Sex for fish: Aid cuts by United States revive risky behaviour in Kenya

As the sun rises over Lake Victoria, fishermen return to Kendu Bay with the night's catch as women traders wait on the shore. But with US aid cuts hitting incomes and health services in western Kenya, many women will pay for the fish with sex.

"We are back to begging with our bodies," says 32-year-old Mary, a fish trader from nearby Homa Bay, who asked to use a pseudonym because of the sensitivity of the subject.

She explained that dwindling incomes and rising health costs have driven her to barter sex for fish, a decades-old practice known as "jaboya" in the local Luo language.

A long-standing practice, jaboya had been in decline as programmes spread awareness about HIV and sister projects bolstered women's incomes through, for example, savings groups.

But many of these programmes were funded by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), which was administered by the U.S. Agency for International Development or USAID, which President Donald Trump gutted this year.

US-funded clinics offering free HIV testing, counselling and medication were dotted around remote fishing towns on Lake Victoria near the border with Uganda.

But now this support has dried up and jaboya has revived.

"The (Kendu Bay) clinic closed. The drugs are gone. We have no choice," said Mary, who does not have HIV but who used to benefit from free U.S. health services, as well as income-generating projects.

According to UNAIDS, adolescent girls and young women in the region are disproportionately affected by HIV, affecting one in five in Homa Bay County — more than triple the national average.

Community activists, health workers and rights groups say it is women and LGBTQ+ people who are among those worst hit by the aid cuts.

"The safety net collapsed overnight," says Judith Anyango, a clinician formerly attached to the USAID-supported community clinic in Kendu Bay that Mary used to attend.

"Every dollar cut in Washington translates to a girl forced into sex at the beach, or a gay man defaulting on treatment," she said.

"These are not numbers. These are lives."

PROGRESS IN JEOPARDY

For two decades, PEPFAR has been central to Kenya’s fight against HIV, helping to reduce adult HIV prevalence from 6.7% in 2003 to 3.2% in 2023, according to UNAIDS.

More than 1.4 million Kenyans are on antiretroviral therapy (ART), which stops HIV from reproducing in an infected body.

PEPFAR supplied about 40% of Kenya’s HIV drugs and related medical supplies, and before the recent aid freeze, the country was slated to receive roughly $300 million in U.S. support this fiscal year to sustain treatment for about 1.3 million people.

Since Trump froze foreign aid in January, community-based clinics in Homa Bay and the nearby town of Mbita have closed.

There are now few healthcare services in Homa Bay County — historically among the counties with the highest HIV rates in Kenya — leaving over a million Kenyans without essential care.

Outreach programmes for adolescent girls and LGBTQ+ people shut up shop. ART supply chains also faltered, leaving patients without life-saving drugs.

"Patients who relied on free ART now face stock-outs," said Anyango. "Many who were virally suppressed are defaulting, risking resistance and re-infection."

Esther Auma, a community activist and widow-support group leader in Mbita, said "jaboya never really disappeared" but transactional sex became less common as HIV awareness campaigns, condom distribution and economic empowerment kicked in.

"Now, with clinics gone and ART unavailable, the risk is much higher. We are burying young women again."

While there are no official figures, community activists told the Thomson Reuters Foundation they are once again seeing young women dying of AIDS-related complications.

RISKS FOR LGBTQ+ PEOPLE

LGBTQ+ communities have also been hit as many depended on PEPFAR-funded safe spaces that offered HIV prevention, ART refills and counselling free from stigma.

With these programmes gone, many are forced underground.

Kevin, a 24-year-old gay man from Mbita who also wanted to use a pseudonym, said he had not been able to refill his ART prescription for months.

"The drop-in centre was closed. The government hospital is hostile. The pharmacist charges more than I can afford," he said.

"Some of my friends have turned to sex work at the beaches, just to survive and get (HIV) drugs."

Human rights groups say LGBTQ+ people, already marginalised in what is a conservative society, now face heightened risks.

"Cuts in funding don't just mean fewer drugs — they mean lost safe spaces, lost trust and increased stigma," said Winnie Odinga, a researcher on gender and health equity.

'FIGHTING A FLOOD WITH A SPOON'

At a conference in August in Homa Bay town, HIV prevention became a flashpoint when activists handed out condoms outside the venue, saying the authorities were failing to deliver basic sexual health services.

With global donors slashing aid - the United States is not alone here - counties are under pressure to finance health services, a responsibility many are ill-prepared to shoulder.

"County hospitals are overwhelmed. We don't have the capacity to absorb the gap left by donor cuts," says Homa Bay County health officer George Okello.

"The reality is that international funding was propping up our HIV response. Without it, we are losing ground."

Community groups are trying to fill the void.

Cooperatives in Mbita are organising savings circles to reduce women's dependency on selling sex.

LGBTQ+ activists in Homa Bay have set up informal networks to distribute anti-retrovirals sourced from city contacts.

But such efforts remain fragmented - and risky.

"We are doing what we can, but it's like fighting a flood with a spoon," said Auma.

At the landing site in Kendu Bay, Mary adjusts a basket of tilapia on her head. She glances toward the lake, where the fishermen are already setting out for another night.

"We survived before because there was hope," she says quietly. "Now hope has been cut, just like the funding."