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

KAMITUGA, Congo (AP) — 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.

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.

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.

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.

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.”

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.

Sifa Kunguja, a 40-year-old sex worker, sits home after recovering from mpox, Wednesday, Sept. 4, 2024, in Kamituga, eastern Congo. (AP Photo/Moses Sawasawa)

Sex workers listen to a briefing on mpox Wednesday, Sept. 4, 2024 in a bar in Kamituga, eastern Congo. (AP Photo/Moses Sawasawa)

Sex workers participate in an mpox awareness program Wednesday, Sept. 4, 2024 in Kamituga, eastern Congo. (AP Photo/Moses Sawasawa)

Atumisi Anaclet treats a sex worker who has mpox Wednesday, Sept. 4, 2024 in the general hospital in Kamituga, eastern Congo. (AP Photo/Moses Sawasawa)

A sex worker suffering from mpox, lies down Wednesday, Sept. 4, 2024 in the general hospital in Kamituga, eastern Congo. (AP Photo/Moses Sawasawa

A sex worker suffering from mpox sits in a hospital courtyard Wednesday, Sept. 4, 2024 in Kamituga, eastern Congo. (AP Photo/Moses Sawasawa)

Miners walk Thursday, Sept. 5, 2024 in Kamituga, eastern Congo. (AP Photo/Moses Sawasawa)

Women sell vegetables Wednesday, Sept. 4, 2024 in Kamituga, eastern Congo. (AP Photo/Moses Sawasawa)

Aerial view of mining in Kamituga, eastern Congo, Thursday, Sept. 5, 2024. (AP Photo/Moses Sawasawa)

Sifa Kunguja, a 40-year-old sex worker, sorts through condoms at home after recovering from mpox Wednesday, Sept. 4, 2024 in Kamituga, eastern Congo. (AP Photo/Moses Sawasawa)

Sifa Kunguja, a 40-year-old sex worker, sits home after recovering from mpox Wednesday, Sept. 4, 2024 in Kamituga, eastern Congo. (AP Photo/Moses Sawasawa)

DEIR AL-BALAH, Gaza Strip (AP) — Israeli strikes killed at least 32 people in southern Gaza overnight, mostly women and children, as the military launched ground operations in the hard-hit city of Khan Younis, Palestinian medical officials said Wednesday.

Israel has continued to strike what it says are militant targets across Gaza nearly a year after Hamas’ Oct. 7 attack ignited the war, even as attention has shifted to Lebanon, where Israel has launched ground operations against Hezbollah, and to Iran, which launched a ballistic missile attack on Israel late Tuesday.

In a separate development, Hezbollah said its fighters clashed with Israeli troops in the Lebanese border town of Odaisseh, forcing them to retreat. There was no immediate comment from the Israeli military or independent confirmation of the incident, which would mark the first ground combat since Israeli troops crossed the border this week.

The European Hospital in Khan Younis said it received the bodies after heavy Israeli airstrikes and ground operations in the city. Hospital records show that seven women and 12 children as young as 22 months old were among those killed. Another 19 people, including two children, were killed in separate strikes late Tuesday in central Gaza, according to hospitals there that received the bodies.

The Israeli military did not immediately respond to a request for comment.

Dr. Saleh al-Hams, head of the nursing department at the European Hospital, said dozens of dead and wounded people were brought to his facility and the Nasser Hospital starting at around 3 a.m. Some of the wounded were in critical condition, meaning the death toll could rise, he said.

He said Israel had carried out heavy airstrikes as its ground forces staged an incursion into three neighborhoods in Khan Younis. Israel carried out a massive offensive earlier this year that left much of Gaza's second largest city in ruins.

Over the course of the war, Israeli forces have repeatedly returned to areas of Gaza where they have previously fought Hamas and other armed groups as the militants have regrouped.

Hamas-led militants killed some 1,200 people, mostly civilians, on Oct. 7 and took around 250 hostage. Around 100 are still in captivity in Gaza, a third of whom are believed to be dead.

Israel’s retaliatory offensive has killed over 41,000 Palestinians, according to local health authorities, who do not say how many were fighters but say a little more than half were women and children. The military says it has killed over 17,000 militants, without providing evidence.

The offensive is among the deadliest and most destructive military campaigns in recent history. It has flattened wide areas of Gaza and displaced 90% of its 2.3 million people, often multiple times.

