Improving Healthcare for Sex Workers in Malawi
In Malawi, Doctors Without Borders (MSF) teams are working with community-based organizations to improve access to healthcare for sex workers. The towns of Dedza and Zalewa, along the main trade route from Tanzania to Mozambique, are hubs for sex work, where many women, mainly from difficult family situations and with limited support, resources, or professional training, have turned to the profession as a way out.
Hamida, 29, used to run a vegetable and charcoal business, but after her husband left her for another woman, she was no longer able to provide for her family. Agnes, 42, has been working as a sex worker since her husband’s death, leaving her with four children and two grandchildren. Both women face challenges in accessing healthcare due to their precarious situation and the stigma they face.
MSF teams have been supporting sex workers in Dedza and Zalewa for six years, helping them form community organizations and develop skills to access healthcare. Trained sex workers, known as “peers,” now carry out health promotion initiatives, provide support in the fight against sexual violence, and prevent sexually transmitted infections.
The MSF approach focuses on sharing experience and information, providing information on Pre-Exposure Prophylaxis (PrEP) and training in screening for HIV and human papillomavirus. The teams also visit locations every other week to provide more in-depth medical support.
However, the economic situation and working environment of these women have deteriorated in recent years, with rising inflation and a devalued local currency. Customers are abusing them more and more, and transaction prices are falling. Charlie Masiku, MSF’s Community Based Organisations project coordinator in Malawi, emphasizes the need for economic and social support from other organizations to help these women and their children escape their situation.
Since the beginning of the year, MSF teams have been trying to establish links with local organizations to help pay children’s school fees or develop professional skills that would enable women to obtain other sources of income. Since 2022, more than 1,800 women have benefited from sexual and reproductive health services, mental health support, health promotion, and treatment.
For Agnès, whose 23-year-old daughter has also become a sex worker, it’s a struggle to find food and school uniforms for her children. She faces a difficult decision: stop working as a sex worker, but have no other means of supporting her family.
