of 61.9% and an incidence rate of 12.5%. The sex workers claim to find their clients at drinking spots and since many of them have wives and girlfriend these clients end up serving as a bridge between the sex workers and the general population. The sex workers interviewed for this study claimed to have knowledge that they are a high risk population and that they try by all means to keep abreast of their status. However only a minority of those HIV positive receive treatment and face a lot of discrimination at an individual level.
Another sub population, men who have sex with men hold a 13.1% prevalence rate and a2.7% incidence rate and according to the BBSS report these figures have a large degree if errors seeing as these sexual acts are not disclosed due to stigma. The MSM group also has a high risk behavior mostly because these men have sex with both men and women and most of them are unaware of the fact that anal sex has a higher biological risk of transmission than vaginal sex.
Unless issues emanating from the key populations are adequately addressed to curb the new infection rates by providing the necessary healthcare in public health facilities devoid of stigma and discrimination, new HIV infections will continue to be on the rise.