Natasha, a mother of three, has been in sex work for 15 years. She says her decision to venture into this trade was not by choice.
The 35-year-old got pregnant at 13 and married the man responsible. At that time, she was staying in Zimbabwe where her parents were working.
She had two more children before her husband died in Zimbabwe. She returned to Malawi with her three children and stayed with her grandparents.
“Life was hard. I figured my children would not get an education if we went on like that, and that is how I ended up into sex work to find some money and send them to school,” Natasha explains.
Now based in Kasungu, sex trade has been a source of income for Natasha for as long as she can remember.
When asked about the risks that come with the trade, she says failure to get health services due to stigma is the biggest challenge.
“There were times when I felt unwell, but would still go to work, afraid to seek medical attention because of stigma,” she explains.
Female sex workers (FSWs) and men who have sex with other men are marginalised by society and from the other services they need to protect themselves from illnesses, including HIV and Aids.
Although one of her children is now a nurse at Zomba Central Hospital and the other two are studying at Lilongwe Technical College, Natasha says she is nowhere close to quitting the trade until the two are also independent.
She has even gone international, going as far as Zambia and Mozambique, searching for clients.
Luckily, Natasha is now among the beneficiaries of Action Aid Malawi’s (AAM) HIV prevention programme for FSWs being implemented in the country.
Thanks to the programme, she now has access to health services through Family Planning Association of Malawi (Fpam) outreach clinics, free of stigma.
“It is now easier for us to get tested and treated without stigma whenever we feel unwell,” she explains.
With a target of 6 000 FSWs in 11 districts, the programme for FSWs is reaching them with a package of services that include health education, promotion and distribution of condoms and lubricants.
The programme also involves HIV testing and counselling and referral to antiretroviral therapy (ART) for those who test positive, as well as screening and treatment of sexually transmitted infections (STIs), among others.
In an interview, AAM HIV programme coordinator Innocent Mulomo says there has been a lot of progress in terms of the key populations accessing health services, with 4 878 FSWs reached so far.
A peer educator for Salima FSWs, Rose Katsache, indicated that with free access to healthcare, they are now healthier. Salima has about 597 FSWs under the programme.
“As peer educators, we encourage fellow sex workers to get tested for HIV and know their status so that if they test positive they are enrolled on ART right away. Most of us are now healthy because we are assisted in various ways through Fpam,” she explained.
Fpam monitoring and evaluation coordinator Dziwani Kambauwa also noted that there has been a reduction in STI cases and improved uptake of ART among FSWs.
Access to health information was also a challenge for the FSWs, according to Kambauwa, but now they know the services they require and where they can access them.
“Some sex workers were shy to seek health services; they would contract STIs but be wary to be seen by health practitioners. Through this project, we meet them in their own hotspots where they are found, and serve them through our outreach clinics,” she said.
Some sex workers have abandoned the trade to start small-scale businesses such as groceries and vegetable shops to take care of their families after amassing enough capital.
“Not all sex workers do it for fun; many of us do it because we have no other sources of income,” a Salima FSW explained.
However, with the programme available in only 11 districts, the FSWs peer educators appeal that it should be scaled up to other districts, considering their nomadic lives.
“We go where the money is, so we are constantly moving. There are instances where a sex worker starts ART in an area only to move elsewhere where there are more business opportunities. They end up missing ART as they are registered in the previous area,” she said.
Iceland, Denmark and Sweden form part of the Global Fund Programme which is behind the AAM HIV prevention programme.
Iceland member of Parliament (MP) and chairperson for the foreign affairs committee, Aslaug ArnaSigurbjornsdottir, noted that something needs to be done to get the women out of sex work, since some argue that with solid business capital they could exit the trade.
“The best solution is to ensure that women and girls are educated and empowered,” she said. n