In Homa Bay, teenage girls face high risk of HIV and unintended pregnancy

It is early morning at Sindo Main Beach in Homa Bay when the fishing boats arrive. The smell of fish is already strong in the air. White egret birds circle and call out, looking to steal a meal. As a new boat arrives, a man wading waist deep in the water shows it where to land. Dozens of women race forward to get their buckets in the boat, reserving a portion of the catch. Fishermen scoop up large handfuls of tiny omena fish, quickly filling up the buckets. Most women hand over 1,000 shillings ($10 USD) but a few do not. For these women, there is an understanding that they will meet the fisherman later for sex.

This ‘sex for fish’ practice is one reason why Homa Bay has one of the highest rates of HIV in Kenya. It is also a hotspot for teenage pregnancy. Gender inequality, difficulties in accessing services and poverty are other key drivers, while inadequate sexual and reproductive health education in schools leaves adolescent girls unsure how to protect themselves.

Colins Ochieng is Secretary of the Beach Management Unit, which makes the rules and maintains order on the fishing beach. While women walk up the beach carrying buckets of fish on their heads or spread hundreds of tiny fish out on mats to dry in the sun, he explains the drivers of the trade.

“This is not a new practice. In our native language, we call it ‘jaboya’ and it’s been going on for generations,” Colins says. “But it’s got worse in recent years because of poverty. Often, teenage girls drop out of school and their parents are not financially stable. They’re lured by the money that fishermen have. Our whole economy depends on fishing. Peer pressure also plays a role. Adolescents do what their fellows do, whether it’s right or wrong.”

Ayesha’s story

One of the adolescents selling sex to fishermen is 19-year-old Ayesha (not her real name). She dropped out of school in Form 8 when her father passed away. She ended up supporting her family, and with little education or skills, was drawn into sex work.

“I am one of three children. My father died when I was young and my mother got sick,” Ayesha recalls. “When I saw there was no food living with my mum, I came here with a friend of mine who told me there was a way to make money. When we went to buy fish, the fishermen said: ‘We don’t want money, we want you’. My friend couldn’t do it. She left and went home. But I stayed.”

Ayesha left school before sex education was taught. She has learnt about family planning from the local NGO LVCT Health, which has a clinic in Homa Bay providing sexual and reproductive health services for adolescents. However, girls usually visit the clinic after they have already become pregnant or contracted HIV.

“Most of our clients are fishermen,” Ayesha explains. “We find the boats that have sold a lot of fish and establish a rapport with the fishermen. Later, we meet them in the club. I always prefer to use a condom but sometimes they offer more money to have sex without one, and I cannot say no. I need to support my family.”

UNICEF’s support

Gender inequality, difficulties in accessing services and poverty are fuelling high rates of teenage pregnancies and HIV in Homa Bay, according to a new report commissioned by Homa Bay County Government and carried out by the Overseas Development Institute and LVCT Health, with support from UNICEF.

The report, ‘Unintended Pregnancies and HIV Amongst Adolescents and Young People: A Situation Analysis of Homa Bay, Kenya’, highlights that two out of five of girls in Homa Bay give birth before the age of 20 – more than twice the national average. 

There are also signs that the COVID-19 pandemic may be making these figures even worse. Children have been away from the protective environment of school for months and families are facing financial hardship, stress and uncertainty. This creates the conditions for an increase in abuse and sexual violence in homes and communities, which can lead to an increase in HIV infections and teenage pregnancies. National helplines have reported a tenfold increase in reports on violence against girls and women since the start of the coronavirus outbreak in Kenya.

“We commend the Government of Homa Bay for commissioning this crucial report that can help bring about change for the entire western and lake basin region of Kenya,” UNICEF Kenya Chief of HIV Pierre Robert says. “It’s particularly striking that teenagers are now more concerned about getting pregnant than getting HIV. They think they can just take the medication and they’ll be fine. But the reality of living with HIV is much worse than they imagine.”

UNICEF is supporting LVCT Health to promote condom use HIV testing and counselling for adolescent girls in Homa Bay. Condoms are provided by UNFPA. The organization targets 15 to 24-year-olds from vulnerable families, including child headed households. It also works with the fishermen, through the Beach Management Unit, to make sure that they get the same messages about safe sex as the girls.

“A lot of the adolescent girls we see are engaged in transactional sex,” Field Officer Bertrand Ouma says. “We try to change the girls’ behaviour to delay starting to have sex, reduce their number of sexual partners, and learn to negotiate condom use. And we also engage with the fishermen and boda boda [motorbike taxi] drivers who are buying sex.”

UNICEF is calling for the Government and partners to urgently implement the Homa Bay report’s key recommendations. “We must take urgent steps to equip teenagers with the knowledge and skills to keep themselves safe from HIV and unintended pregnancies,” Pierre Robert says. “This is especially important during COVID-19, when safety nets like school have been closed. Kenya’s adolescents are a vital national resource and we must give them the best possible chance in life.”