Iran launched at least 180 missiles into Israel on Tuesday in what it said was retaliation for a series of devastating blows Israel has landed in recent weeks against Hezbollah, which has been firing rockets into Israel since the war in Gaza began.

Israelis scrambled for bomb shelters as air raid sirens sounded and the orange glow of missiles streaked across the night sky.

The Israeli military said it intercepted many of the incoming Iranian missiles, though some landed in central and southern Israel and two people were lightly wounded by shrapnel.

Several missiles landed in the Israeli-occupied West Bank, where one of them killed a Palestinian worker from Gaza who had been stranded in the territory since the war broke out.

Israeli Prime Minister Benjamin Netanyahu vowed to retaliate against Iran, which he said “made a big mistake tonight and it will pay for it.”

President Joe Biden said his administration is “fully supportive” of Israel and that he’s in “active discussion” with aides about what the appropriate response should be.

Iran said it would respond to any violation of its sovereignty with even heavier strikes on Israeli infrastructure.

Hezbollah and Hamas are close allies backed by Iran, and each escalation has raised fears of a wider war in the Middle East that could draw in Iran and the United States, which has rushed military assets to the region in support of Israel.

Israel and Iran have fought a shadow war for years but only traded fire directly for the first time in April, when Iran launched an aerial attack to avenge the killing of two of generals in an apparent Israeli airstrike on its embassy complex in Damascus. Few of its projectiles reached their targets, with many shot down by a U.S.-led coalition.

Israel appeared to have responded with a smaller strike of its own before both sides stepped back from the brink.

Iran said it fired Tuesday’s missiles as retaliation for attacks that killed leaders of Hezbollah, Hamas and the Iranian military. It referenced Hezbollah leader Hassan Nasrallah and Revolutionary Guard Gen. Abbas Nilforushan, both killed in an Israeli airstrike last week in Beirut. It also mentioned Ismail Haniyeh, a top leader in Hamas who was assassinated in Tehran in a suspected Israeli attack in July.

The U.N. Security Council scheduled an emergency meeting for Wednesday morning to address the escalating situation in the Middle East.

Israel is meanwhile carrying out what it says are limited ground incursions into southern Lebanon. Israeli airstrikes and artillery fire pounded southern Lebanese villages on Tuesday, and Hezbollah responded with a barrage of rockets into Israel.

Israel has said it will continue to strike Hezbollah until it is safe for tens of thousands of its citizens displaced from homes near the Lebanon border to return. Hezbollah has vowed to keep firing rockets into Israel until there is a cease-fire in Gaza with Hamas.

Israel has warned people in southern Lebanon to evacuate to the north of the Awali River, some 60 kilometers (36 miles) from the border and much farther than the Litani River, which marks the northern edge of a U.N.-declared zone intended to serve as a buffer between Israel and Hezbollah after their 2006 war. The border region has largely emptied out over the past year as the two sides have traded fire.

Israeli strikes have killed over 1,000 people in Lebanon over the past two weeks, nearly a quarter of them women and children, according to the Health Ministry. Hundreds of thousands have fled their homes.

Hezbollah is a widely seen as the most powerful armed group in the region, with tens of thousands of fighters and an arsenal of 150,000 rockets and missiles. The last round of fighting in 2006 ended in a stalemate, and both sides have spent the past two decades preparing for their next showdown.

Magdy reported from Cairo. Associated Press writers Kareem Chehayeb in Beirut and Melanie Lidman in Tel Aviv, Israel contributed.

Follow AP’s war coverage at https://apnews.com/hub/israel-hamas-war

Flames rise from an apartment which caught fire after an Israeli airstrike in Dahieh, Beirut, Lebanon, Wednesday, Oct. 2, 2024. (AP Photo/Hussein Malla)

Civil defense firefighters try to extinguish the fire on an apartment following an Israeli airstrike in Dahieh, Beirut, Lebanon, Wednesday, Oct. 2, 2024. (AP Photo/Hussein Malla)

An Israeli mobile artillery unit fires a shell from northern Israel towards Lebanon, Wednesday, Oct. 2, 2024. (AP Photo/Baz Ratner)

Smoke rises following Israeli bombardment in southern Lebanon as seen from northern Israel, Wednesday, Oct. 2, 2024. (AP Photo/Baz Ratner)

