Stories

Amina is a peer educator trained by Family Planning Association of Malawi’s (FPAM) Linkages project. “I am a HIV positive sex worker and a peer educator,” she says. “I have 51 other sex workers in my care, I inform them on testing and treatment, also about STI treatment and condom use. I teach about the disadvantages of sharing ART (anti-retroviral therapy) and encourage them to go for tuberculosis testing if they are coughing.” Another educator called Cecilia adds: “I reached out to 60 female sex workers. We are all friends and they trust me. I refer them to services and we address abuse by the police. They rape us and steal our money but through the project, we can follow up since the project has access to the managers of the police.” Basic sexual health information Her colleague Florence says: “It also helped that the rogue and vagabond law was repealed.” The law was a permanent curfew, giving the police the power to round up, fine or jail anybody who was on the streets after eight o’clock at night. Lucy, also a peer educator, says part of the work is giving basic information. “I teach my friends on HIV and GBV (gender-based violence),” she explains. “And I teach how to use condoms and lubricants and how to persuade clients to use condoms. I also talk about family planning. Many female sex workers do not know they need it.” “The project helped me with condoms and I shared that with others,” says another client of the programme, Angela. “Through the project, I got tested for HIV and treated for STIs. I also encourage pregnant sex workers to go for pre-natal care so that they do not infect their babies. It is the first time that an organisation like FPAM worked with us. We got respected within the community because we are knowledgeable.” In the year the Linkages project ran, 627 female sex workers were supported in getting tested for HIV, the initiation of anti-retroviral treatment and therapy adherence. 2,700 women were referred to services and many more received information. The HIV prevalence rate among female sex workers went down from 77% to 62%. Global Gag Rule effects FPAM’s Linkages project was phased out in 2016 due to the Global Gag Rule. The effects are keenly felt amongst those who benefitted from the project: Amina says: “Many stopped taking medication. Healthcare facilities are not for us. I sing in a church choir, which is important to me. If they find out what I do, they will throw me out.” “My family thinks I work at a filling station at night,” says Lucy. Cecilia adds: “This project has to come back, please bring it back. If not, we will all die early.”

At a local bar, we meet nine women from Kirundo. They’re all sex workers who became friends through Association Burundaise pour le Bien-Etre Familial's (ABUBEF) peer educator project. Yvonne is 40 and has known that she’s HIV-positive for 22 years. After her diagnosis she was isolated from her friends and stigmatized both in public and at home, where she was even given separate plates to eat from. “I started to get drunk every day,” she says. “I hoped death would take me in my sleep. I didn’t believe in tomorrow. I was lost and lonely. Until I got to the ABUBEF clinic.” ABUBEF has supported her treatment for the past six years. “I take my pill every day and I am living example of having a good life even with a previous death sentence,” Yvonne explains. “But I see that the awareness of HIV, protection and testing provided by ABUBEF is still very small.” Yvonne became a peer educator, speaking in public about HIV awareness, wearing an ABUBEF T-shirt.  The project spread to the wider region, and volunteers were given travel expenses, materials and training, along with condoms for distribution. But funding cuts mean those expenses are no longer available. Yvonne says she’ll carry on in Kirundo even if she can’t travel more widely like she used to. Her friend, 29-year-old Perusi, shares her experience of ABUBEF as a safe space where her privacy will be respected. It often happens, she says, that her clients rape her, and run away, failing to pay. Since sex work is illegal, she says, and there’s no protection from the authorities, and sex workers like her often feel rejected by society.  But at ABUBEF’s clinics, they are welcomed.

Monica has never told anyone about the attack. She was pregnant at the time, already had two teenage sons, and rape is a taboo subject in her community in Burundi. Knowing that her attacker was HIV-positive, and fearing that her husband would accuse her of provocation - or worse still, leave her - she turned to a place she knew would help.   ABUBEF is the Association Burundaise Pour Le Bien-Etre Familial. Their clinic in Kirundo offered Monica HIV counselling and treatment for the duration of her pregnancy.  Above all, ABUBEF offered privacy.  Neither Monica nor her daughter has tested positive for HIV. “They saved the life of me and my child,” Monica says. “I hope they get an award for their psychological and health support for women.” Three years on from the attack, Monica, now 45, raises her children and tends the family farm where she grows beans, cassava, potatoes and rice. She’s proud of her eldest son who’s due to start university this year. She educates her boys against violence, and spreads the word about ABUBEF. Monica speaks to other women to make sure they know where to seek help if they need it. Her attacker still lives in the neighbourhood, and she worries that he’s transmitting HIV. But the ABUBEF clinic that helped Monica is under threat from funding cuts. The possibility that it could close prompted her to tell her story.    “This is a disaster for our community,” she says. “I know how much the clinic needs support from donors, how much they need new equipment and money for new staff. I want people to know that this facility is one of a kind - and without it many people will be lost.”

It is 9.00pm in Lilongwe, the capital of Malawi , the fish market is one of the “hotspots” where the Family Planning Association of Malawi’s (FPAM) opens its trailer doors to  sex workers, a “key population” in the fight against HIV. Thoko Mbendera is the Executive Director of FPAM: “Key populations are groups whose needs you have to address if you ever want to bring down HIV prevalence in the general population. Sex workers clearly need help here: the HIV prevalence rate among them is 77% while among the general population it is 10.2%.” The clinic offers STI screening, family planning, HIV testing, tuberculosis (TBC) testing and cervical cancer screening. Outside, peer educators distribute condoms and talk to waiting clients. Thoko Mbendera says: “This group does not (have) access the public health sector, it is simple not an option for women who do not disclose what they do to anyone, so in the Linkages program we reach out to the hot spots at night.” Florence Mushani, is the coordinator of Linkages: “In the project we trained 63 peer educators. They are HIV positive; they approach their colleagues with information and advice. Our goal is the 90-90-90 target meaning 90% of sex workers know their status, 90% of HIV positive women are on anti-retroviral treatment (ART), and 90% of the women on ARTs will be virally suppressed. We also trained 21 peer navigators; they support others to adhere to therapy. We pay them a small stipend of 25 dollars a month, we expect a lot of them.” Tusekele Mwakasungula is FPAM’s Programs Manager: “The goal of the peer educators training is to build up the person,” he says. And it shows: these women are no shy victims of an unjust society, they are self-confident and outspoken, determined to improve the situation of female sex workers.” FPAM’s Linkages project was phased out in 2016 due to the Global Gag Rule.