HIV AND AIDS INTERVENTIONS FOR SEX WORKERS – AN OPPORTUNITY FOR REDUCING TRANSMISSION As Ghatsha Mathias Ghatsha Chatuluka Director Of Programmes Family Planning Association of Malawi Private Bag B424 Lilongwe 3 Tel: 01773915 mchatuluka@fpamalawi.org ghatsha@yahoo.co.uk 4/7/2019

Presentation outline About FPAM as an NGO The Sex Workers Initiatives Activities Lessons and challenges What next? 4/7/2019

FAMILY PLANNING ASSOCIATION OF MALAWI an NGO providing Youth Friendly Sexual and Reproductive Health services in Malawi a Member Association (an affiliate) of International Planned Parenthood Federation (IPPF) Launched on 25 September, 1999 to provide SRH information and services family planning and emergency contraception management of sexually transmitted infections, treatment of opportunistic infections and voluntary counselling and testing, cervical cancer screening using visual inspection, post abortion care, general ailments and referrals to other facilities Targets young people 10 – 24 years, vulnerable groups (sex workers and young market vendors) Is operational in five districts in Malawi 4/7/2019

VISION AND MISSION AND APPROACH Our vision is to have a healthy Malawian society free of poverty where young people, men and women enjoy basic Sexual and Reproductive Health and Rights (SRHR) Our mission is to provide high quality and affordable comprehensive sexual and reproductive health and rights information and services for young people, women and men by promoting and protecting sexual and reproductive health rights; preventing and mitigating against HIV/AIDS. Advocating for the elimination of all barriers to access provision of sexual and reproductive health services and information to all with special focus on young people Priority focus areas: the 5 As – Access, Adolescent, HIV/AIDS Post Abortion Care, Advocacy 4/7/2019

FPAM’s Core Values We believe that sexual and reproductive rights should be guaranteed for every Malawian because they are fundamental human rights that are universally recognized. 2. We strive to provide comprehensive, integrated youth friendly health services through innovative community based and clinical services.  3. We believe in working with well-trained, quality, efficient and effective staff and volunteers to fulfil our mandate.  4.  We value diversity and we embrace in particular, the participation of young people and people living with HIV/ AIDS in programming and governance 5.   We are committed to ensuring gender equality and eliminating discrimination that adversely affects sexual and reproductive health outcomes. 6.   We believe in working in partnership with stakeholders to contribute towards improvement in the sexual and reproductive health status of Malawians. 7.   We believe that volunteerism is fundamental to achieving our mandate. 4/7/2019

The Sex workers Initiative An opportunity to reduce HIV transmission HIV and AIDS programmes exist and address a number of target groups in Malawi Most programmes engage the general population However, there is high prevalence among sex workers (SW) currently at 69.1% (2007 NAC M&E report) Transmission of HIV continues to cross over from the general population to sex workers and vice versa Specific interventions needed to address HIV transmission, care and support of vulnerable populations such as sex workers where HIV is highly concentrated Interventions for sex workers act as transmission barrier between Sex Workers (vulnerable population) to general population 4/7/2019

The Interventions by FPAM Understanding the dynamics of sex workers a situation analysis in 2004 involving152 sex workers, DJs, managers, proprietors revealed that Age range of most sex workers is between 18 -24 50.9% have attained some secondary education 2.8% went for Technical and university education Some dropped out of school Majority knowledgeable on the transmission, signs and symptoms and prevention of HIV and other sexually transmitted infections and yet continue to expose themselves despite knowledge of risks to infections, due to the higher monetary value offered. 72.2% acknowledged to having had an unprotected sex with 21.3% having had an STI. Low self esteem, poor perception on risks, power imbalance and lack of skills to negotiate for safer sex increase the chances for HIV transmission in sex workers Sex workers willing to participate in programmes addressing HIV and AIDS Other important stakeholders include owners of entertainment places, disc jockeys, traditional and community leaders, health service providers and other interest groups or NGOs 4/7/2019

The Interventions by FPAM A phased approach that starts with safer sex promotion and move to economic options for livelihood Objective is to empower vulnerable sex workers with information and skills to practise safer sex and provide options and alternatives for livelihood Specific focus on access to SRH information, services and condoms for safer sex, strengthening negotiation skills among sex workers to practise safer sex, increasing VCT uptake and STI treatment seeking behaviour. Conducted peer education and safer sex and condom promotional campaigns in hot spots and engage both sex workers and “customers” into discussion Has been providing family planning, VCT, STI treatment, counseling and distributed both male and female condoms since 2005 Provided training in business management, training in various trades and start up capital to 55 sex workers in Lilongwe and Dowa Districts Monitoring the progress 4/7/2019

Achievements Managed to increase sex workers knowledge on HIV and AIDS and other SRHR issues through. Sensitization seminars for sex workers Peer education which included life skills and negotiation for safer sex Increased the capacity of sex workers to address HIV/AIDS and other SRHR issues affecting them and their fellow sex workers by Demonstrating to fellow sex workers on how to use and dispose off condoms correctly. Distributing both male and female condoms Keep them fit through sports (football) SRH services provided to sex workers e.g. FP, VCT, STI treatment and treatment of general ailments 4/7/2019

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Achievements Initiated small scale business entrepreneurship in mushroom production, hair saloon, restaurant, poultry management, tailoring according to the choices of the sex workers with startup capital provided for each group Interest to change life styles if supported strongly observed Sex workers scrambling to be amongst the first 55 sex workers trained in vocational training and to set up business Empowered sex workers to negotiate for safer sex using the twelve points safer sex flyer. Discussions on safer sex conducted by sex workers in the action groups DJs and proprietors of entertainment places have actively participated printed IEC materials and audio messages enhanced the ability to negotiate for safer sex. Safer sex promotion campaigns accorded male partners an opportunity to participate in the activities and get better informed 4/7/2019

Achievements National level – Informal stakeholder meetings Participation to the Maputo Regional Meeting Post Maputo Feedback Meeting National Stakeholder Consultations – Access, Rights, Protection and Security, Partnership, Livelihood skills, community participation 4/7/2019

Lessons learnt It is possible to reach the marginalised, underserved, underprivileged segments of the population. Multisectoral involvement is key in achieving success in a project like this Winning confidence of sex workers and providing assurance for security creates a very positive working relationship and a culture of trust Partnerships and information sharing vital in development of programmes for sex workers 4/7/2019

Challenges Access to resources for scaling up Staffing and personnel issues Mobility of sex workers (go by season especially the young ones) Facilities for mobile services and community mobilization 4/7/2019

Way forward Getting more comprehensive Awareness creation on the dangers of sex work Addressing livelihood skills Linking with communities Continue with safer sex and service provision Mapping of stakeholders involved in sex workers interventions Develop a model for use by different stakeholders Orientation of interested stakeholders Scaling up the project through effective collaboration, coordination and partnership and capacity building 4/7/2019

Government STAKEHOLDERS 4/7/2019

Thank You Family Planning Association of Malawi Private Bag B424 Capital City LILONGWE 3 Tel: 01773915 email: fpam@fpamalawi.org 4/7/2019