Sexual and Reproductive Health Needs for Female Sex Workers

This formative qualitative study was conducted to explore the Sexual and Reproductive health needs for mobile populations, specifically female sex workers (FSWs), and is based on research conducted at the Mwanza border, the main border between Malawi and Mozambique. The research was undertaken by Pakachere Health and Development Commmunication to inform the communication strategy for an intervention involving sex workers and mobile populations. The findings show that FSWs face many challenges. They reported that not much is being done around HIV prevention specifically for them, and that currently there is only Pakachere and sometimes ministry of health personnel who attend to their needs, but that this is only on an irregular basis.

Findings show that FSW face the following challenges:

• Challenges perpetrated by the police: FSW's face a number of challenges from police officers, such as arrests, as well as lack of assistance when FSW have been physically abused by clients or robbers. FSW reported that some police officers rebuke them for being sex workers and treat them as people who do not deserve assistance. It was also reported that some police officers say that there is no law to protect sex workers.
• Challenges with the Health Care System: While FSW reported that they are assisted when they need help, however they are not being attended as quickly as other patients who come to the hospital. Some FSW reported that some health care workers demand money from them in order to be assisted quickly. They mentioned that payment is demanded when they want to get treatment and sometimes if they want to access ARVs quickly.
• Sexual and Reproductive Health Challenges: Participants in the study mentioned that they also face a lot of sexual and reproductive health (SRH) problems within their work. FSW reported that they fear contracting sexually transmitted infections and HIV, and for those living with HIV of having full blown AIDS. One of the challenges reported was the pressure for unprotected sex, and that clients burst the condom deliberately. Findings show that most FSW get their SRH services from the government hospital, Banja La Mtsogolo, a semi-private SRH provision hospital (run by an NGO), and the North Star Alliance clinic which is located at the border.
• Violence: Findings also show that FSW face a lot of violent abuse from their clients. They reported that they are either beaten or not given money after sex. Sometimes they are forced to eat a used a condom.

Findings show that FSW know that condoms can protect them from pregnancy, HIV and STIs. FSW were also asked to express their views on a number of issues:

• Views about condoms: Findings show that most FSW have ever used a condom and the female condom. Most of the FSW who have ever used a female condom reported that the female condom is good. They also said that if properly put on, it makes them feel like they are having unprotected sex. Most of the FSW also reported that it protects them from men who would want to have unprotected sex because they do not realise that she has put on a female condom, while some also said it causes pain when not put in properly. Findings show that FSW access condoms easily. They reported that they access free condoms through the hospital, community-based distribution agents, and sometimes from the entertainment places. They also reported that they prefer the free condoms because the socially marketed ones are expensive.
• Reasons for unprotected sex: FSW reported that sometimes clients refuse condom use and offer more money. FSW often give in because they need the money to support their families. Some reported that sometimes they do not use condoms because they simply prefer to do so or because they just want to have unprotected sex. It was also reported that FSW do have regular partners. They develop trust with such partners and later indulge in unprotected sex.
• Views about HIV and AIDS: FSWs reported that they are at higher risk of HIV infection because of the behaviour of the clients they meet. They mentioned clients’ insistence to unprotected sex and the use of violence. They reported that they discuss HIV and AIDS and that many of them belong to a group which meets regularly to discuss HIV and AIDS and issues regarding testing, condom use, and regular check ups. Most FSW expressed the importance of testing and reported that they had gone for HIV testing - many of whom were tested postively for HIV. Some FSW reported that the issue of HIV makes them think about their clients' HIV status and that they are afraid of getting infected. They reported that they fear that if a condom bursts and the client is HIV positive, they would be infected.

The study found that most FSW do not know any laws related to FSW, while many said that they know that they must report any forms for abuse to police or organisations such as Pakachere. When asked for suggestions on what must be done to stop the violence, they reported that there is a need for organisations to facilitate meetings between FSW, police, and health care people. They also reported that sometimes senior police and medical officers may not know the abuse that FSW face when they go to seek help. The research showed that FSW get messages from their groups when they are discussing HIV and AIDS. They also get information from the hospital and Pakachere.  Findings showed that FSW require information regarding pregnancy, drug adherence, condom use, how to motivate each other to go for HIV testing, and anything related to sexual and reproductive health.