Yaounde — While one in 25 people in Cameroon are living with HIV, more then a third of the country's sex workers are infected, meaning they hold the key to halting the spread of the virus
During six years of selling sex on the streets and in brothels across Cameroon's capital Yaounde, Rose has been abused, attacked and forced to have unprotected sex by her clients.
"There are some ferocious beasts amongst them," said the sex worker, a tall woman in her late thirties, wearing a short black dress and sporting a neck-length wig of straight dark hair. "Some men get violent... sometimes they attack you.
"We deal with it as Cameroonian women do. We are strong," Rose told the Thomson Reuters Foundation outside a brothel in Emombo, an area known for high rates of crime and prostitution.
Despite the frequent insults, threats and attacks, sex workers such as Rose are helping to save the lives of their clients from the Central African nation's biggest killer - HIV.
Prostitutes are persuading these men to take free HIV tests in mobile clinics, set up inside or nearby brothels and run by teams of doctors, nurses, social workers and lab technicians, in a drive to tackle the prevalence of the virus which causes AIDS.
Cameroon has the second highest HIV rate in West and Central Africa, after Nigeria, says the U.N. AIDS programme (UNAIDS).
While an average of one in 25 people across the country are living with HIV, more then a third of sex workers are infected, meaning they hold the key to halting the spread of the virus which kills at least 30,000 Cameroonians a year, experts say.
People who buy sex have in the past proved hard to reach with anti-HIV efforts due to the stigma surrounding the virus and the fact that prostitution is illegal in Cameroon.
Yet thousands of men in Yaounde have been convinced by sex workers to get tested since last October in a project run by CARE International and local partners such as Horizons Femmes.
"No one would tell you officially: 'I'm a client of a sex worker' - people hide these kinds of things," said Flavien Ndonko of CARE, explaining how HIV would then quickly spread undetected through networks of sex workers and their clients.
"Now, we are going directly to the place where the sex is taking the place," added the HIV/AIDS senior technical adviser.
"DENIAL, OR SOMETHING WORSE"
On a Friday evening in a narrow alleyway in Emombo, a queue is forming outside the brothel where Rose works - a dilapidated wooden shack where rooms contain nothing but a rolled-up rotting mattress and a rusty nail banged into the doorframe for a lock.
These men are not waiting for sex, but to be tested for HIV.
"You need to talk to them gently," said Rose. "Some men don't like it. They say: 'No, no, I don't have the money for it' and I tell them : 'No, it is already paid for, it is free'."
Sex workers get paid a small fee for each client they refer - 500 CFA francs ($0.85) - and get tested at the same time.
The test takes about 15 minutes, during which time the medical team explains the procedure and the health risks associated with HIV and other sexually transmitted diseases.
"When the test is negative, they're relieved," said psychosocial worker Doreen Mongo, sitting in one of several brothel rooms rented for the night by the health workers.
Those who test positive for HIV are given an appointment in a health centre, through which parents are prescribed a course of drugs, and are offered counselling and follow-up sessions.
"When it's positive, it's either denial or something worse," Mongo added. Some of her fellow health workers said they felt vulnerable being tucked away in a flimsy shack, with little to no security, and having to deal with rowdy, drunken, clients.
One of the medical team said her handbag was stolen while at work, and another had her identity card taken from the brothel.
To improve security for the sex workers and health staff, Horizons Femmes has enlisted community leaders, known locally as 'gatekeepers', to help maintain order and peace in the area.
"They make the area safer for us, they watch out for us," said Roseline Waseem of Horizons Femmes.
BEYOND SEX WORKERS
More than 5,000 clients of sex workers have been tested for HIV so far this year as part of the project, which is funded by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) and believed to be the first of its kind in West and Central Africa.
The results are so promising that Ndonko of CARE plans to present the programme and its results at the world's biggest annual AIDS conference, which takes place in Paris next month. Civil society groups in Cameroon are also going beyond sex workers and their clients, and are working to improve HIV prevention efforts and healthcare for men who have sex with men (MSM) and lesbian, gay, bisexual and transgender (LGBT) people.
Almost a quarter of MSM in Yaounde, and two in five in Douala, the economic capital, are living with the virus, according to the state's national AIDS control committee.
Yet fear of discrimination and the threat of up to five years in prison are driving MSM and LGBT people away from hospitals and state HIV programmes, activists say.
"(In the past), it was really difficult for MSM to just walk into a health facility and consult a doctor because they were scared that even the doctor may just call the police," said Carrine Angumua, CARE's national coordinator for HIV prevention.
But the government has strived in recent years to reduce the number of new infections, by making antiretroviral treatment free, while sex workers, LGBT people and MSM are now part of the country's national HIV strategy.
"This is a major step... access to health is a human right," added Angumua. "That's the platform on which we are working."
(Reporting By Inna Lazareva, Editing by Kieran Guilbert and Ros Russell; Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers humanitarian news, women's rights, trafficking, property rights, climate change and resilience. Visit http://news.trust.org)