Improving the health of sex workers in Blantyre City

Female sex workers (FSWs) form a group who exchange sex for money, goods or services. The number of FSWs in Blantyre is estimated at 4,000 most of who remain hidden because of stigma. FSWs are held in very low regard and lots of abuses including rejection by family, physical and psychological abuse. The HIV prevalence rate amongst FSWs is estimated to be at 70% with very low condom use and high STI cases and yet services are not accessible and friendly to FSWs. Badilika Foundation was started in 2006 with the goal to improve the quality of life and uphold the dignity of FSWs through socioeconomic empowerment, literacy training and education. Since October 2013 with funding from ViiV Healthcare Badilika has implemented a project that aimed at preventing HIV infection among FSWs and their clients by focusing on community interventions that decrease risky behavior; promote use of condoms, improve access to HIV/STI testing and treatment, promote policy changes and empowerment of FSWs.

CAMPAIGN OBJECTIVES

1. To increase knowledge and skills on HIV/STIs prevention;
2. To reinforce the view of sex work as valid work and increasing voices of FSWs to demand their rights;
3. To increase access to comprehensive and friendly integrated HIV and health services for FSWs and their clients;
4. To advocate for the rights of FSWs.
5. To organize FSWs into community networks for enhancing solidarity;
6. To increase savings and alternative income generating activities.

HOW THE OBJECTIVES WERE ACHIEVED

1. Conducted orientation among police officers of existing laws that protect FSWs;
2. Oriented healthcare providers on human rights as regards to right to health and protection;
3. Facilitate the formation of community support groups.
4. Sensitized FSWs on their rights as girls and women.
5. Trained FSWs on safe sex negotiating skills;
6. Trained peer educators and conducted peer education sessions.
7. Engaged law enforcement in dialogue to reduce police violence and interference;
8. Conducted mobile HTC clinics at hot spots to increase access to HIV services for clients and mobile FSWs.
9. Established referral linkages with six healthcare facilities.
10. Provided vocational skills training and start up equipment to six FSWs;
11. Provided secondary school bursaries to over 50 children of FSWs and under age FSWs.

CAMPAIGN INNOVATIONS

1. Peer education was one of the most strategic interventions. Peer education allowed for the interaction and participation of FSWs thereby promoting easy learning and skills sharing on safer practices.
2. Provision of health services such as prevention messages, HTC, STI diagnosis and condom distribution at night and in places where FSWs and their clients frequent seemed to be effective. This is because this is the time when FSWs and their clients are easily found and bringing the services to their own settings made it easy for them to access the services.
3. Clients of FSWs are the most difficult group to reach with HIV prevention messages. The project pioneered programs that addressed the full range of HIV services for FSWs.

CAMPAIGN IMPACT

1. 1,257 people mainly FSWs and their clients know their HIV status through mobile outreach services.
2. 760 clients of FSWs were targeted with messages which have imparted knowledge and changed perceptions and attitudes on HIV.
3. Increased correct and consistent use of condoms by FSWs and their partners, so far we distributed 11, 344 male and female condoms within 10 months of 2015.
4. Increased access and utilization of friendly HIV Testing and Counseling (HTC) services.
5. Improved capacity of community based peer educators to conduct peer education and counseling.
6. Badilika has mobilized and trained sex workers to have a strong voice to demand positive changes for better respect of rights.
7. Badilika has contributed to a reduction in the levels stigma and violence by encouraging FSWs to report cases of abuse.
8. Provided business opportunities to FSWs through vocational training and start up equipment.
9. Rescued over 50 under age FSWs and provided educational support.

CHALLENGES FACED

a. The inadequacy of funds made it impossible for us to reach more female sex workers and their clients with HIV information and services.
b. FSWs, particularly those who are street-based, face a range of challenges which affect their health including violence, discrimination, social isolation, poverty, unstable housing and homelessness, and addiction.
c. Restrictive office hours at health facilities, lack of women-specific services, concerns of privacy and disclosure, and limited means of transportation to service locations are some of barriers to health care services for FSWs.
d. The abuse drugs and alcohol by female sex workers and their clients exposes them to greater risks of HIV infection.
e. Ability to negotiate for condom use among sex workers is threatened by the significantly high number of clients that demand sex without a condom and the attendant high premium that unprotected sex gets.

LESSONS LEARNT

- Due to the low position that FSWs hold in society, and that they do not have equal access to the protection of the law, they are inhibited from coming forward with complaints of sexual harassment, assault or rape. Badilika engaged the police to whom they would turn for assistance but they are usually the first ones to harass them when they are arrested.
- Organizing FSW into community networks promotes solidarity to provide effective and sustainable social support.
- Strengthening community-facility linkages improves uptake of health care and follow up services.
- The involvement of clients of FSWs in the project contributed to the reduction of stigma and violence against FSWs.
- Most female sex workers enter into the sex industry due to poverty. There is need for more funding to provide alternative means of earning an income to girls and women who work as commercial sex workers.