Civil Defense remove debris from a destroyed complex hit in Israeli airstrikes in Dahieh, Beirut, Lebanon, Wednesday, Oct. 2, 2024. (AP Photo/Hussein Malla)

A man takes pictures by his mobile phone of a destroyed building hit by an Israeli airstrike in Dahieh, Beirut, Lebanon, Wednesday, Oct. 2, 2024. (AP Photo/Hussein Malla)

A man passes in front of a destroyed building that hit by an Israeli airstrike in Dahieh, Beirut, Lebanon, Wednesday, Oct. 2, 2024. (AP Photo/Hussein Malla)

Smoke rises from a destroyed resident complex hit by Israeli airstrikes in Dahieh, Beirut, Lebanon, Wednesday, Oct. 2, 2024. (AP Photo/Hussein Malla)

Workers remove broken glass from a damaged building that was hit during Iran's missile attack in Tel Aviv, Israel, Wednesday, Oct. 2, 2024. (AP Photo/Ariel Schalit)

A woman looks from a damaged building that was hit during Iran's missile attack in Tel Aviv, Israel, Wednesday, Oct. 2, 2024. (AP Photo/Ariel Schalit)

Broken wine glasses are seen in a damaged restaurant that was hit during Iran's missile attack in Tel Aviv, Israel, Wednesday, Oct. 2, 2024. (AP Photo/Ariel Schalit)

A man takes pictures with his mobile phone of a destroyed resident complex where he lives that hit by an Israeli airstrike in Dahieh, Beirut, Lebanon, Wednesday, Oct. 2, 2024. (AP Photo/Hussein Malla)

Smoke rises a neighborhood that was hit by an Israeli airstrike in Dahieh, Beirut, Lebanon, Wednesday, Oct. 2, 2024. (AP Photo/Hussein Malla)

Smoke rises from neighbourhoods hit by Israeli airstrikes in Dahieh, Beirut, Lebanon, Wednesday, Oct. 2, 2024. (AP Photo/Hussein Malla)

Lebanese soldiers stand in front of an apartment which caught fire after an Israeli airstrike in Dahieh, Beirut, Lebanon, Wednesday, Oct. 2, 2024. (AP Photo/Hussein Malla)

Smoke rises following Israeli bombardment in southern Lebanon as seen from northern Israel, Wednesday, Oct. 2, 2024. (AP Photo/Baz Ratner)

An Israeli soldier covered in a prayer shawl prays at a mobile artillery position in northern Israel, Wednesday, Oct. 2, 2024. (AP Photo/Baz Ratner)

An Israeli mobile artillery unit fires a shell from northern Israel towards Lebanon, Wednesday, Oct. 2, 2024. (AP Photo/Baz Ratner)

An Israeli mobile artillery unit fires a shell from northern Israel towards Lebanon, Wednesday, Oct. 2, 2024. (AP Photo/Baz Ratner)

Smoke rises following Israeli bombardment in southern Lebanon as seen from northern Israel, Tuesday, Oct. 1, 2024. (AP Photo/Leo Correa)

A Middle East Airlines airplane flies over Beirut as smoke rises from Dahiyeh, in Beirut, Lebanon, Tuesday, Oct. 1, 2024. (AP Photo/Bilal Hussein)

An Israeli tank maneuvers in northern Israel near the Israel-Lebanon border, Monday, Sept. 30, 2024. (AP Photo/Baz Ratner)

People take cover on the side of a road as a siren sounds a warning of incoming missiles fired from Iran on a freeway in Shoresh, between Jerusalem and Tel Aviv in Israel Tuesday, Oct. 1, 2024. (AP Photo/Ohad Zwigenberg)

A cleric clenches his fist as he celebrates Iran's missile strike against Israel in an anti-Israeli gathering at Felestin (Palestine) Sq. in Tehran, Iran, Tuesday, Oct. 1, 2024. (AP Photo/Vahid Salemi)

Israelis take cover as projectiles launched from Iran are being intercepted in the skies over in Rosh HaAyin, Israel, Tuesday, Oct. 1, 2024. (AP Photo/Maya Alleruzzo)

An Israeli mobile artillery unit fires a shell from northern Israel towards Lebanon, Wednesday, Oct. 2, 2024. (AP Photo/Baz Ratner)