On World TB Day (24 March) read Hope's chronicle of life as a sex worker and being diagnosed with TB, then later HIV.
Sitting in her small flat that she once shared with friends in Zimbabwe’s capital Harare, Hope* (27), a sex worker chronicles life from her first diagnosis with tuberculosis (TB) and later HIV. A journey, she says, that has never been easy.
Her first signs of illness started in October 2015. Hope says: “I was healthy-looking when I started coughing and did not take it seriously. I thought it was just a cold but in three days it was worse with chest pains and breathing difficulties.”
Luckily for Hope, a fellow sex worker who was a former TB patient spoke to her about her experience and encouraged Hope to get help and counselling.
She said: “I was reluctant at first because health workers sometimes ill-treat us [sex workers] but when the pain got worse and after talking to a friend, I went to a local clinic.”
Confronting TB and HIV
Although Hope, as a sex worker in a country where it is illegal, had faced problems such as stigma, harassment by police and by some of her clients, she says testing positive for TB brought other problems she had never imagined.
As a newly diagnosed TB patient, Hope also had to undergo a test for HIV – the Zimbabwean Ministry of Health and Child Care made HIV testing for TB patients mandatory in 2015.
In Zimbabwe, the TB epidemic is largely driven by HIV, with 68 per cent of TB patients testing positive for HIV, according to the Global TB Report 2015. Therefore getting as many people as possible testing for HIV and on antiretroviral treatment is an important strategy for stopping TB in the country.
For Hope, when she went to get tested she was naturally very frightened, remembering when she was first introduced to sex work and had failed more than once to negotiate condom use with clients, as some of them demanded having unprotected sex under the pretext that they would pay more money.
Hope also revealed that some of the clients removed condoms in the middle of intercourse. Being new to sex work, she did not know how to handle the situation.
When she tested HIV-positive, Hope recalls: “It was like my life came crushing on me. I had not prepared myself to deal with these two diseases at the same time.”
Hope’s experience is not uncommon. It is estimated that around half of all sex workers in Zimbabwe are living with HIV.[i]
Hope went through intensive counselling and began treatment for TB, a course of antibiotics taken daily for six months. However, this initially had little impact on her health, as the two positive diagnoses had meant she was dealing with discrimination from friends, family and clients.
Pain and emotional suffering
The first few weeks after her diagnosis were the most difficult for Hope, as she struggled to keep up with the large amount of daily medication needed to treat TB and HIV.
Adding to her problems, her former roommates abandoned her in fear of catching both diseases, so she was living alone.
“Taking medication is not easy but doing it broke and without emotional support is even worse,” adds Hope. “I came home one day from the clinic where I had gone to take my pills and found the house almost empty with my few belongings packed in a corner.”
Hope, who has also been labelled an ‘outcast’ by her family after they discovered she was a sex worker, was now left alone to deal with her diagnosis. Unable to work, Hope couldn’t afford nutritious food to help her immune system, and struggled paying rent.
Traumatised by the sudden changes in her life, Hope’s health quickly deteriorated, and in a few weeks, the once big bodied and healthy looking woman became frail and visibly small.
“I became the talk of the town and once the word spread, my regular clients were taken by other sex workers,” she says. “In short, I was alone, lonely, sick and broke.”
According to Lee Zhomwa, a nurse counsellor with the Centre for Sexual Health HIV and AIDS Research (CeSHHAR) based in Gweru, Hope’s experience is common, especially among sex workers who are at high risk of contracting sexually transmitted and other chronic diseases.
But with the right support, it can be a very different story.
More than medication
Zhomwa explains that TB and HIV patients require more than just medication to cope with their situation.
“Most people do not recover quickly even when taking medication and eating healthy because they lack emotional support and often suffer alone with no one to talk to and share problems,” she says.
For Hope, the road to full recovery started with talking to health counsellors at the clinic and sharing her experiences with other people in her community.
“Three things have kept me going; taking my medication, eating healthy and talking to people have kept me going over the past few months,” she says.
The counselling helped her accept her condition and further discussions with friends who are on TB medication gave her hope.
Currently, she is in her last month of TB medication which is provided free at a local hospital under a government scheme. Hope continues to undergo counselling sessions.
With a smile, Hope says: “I have not given up, I will fight until I am well enough to share my story and educate other sex workers so that they do not have to go through a similar experience.”
*name changed to protect identity
[i] UNAIDS (2014) ‘The Gap Report’
This story was originally published by AVERT
Read more personal stories about living with HIV on our blog