Sexual health on HIV corridor

The colours around us were vivid. At Zalewa in Mwanza, almost 100 women and girls, clad in lime-green and grey T-shirts, were exploring ways of protecting themselves and other at-risk mobile populations from HIV and Aids.

The group constitutes some of over 20 000 sex workers in the country.
Nearly 10 of them were pregnant and about 40 had babies on their lap.

“It is part of life,” a pregnant 21-year-old said.

She candidly termed her bulge and some of the babies “fruits of our mistakes”, saying condoms burst and some clients pay more for unprotected sex.
“In our work, anything can happen,” she said. “Many babies bear mothers’ surnames because it is difficult to pinpoint the father of your children.”
Approximately 350 sex workers are plying their trade in the busy trading centre traditionally known for roadside sales of fresh farm produce.

Many travellers no longer stop at Zalewa Roadblock to buy fruits, vegetables and meats as falling yields and rising economic activity have left prices skyrocketing.

The new big business hinges on an influx of sex workers from the neighbouring districts and beyond.
“Sex is the only cheap thing nowadays,” a resident said. “Sex workers from all parts of the country are camping here.”
Surging sexual activity is part of Zalewa’s nightlife.

Health officials call it a time-bomb as the prevalence of sexually transmitted infections (STIs), including HIV and Aids, is high among sex workers.
According to National Aids Commission (NAC), nearly 62 in every 100 sex workers are HIV positive.
This is over seven times higher the national prevalence estimated at 8 percent.

“A lot of sex work is happening in border districts, but transit routes have always been havens of transactional sex and highways of HIV infections,” said NAC spokesperson Francis Thawani.
Zalewa sits at crossroads, with transport corridors to Mwanza Border, Lilongwe and Blantyre as well as Mozambique, Zimbabwe, South Africa and other countries.

The recent influx of sex workers follows the construction of the $1 million railway line from the Moatze coalfields in Mozambique to the coastal port of Nacala.

A decade ago, there were about five night clubs where long-distance truck drivers, travellers, traders and their partners used to stop over and buy drinks for the road.
The pregnant sex worker arrived in 2013, attracted by hundreds of migrant workers who laid the rail line funded by Vale, a Brazilian mining and logistical firm.

The railway connects Kachasu in Chikwawa to Nkaya in Balaka, splitting Mwanza, Neno and Machinga.
As it took shape, pubs, lodges and sex workers mushroomed in every corner of Zalewa.
Cross-border drivers prefer parking at Zalewa to the Mwanza border town.

“Zalewa is self-contained. You get what you want without,” said a driver whose tanker hauls fuel from the Indian Ocean port of Beira in Mozambique.
The attractions include beer and transactional sex, an escape for mobile workers who spend weeks without seeing their homes stable sexual partners.

For sex workers, competition is getting rough and safe sex is not guaranteed.

There is no time to sleep, says the woman waiting for her third born.
“My pregnancy is advanced and backaches frequent, but I still go out because I will starve if I take a break,” she said.

“We’ve dependents”
The hand-to-mouth lifestyle mirrors desperation. Some women confessed engaging in transactional sex until they give birth.
All interviewees said they know a peer who experienced labour pains while hanging around and returned to the pubs barely a week after giving birth.
Some men find quickies with pregnant partners “really hot”, they say.
But the sex workers say they have no choice.

“We have accommodation bills to foot, our stomachs and children to feed. We have dependents too,” said Chrissie whom we found on the prowl.
The sex workers sleep with up to four clients a night, they say.
Their babies and bulges expose risky sexual tendencies associated with STIs and HIV infections.
Mwanza district health officer Nelson Piringu is worried about rising incidence of STIs, unintended pregnancies, and HIV infections.

Undercover agents
The Ministry of Health is working with Partners in Health (PIH) and Doctors Without Borders to empower the sex workers with business loans and skills as well as HIV and Aids information, preventive measures and treatment.
“If you protect one sex worker, you will save her and clients,” says PIH corridor project programme coordinator Russell Msiska.
PIH runs a clinic at Zalewa where the underground population access counselling, condoms, antiretroviral drugs and family planning methods.
In their safe space, they meet monthly to share business skills and ways to save.

“Zalewa is a unique meeting place for mobile workers,” says Msiska. “The Corridor Project aims to empower the sex workers to avoid contracting and spreading STIs and HIV.”
The sex workers have formed an alliance whose members have received training in running business and saving.

They use their business groups and meetings to encourage each other to take HIV testing and adhere to treatment.
This is part of the 90:90:90 agenda—a global race, backed by UNAids, to ensure 90 percent of people with HIV know their status, 90 percent of those who test positive get treatment and 90 percent of ARV recipients remain on treatment for suppressed viral load.

Interestingly, most of the sex workers, linked with microfinance institutions for business loans, are undercover change agents.
They provide condoms, contraceptives and pep talk among the night queens, drivers, cross-border traders and other clients. 