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 Basic sexual health information Her colleague Florence says: “It also helped that the rogue and vagabond law was repealed.”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.”

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.

  Few people are at higher risk of HIV infection or STIs than sex workers. Although sex work is illegal in Thailand, like in so many countries many turn a blind eye. JiHye Hong is a volunteer with PPAT, the Planned Parenthood Association of Thailand, and she works with the HIV and STIs prevention team in and around Bangkok. One month into her volunteer project, she has already been out on 17 visits to women who work in high risk entertainment centres. “They can be a target group,” explains JiHye. “Some of them can’t speak Thai, and they don’t have Thai ID cards. They are young.” The HIV and STIs prevention team is part of PPAT’s Sexual and Reproductive Health department in Bangkok. It works with many partners in the city, including secondary schools and MSM (men who have sex with men) groups, as well as the owners of entertainment businesses. They go out to them on door-to-door visits. “We visit them in their real lives, because they may not have time to go to clinics to check their status,” says JiHye. “Usually we spend about an hour for educational sessions, and then we do activities together to check if they’ve understood. It’s the part we can all do together and enjoy.” The team JiHye works with takes a large picture book with them on their visits, one full of descriptions of symptoms and signs of STIs, including graphic images that show real cases of the results of HIV/AIDs and STIs. It’s a very clear way of make sure everyone understands the impact of STIs. Reaction to page titles and pictures which include “Syphilis” “Gonorrhoea” “Genital Herpes” and “Vaginal Candidiasis” are what you might expect. “They are often quite shocked, especially young people. They ask a lot of questions and share concerns,” says JiHye. The books and leaflets used by the PPAT team don’t just shock though. They also explain issues such as sexuality and sexual orientations too, to raise awareness and help those taking part in a session understand about diversity and equality. After the education sessions, tests are offered for HIV and/or Syphilis on the spot to anyone who wants one. For Thai nationals, up to two HIV tests a year are free, funded by the Thai Government. An HIV test after that is 140 Thai Baht or about four US Dollars. A test for Syphilis costs 50 Bhat. “An HIV rapid test takes less than 30 minutes to produce a result which is about 99% accurate,” says JiHye. The nurse will also take blood samples back to the lab for even more accurate testing, which takes two to three days.” At the same time, the groups are also given advice on how it use condoms correctly, with a model penis for demonstration, and small PPAT gift bags are handed out, containing condoms, a card with the phone numbers for PPATs clinics and a small carry case JiHye, who is from South Korea originally, is a graduate in public health at Tulane University, New Orleans. That inspired her to volunteer for work with PPAT. “I’ve really learned that people around the world are the same and equal, and a right to access to health services should be universal for all, regardless of ages, gender, sexual orientations, nationality, religions, and jobs.”