1. 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:
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2. Presentation outline About FPAM as an NGO The Sex Workers Initiatives
Activities
Lessons and challenges
What next?
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3. 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
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4. 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
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5. 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.
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6. 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
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7. 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
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
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8. 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
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9. 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
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12. 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
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13. 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
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14. 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
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15. 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
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16. 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
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17. Government
STAKEHOLDERS
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18. Thank You
Family Planning Association of Malawi Private Bag B424 Capital City LILONGWE 3 Tel:
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