HIV risk rises as climate disasters push African women to sell sex | Context

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African climate disasters are pushing more women into transactional sex and increasing the risk of HIV

• Climate crises hit African women’s livelihoods
• More women, girls forced into transactional sex
• HIV infection risk higher in young women and girls

NAIROBI – In Nairobi’s informal settlement of Kawangware, Kenyan vegetable seller Beverly confronts a grim reality – her one-room corrugated iron home and everything she owned has been destroyed in the worst floods in years.

Since March, torrential rains linked to climate change have inundated parts of East Africa, destroying homes and livelihoods, and displacing hundreds of thousands of people.

Now, with hunger knocking, the mother-of-two contemplates a dangerous exchange – sex for food.

“I know others who had to do it,” 23-year-old Beverly, who did not want to provide her full name, told Context.

“I know about risks like AIDS. But I have lost everything and I still have to feed my children. At this moment, I am praying to God to help me,” she said.

Amidst the turmoil of Africa’s climate crisis, an unseen threat is unfolding where hunger is pushing women and girls into sexual exploitation and increasing the risk of HIV, health experts and aid workers warned.

The continent is on the frontline of the impacts of climate change. This year has already seen floods in east Africa, heatwaves in the west and drought in the south.

As a hotter planet produces more intense and frequent weather-related events, communities already teetering on the brink are being hit the hardest, their livelihoods, often based on farming, destroyed. Many are forced to migrate to survive.

This is not only exposing girls and women to exploitation in the form of transactional sex and sexual violence, but is also raising the risk of increased HIV infection. 

Health experts are now sounding the alarm, cautioning that this neglected crisis might reverse years of advancements in the fight against HIV, potentially undoing hard-won gains.

Research conducted by Frontline AIDS last year found that if temperatures continued to rise as predicted, sub-Saharan Africa could see an additional 16 million cases of HIV by 2050.

“We were really shocked with the results of modelling data from the study,” said David Clark, head of programmes at Frontline AIDS, a global network of 60 charities tackling HIV.

“We are really concerned that the impacts of climate change could wipe away decades of progress on HIV.”

‘Risky behaviours’

Sub-Saharan Africa has made great strides in tackling HIV since it was discovered more than 40 years ago. In east and southern Africa, for instance, new infections have dropped by 57% since 2010.

The region however remains the world’s most affected – accounting for 25.6 million of the 39 million people living with virus globally, the United Nations AIDS programme (UNAIDS) says.

Adolescent girls and young women make up more than 77% of new infections among people aged 15-24 years in sub-Saharan Africa, and are more than three times more likely to acquire HIV than their male peers.

“Many of these young women are highly vulnerable,” said Pasquine Ogunsanya, executive director of the Kampala-based charity Alive Medical Services.

“They don’t have economic power or a proper education so it’s very difficult for them to even negotiate for a condom,” she said.

Yet only about 42% of districts with high HIV incidence in sub-Saharan Africa have dedicated HIV prevention programmes for adolescent girls and young women, UNAIDS data shows.

At the same time, Africa is heating up at a faster rate than the rest of the planet and enduring more severe and frequent disasters such as droughts, floods, heatwaves and storms.

In 2022, the continent was hit by 80 extreme climate-related events. These included the Horn of Africa’s worst drought in 40 years and wildfires in Algeria, and resulted in 5,000 deaths and more than $8.5 billion in economic losses.

Aid workers said such disasters resulted in girls dropping out of school to find work, being forced into early marriage, or pushed into sexual exploitation where they have to exchange sex for money, food or water.     

“During times of drought and food insecurity, we have seen women and girls resort to risky behaviours to put food on the table,” said Zvidzai Maburutse, Oxfam’s country director in Zimbabwe.

“This could be by visiting bars for transactional sex, or at boreholes where men will offer to help young women skip long queues or help them use the water pump in exchange for favours.”

Women also faced the increased risk of sexual violence as they had to walk longer distances, often in the evening when it was cooler, to collect water or find food, said Maburutse, adding that these situations were putting them at risk of HIV.

Researchers agree.   

A February study by Bristol University found droughts which led to food insecurity and poverty in Lesotho, Eswatini, Zambia, Tanzania and Uganda were pushing rural women into transactional sex and raising their risk of HIV transmission.

Researchers used survey data from more than 100,000 adults in the five countries, linked it with rain data to define drought areas, and used statistical models to determine if people exposed to drought were more likely to have acquired HIV.

Overlooked in climate action

Health experts said new infections during climate disasters could also arise when people living with HIV were unable to access their medication, often due to migration.

Without medication, people living with HIV can have a higher viral load which elevates the risk of transmitting the virus to others, they said.

Health experts and aid workers said HIV response in terms of prevention, testing and treatment during weather-related crises had been overlooked and did not feature in most countries’ national disaster risk reduction plans.

Organisations focused on tackling HIV needed to partner with humanitarian organisations during disasters and focus on support such as cash transfers and provision of food and clean water to girls and women as a form of prevention.

Government and aid agencies should also look to introduce testing facilities and spread stockpiles of HIV medications to ensure migrant populations could access treatment during crises, they said.

Chalilwe Chungu, head of programmes for Catholic Relief Services in Zambia, said there needed to be increased support for food, nutrition and health services for vulnerable communities during disasters.

“Because of the level of investments and commitments required into tackling climate change issues, the links with HIV is a subject most people do not want to delve into,” Chungu told Context.

“But there is enough evidence out there to help us extrapolate that climate change could reverse the gains that we have made in HIV/AIDS. We need to act now and protect those gains before it is too late.”

(Reporting by Nita Bhalla; Editing by Jon Hemming.)