Since 2014, MSF has been developing ways to reach sex workers and MSM (men who have sex with men) groups along main transport routes or busy centres of trade between Mozambique and Malawi through its ‘key populations’ project.
In Malawi, the project focuses only on female sex workers who each exist somewhere along the fluid continuum between ‘transactional’ and ‘commercial’ sex work. The project is located across four districts, with activities across Mwanza, Dedza, Nsanje districts and in Zalewa town in Neno district. In each site the project offers a range of approaches designed to address the health risks faced by women or adolescents who exchange sex for goods or financial rewards, and aimed at ensuring regular access to a minimum package of integrated HIV, TB and SRH care including condoms and lubricant distribution.
By the end of 2018, of the 5171 sex workers ever enrolled in the Malawi program, 1797 female sex workers were actively attending sessions and clinic visits at the four sites combined.
Of the 5171 sex workers enrolled, out of 5021 tested, 2527 sex workers were HIV positive (50%) of which 1811 (72%) were enrolled onto the national ART program, while 863 (48%) were ‘active’ (seen within the last nine months) and 494/579 of the total were virally suppressed (85%).
MSF is using the hands on experience of piloting health programmes for sex workers to advocate for the funding and implementation of adapted models of healthcare, delivered through health care staff and peer networks that meet the needs of sex workers.
Malawi context
In Malawi, where poverty and unemployment remain high, many women turn to sex work – offering sexual services in exchange for payment of some sort - to support themselves and their families. Sex workers find themselves in high demand throughout night spots and drinking venues in cities of trade and along the busy trade and transport hubs, where truck drivers pass through.
Sex workers face much higher risks of contracting HIV, STIs and unwanted pregnancies than women not engaged in sex work. Overall, sex workers in Malawi are 5.4 times more at risk of contracting HIV than their counterparts in the general population.
MSF data (2018) shows an overall HIV prevalence of 53,1% compared to an HIV prevalence of 12,5% among females in the general population. The data also shows an exponential increase in HIV prevalence between ages