Malawi: Exclusion of female sex workers in HIV fight is counterproductive

In 2015, the Malawi National AIDS Commission identified female sex workers (FSWs), men who have sex with men (MSM) and adolescent girls and young women (AGYW) as key or priority groups in the country’s fights against HIV and AIDS.

Studies done within the country have shown that among MSMs one in five is HIV infected; many do not yet know they are infected and for those who know their HIV status, concerns about access to (health) services abound. This is largely because of the legal status of homosexuality and prevailing societal attitudes towards MSMs and homosexuality.

Adolescent girls and young women have one of the highest incidences of HIV in the country. Compared to boys and young men under the age of 24 years, AGYW have up to five times the HIV prevalence; hence prioritising prevention, treatment and care, as well as support among these groups is imperative. In the case of FSWs, HIV prevalence exceeding 60% have been documented in some surveys. There are very little data on male sex workers.

What we are doing

In order to inform practice, policies and encourage community/societal conversions on the issues raised above, we, at the University of Malawi, College of Medicine are conducting implementation science research under the umbrella of the EHPSA (Evidence for HIV Prevention in Southern Africa- programme. EHPSA is funded by the UK’s Department for International Development (DFID) through Mott MacDonald.

Malawi’s adult HIV prevalence is estimated at 10.8 percent (according to the 2010 Malawi Demographic and Health Survey). New HIV figures to emerge from the recent (2014) Demographic and Health Survey (DHS) are being awaited. While the DHS will not have HIV prevalence for FSWs and MSMs, data on 15-24 year age group will be available.

The research that we are doing is aimed at identifying service facilitators and bottle-necks that are affecting access to services by MSMs. With new funding from the UN, we are also moving ahead to expand the work to include service barriers and facilitators for lesbians, bisexual intersex and transgender individuals. The key questions we are exploring are:

  1. What is currently happening with respect to access to sexual and reproductive health services?
  2. what facilitators and barriers exist on the path to accessing services?
  3. What could be done to ensure that these barriers are removed?
  4. what models of health services do the concerned groups prefer?
Everyone is involved

The design for our studies is that everyone is involved. We are working with, or sampling NGOs and civil society organizations, government partners, community and religious leaders, health professional students and their trainers, as well as service providers.

We believe such a comprehensive assessment will provide us with the much needed answers to our questions. The battle against HIV will be difficult if segments of our society do not have access to prevention, treatment, care and support that suit their lifestyles and life circumstances.

Dr Adamson Muula is a Professor of Epidemiology and Public Health at University of Malawi College of Medicine