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HIV Situation in Malawi

By Ashok Ramsarup :: The international-based  –  independent medical humanitarian organization – Medecins Sans Frontieres (Doctors Without Borders) has confirmed that 80 percent of the one million people who have been diagnosed with HIV are receiving treatment in the areas  Dedza, Mwanza, Zalewa and Nsanje in Malawi.

Doctors Without Borders (MSF) has been working feverishly with the Ministry of Health to establish care to meet the health challenges of sex workers in the towns of Dedza, Mwanza, Zalewa and Nsanje. The medical organization found ways of seizing the health gaps since found ways of seizing the health gaps since 2014.

Doctors Without Borders have been at the forefront of providing medical assistance to people affected by conflict,   epidemics, disasters, or exclusion from healthcare.  The teams are made up of thousands of f  thousands of health professionals including, logistic and administrative staff – while most of them hired locally.

The health organisation  says   sex workers remain disproportionally affected by HIV and extremely vulnerable due to the criminalization of sex work, stigmatizing attitudes in society and frequent violence (from police, clients, bar owners) which further affects their mental and physical health and well-being. Violence against women – which AIDSfonds says includes stigma and discrimination – actively contributes to higher rates of HIV infection and poorer health outcomes in general since they’re effectively locked out of the health system.

Several Sex workers were trained by MSF teams to operate as community health workers and peer counsellors    as they have experience of the various  challenges and dangers associated with sex work.  Doctors Without Borders says this shared experience enables them to discreetly link with other sex workers, understand their health situation and explain the medical services they need.  Medical staff in the project have also been given sensitivity training to provide friendly services for sex workers.

Doctors Without Borders    community health worker in Mwanza,  says their  job includes going door-to-door and visiting bottle stores and brothels where  meet sex workers and provide them with information related to HIV testing and how they can take care of their health.   They also set up home visits for  those who agree to be tested for HIV.

In  2018 MSF teams and community health workers have been successful in enrolling:

** 5,171 sex workers in MSF’s project in Malawi

** 1,797 were actively seeking regular care.

** About half of the enrolled patients are HIV-positive of which 85% are virally suppressed – evidence that the women are able to take their treatment well, thereby more likely to stay healthy and less likely to transmit HIV in the event of unprotected sex

Today,  Doctors Without Borders  shares a compelling story about how sex workers who now work as MSF health workers have helped turn the tide on sex workers accessing HIV treatment.

Names have been changed to protect the identities of sex workers.    Bernadette  X, who lost both parents when she was 7 years old and was taken in by her grandparents, who would send her to school without food.

“I started having sex in exchange for things as my grandparents were not able to provide me. This is how I got pregnant and dropped out of school,” says Bernadette who moved from her village to Dedza, Malawi at the end of last year.    “When I became a sex worker I didn’t know anything about condoms, or any other family planning methods. I had heard of HIV but never thought about contracting it myself,” she says.

“This was the very first time I was given information on issues like HIV testing and sexual health,” says Bernadette after MSF community health worker Emily X  gave a health education session at the bar where she works and lives. “I saw it as an amazing opportunity that could help me to be healthy, no matter my circumstances.” Emily listened closely to what she had to say because she too was a sex worker, she knew where Bernadette came from and what she was facing every day.


In Malawi, poverty and unemployment remain high, many women like Bernadette turn to sex work – offering sexual services in exchange for payment of some sort – to support themselves and their families.

Malawi has one of the world’s highest rates of HIV, and while the country has made huge strides in fighting the epidemic, sex workers remain extremely exposed. With much lower access to health information and healthcare than their counterparts in the general population, sex workers are over five times more likely to contract HIV, and face much higher risks of unwanted pregnancy and  sexually transmitted diseases.

Ashok Ramsarup is a senior journalist of South Africa.

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