A man alights at Majengo from the matatu bus stop. Everyone stares at him; they know he has come here for sex. He manoeuvres around fragile tin houses, dodges the sewage, and walks to where "the women on stools sit". He sees a woman on her stool, walks into her home, and ten minutes later they exchange money. He leaves; she takes a soda, and awaits her next client. That is how life is here.

Imelda Angelo should know. At the age of 43, she has spent the last 20 years as a sex worker in Majengo, a heavily populated Tanzanian settlement in Nairobi.

"In Majengo, men know they can get cheap sex. Some girls get a flat rate of 100 KES ($1), but I have worked for 50 KES," says Imelda. "We have a mixture of clients, but the business men from other countries are always the good ones. Lots of our clients do not work; young people around here have nothing to do, no job, no education. They just sit around during the day, or wash cars for a few bob, and then mug people at night. Those clients have threatened me with a knife, or just abuse me until I have sex with them for free."

Following her mother's death, Imelda travelled from Bukoga in Tanzania to look after her younger siblings in Nairobi, Kenya. Arriving in Majengo, Imelda had no money to support her family. Her Tanzanian friends told her the only option was sex work, and at the age of 23, Imelda found herself with her first client.

"We urgently need to scale up health care in urban settlements. IOM's existing tuberculosis and HIV programme is limited to biomedical interventions due to funding limitations. With more funds, IOM envisions a comprehensive programme with increased community engagement and behavioural components. The envisioned package would be government-led and cover primary health care, communicable disease surveillance, reproductive and child health, and prevention and treatment of tuberculosis and HIV. It should strengthen health systems to reach marginalized groups in many migrant communities scattered across Nairobi."

–Dr Wilbert Shihaji, National Health Programme Officer, IOM

"Men who have HIV don't care about protection," says Imelda. "The men will pierce a condom without you knowing, I don't know why they do it. Maybe it feels better? I was young and didn't know that men were doing this. Men would also pay you more money if you didn't wear a condom. When I was pregnant with my third child, I found out my status. I was HIV positive. A year later, in 2003, I went on ARVs (anti-retroviral treatment for HIV)."

Imelda's husband died from AIDS two years ago: "He was in denial and refused to accept that he was HIV positive. He did not want help, or ARVs. I think that is why he died. We need intensive counselling here in Majengo, we need free condoms, and we need money so we don't have to sit on the stools anymore. Here we must have the highest number of sex workers living positively in Nairobi. It could be as high as 500."

Imelda travels to neighbouring Eastleigh, another urban migrant settlement in Nairobi, to access services by UMA CBO, a community-based organization supported by the International Organization for Migration. Imelda is one of 1,275 female sex workers enrolled in a pilot urban female sex worker programme where she can now access health education, HIV counselling and testing, free sexually transmitted infection screening, and English lessons.

"The programme has given me hope," says Imelda during her English class. "It has helped me to accept my HIV status, and given me the chance to learn English. Most businesses are in English, so only understanding Swahili reduces my chance of getting proper work."

With ongoing support from the pilot programme, Imelda has started her own vegetable stall: "Now my children don't come home from school and ask why I am sat on a stool anymore. I just wish these services were available in my community so all the other sex workers I know in Majengo can access them easily."

Top: Imelda now accepts her status and lives positively. Bottom left: Imelda sells vegetables at her stall in Majenga. Bottom right: Imelda sat on a stool offering sex work for 20 years. © IOM (Photo by: Celeste Hibbert)