Sex workers find themselves at the center of Congo's mpox outbreak

KAMITUGA, Congo — It's been four months since Sifa Kunguja recovered from mpox, but as a sex worker, she said, she's still struggling to regain clients, with fear and stigma driving away people who've heard she had the virus.

''It's risky work,'' Kunguja, 40, said from her small home in eastern Congo. ''But if I don't work, I won't have money for my children.''

Sex workers are among those hardest-hit by the mpox outbreak in Kamituga, where some 40,000 of them are estimated to reside — many single mothers driven by poverty to this mineral-rich commercial hub where gold miners comprise the majority of the clientele. Doctors estimate 80% of cases here have been contracted sexually, though the virus also spreads through other kinds of skin-to-skin contact.

Sex workers say the situation threatens their health and livelihoods. Health officials warn that more must be done to stem the spread — with a focus on sex workers — or mpox will creep deeper through eastern Congo and the region.

Mpox causes mostly mild symptoms such as fever and body aches, but serious cases can mean prominent, painful blisters on the face, hands, chest and genitals.

Kunguja and other sex workers insist that despite risks of reinfection or spreading the virus, they have no choice but to keep working. Sex work isn't illegal in Congo, though related activities such as solicitation are. Rights groups say possible legal consequences and fear of retribution — sex workers are subject to high rates of violence including rape and abuse — prevent women from seeking medical care. That can be especially detrimental during a public health emergency, according to experts.

Health officials in Kamituga are advocating for the government to shutter nightclubs and mines and compensate sex workers for lost business.

Not everyone agrees. Local officials say they don't have resources to do more than care for those who are sick, and insist it's sex workers' responsibility to protect themselves.

Kamituga Mayor Alexandre Bundya M'pila told The Associated Press that the government is creating awareness campaigns but lacks money to reach everyone. He also said sex workers should look for other jobs, without providing examples of what might be available.

Sex work is a big part of the economy

Miners stream into Kamituga by the tens of thousands. The economy is centered on the mines: Buyers line streets, traders travel to sell gold, small businesses and individuals provide food and lodging, and the sex industry flourishes.

Nearly a dozen sex workers spoke to AP. They said well over half their clients are miners.

The industry is well organized, according to the Kenyan-based African Sex Workers Alliance, composed of sex worker-led groups. The alliance estimates that 13% of Kamituga's 300,000 residents are sex workers.

The town has 18 sex-worker committees, the alliance said, with a leadership that tries to work with government officials, protect and support colleagues, and advocate for their rights.

But sex work in Congo is dangerous. Women face systematic violence that's tolerated by society, according to a report by UMANDE, a local sex-worker rights group.

Many women are forced into the industry because of poverty or because, like Kunguja, they're single parents and must support their families.

Getting mpox can put sex workers out of business

The sex workers who spoke to AP described mpox as an added burden. Many are terrified of getting the virus — it means time away from work, lost income and perhaps losing business altogether.

Those who recover are stigmatized, they said. Kamituga is a small place, where most everyone knows one another. Neighbors whisper and tell clients when someone is sick — people talk and point.

Since contracting mpox in May, Kunguja said she's gone from about 20 clients daily to five. When she was sick, the lesions on her genitals were so painful she could hardly walk, hunched over and wobbling to get around. Her 9-year-old son caught it from her, she said — he's out of the hospital but still has lesions.

She's been supporting her 11 children through sex work for nearly a decade, but said she now can't afford to send them to school. To compensate, she's selling alcohol by day, but it's not enough.

She said she wants the government to subsidize her income so she doesn't have to put herself or others at risk.

Experts say information and awareness are key

Disease experts say a lack of vaccines and information makes stemming the spread difficult.

Some 250,000 vaccines have arrived in Congo, but it's unclear when any will get to Kamituga. Sex workers and miners are among those slated to receive them first.

Community leaders and aid groups are trying to teach sex workers about protecting themselves and their clients via awareness sessions where they discuss signs and symptoms. They also press condom use, which they say isn't widespread enough in the industry.

Sex workers told AP that they insist on using condoms when they have them, but that they simply don't have enough.

Kamituga's general hospital gives them boxes of about 140 condoms every few months. Some sex workers see up to 60 clients a day — for less than $1 a person. Condoms run out, and workers say they can't afford more.

Dr. Guy Mukari, an epidemiologist working with the National Institute of Biomedical Research in Congo, noted that the variant running rampant in Kamituga seems more susceptible to transmission via sex, making for a double whammy with the sex industry.

Even health experts admit the lack of information about the virus makes it unclear how effective condoms are. Lesions are usually found around the base of the penis, an area that condoms don't cover, they note.

Some women resort to flimsy plastic bags when they can't find condoms, sex worker Irene Mabwidi said. As a leader in her local sex industry group, she said she tries to advise women on other protection measures, such as inspecting clients' bodies for lesions, though that's far from foolproof.

Erin Kilbride of Human Rights Watch said it's crucial that sex workers are in the room when the government designs outreach programs.

''The government should proactively reach out to sex worker organizations, at the local and national level, who are experts in what their communities need,'' Kilbride said.

Mines also lack safety measures

Health experts say miners are also key to containing the virus. While mpox is spread mainly through close contact, it can also occasionally spread from the environment via objects or surfaces touched by an infected person, according to the World Health Organization.

There's little awareness of that in mines, where conditions are often unsanitary. Mines have few, if any, handwashing stations, and sometimes miners don't shower for days. Infected miners might urinate or openly defecate in mines and contaminate water sources, health officials say.

Miners told AP more information and advocacy is needed in mines. Debus Bulambo said he got mpox in February, but sees most fellow miners failing to take the virus seriously. People want to spend cash on sex, even during an epidemic, sometimes paying five times more to go without a condom, he noted. And miners earn a lot — up to about $120 a month, more than double the country's average annual income.

Bulambo said he occasionally paid for sex in the past but stopped, though he realizes he's the exception.

''People aren't afraid," he said bluntly. "I don't understand.''

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute's Science and Educational Media Group. The AP is solely responsible for all content.