By Andrew Bishop Mkandawire

Frontline workers who have been oriented to promote Female Sex Workers (FSWs) access to HIV, TB, and Malaria services in time of COVID-19 in Karonga, Nkhatabay and Nkhotakota have powered their stamina never to backdown sustenance of HIV prevention in the districts implementing Global Fund FSW and Covid-19 Response Mechanism projects.

The orientation which took place in February 2023 showed that to date most FSWs have no trust issues with efficacy of COVID-19 vaccine as commented by frontliners. “All FSWs have good knowledge of COVID-19 pandemic and accept to access the COVID-19 vaccine. However, distance to the nearest health facility and availability of the vaccine bars them from getting the recommended protection from severe sickness and potential death, “explained Sara Mwale, Dwangwa Outreach Workers from Nkhotakota.

Mwale (Left) in a dialogue session during the Nkhotakota orientation..

COVID-19 pandemic affected not only sex work business but also affected access to ART, TB and Malaria services due to lockdowns and restrictive mobility which limited clients from travelling to health facilities. Some clients also failed to get to the health facilities in fear of rumors of contracting COVI-19 at the health facility. According Esther Munthali, Outreach Worker in Nkhatabay, “COVID-19 heavily affected our business because the restrictions that came as preventive measures scared our customers, mobility was limited, and the level of interaction was downgraded as everyone was a suspect of COVID-19 transmission. This also increased gender-based violence as many men who would want to transact sex had no money as some lost their jobs and businesses due to COVID-19.”

Karonga, Nkhatabay and Nkhotakota facilitators encouraged participants who attended the orientation to adhere to ART drugs if they are to achieve and sustain HIV Low Detectable Levels (LDL) in their bodies. “LDL does not mean you are healed from HIV infection. It means your chances of good health are higher and the rate of HIV transmission is likely lower,” said Thumbiko Munthali, HIV AIDS Coordinator and Female Sex Workers Focal Person for Karonga DHO. “Continued safer sex by using condoms remains key even when you are taking PREP because the drug is not 100 percent although discordant couple have a unique case,” emphasized Yvone Mnjeza Kuntha, ART Coordinator for Nkhatabay DHO and Joshua Monday, Female Sex Workers Focal person for Nkhotakota DHO.

Mnjeza Kuntha emphasized that frontline workers must promote duo protection.

The orientation sessions also helped some female sex workers on approaches to link their peers with service delivery points for an improved access to health services. “I have learnt the importance of linking FSWs to service delivery points to ensure they are able to access HIV and sexually transmitted infections on time. Previously we could not fully follow up on all FSWs on HIV and STI’s treatment. This could not encourage them to adhere to treatment,” said Esther Musukwa, who operates a Mama’s restaurant and a bar in Karonga.

The district health office directors appreciated the orientation sessions claiming that partnerships and networking are keyways to help curb HIV infection transmission in Malawi. “We appreciate FPAM for continuous support of Nkhotakota DHO to ensure FSWs dearly prevent and reduce HIV and STIs infections through provision of health services through a moonlight clinics that follow FSWs in hotspots,” said Jacob Kafulafula, Nkhotakota Director of Health, and Social Services.

Kafulafula called on sustained partnerships to promote good health of FSWs.

The severity of COVID-19 in Global Fund Project implementing districts cannot be underrated with current statistics as of February 2023 indicating morbidity and mortality rates in Karonga, Nkhotakota and Nkhatabay. In Karonga, 23,639 people tested for COVID-19, 1566 tested positive and 44 died. In Nkhotakota, over 8300 people tested for COVID-19, 1447 tested positive and 39 died. In Nkhatabay tested 5425 for COVID-19, 1107 tested positive and 32 died.

Family Planning Association of Malawi (FPAM) also provided the district health offices with COVID-19 preventive supplies and Esther Munthali, Outreach Worker in Nkhatabay, observed that “the relief items including pails, bicycles, and soap helped to sustain health promotion operations among Female Sex Workers as they are able to comply with hygiene standards and move from one place to the other to monitor adherence to ART drugs among their peers while continuously organizing hot spot clinics to increase health services reach.”

The Global Fund COVID-19 Response Mechanism project started in December 2021 and will end in December 2023.