Tackling HIV/AIDS through sex hotspots

Maria Banda has just resigned as a housemaid in Balaka District; she now plies her trade as a prostitute in Mangochi and earns a much better income.

A young woman with an easy smile, Maria seems to like her new job stating that it is very easy to become a prostitute which is more like setting up one’s own business.

“The reason for doing such business is simple. We are very poor. Offering our bodies is an easy way of making money and also being independent,” says Maria.

The place I found Maria is Makawa Trading Centre in the Lakeshore District of Mangochi.

Makawa, situated about 26 kilometers from the resort town of Mangochi, is relatively a small fast growing trading centre but with several socio-economic activities including prostitution.

At the Trading Centre, you do not need to be told that sex is a vibrant activity that adds some wealth, if not deadly, flavour at the trading centre.

Makawa is an interesting place and as early as 6 pm people flock the place from all directions.

“I know that I risk contracting HIV but what option do I have? Most of these men are business people and others are from different hotels who are attending conferences and different functions. Some tell sex workers that since both of them look healthy then there is no need for them to use condoms,” Maria claimed.

While chatting with her, I saw fancy vehicles picking up women one after another. This is when I notice that sex is really big business at the trading centre.

Mangochi is one of the districts in the country hardest hit by HIV. The district has a prevalence rate of 17 percent, translating into over 53,000 infected people.

Senior Nutrition and HIV/AIDs Officer at Mangochi District Council, Ernest Kadzokoya said there are close to 40, 000 people who are on ART.

However, this is almost 50 percent of those who are HIV positive in the district which shows that still the district has a lot of work to do if it is to achieve the much touted 90:90:90 target set in the strategic plan for Malawi.

“This year the district is celebrating the success achieved in the response to the HIV/AIDS pandemic. The prevalence has steadily decreased from 21 percent in 2004 to 10.1 percent in 2016 according to the Malawi Demographic Health Survey.

“There are a number of interventions being implemented by both government and the civil society organizations in all the pillars of interventions like; prevention and behavior change, treatment, care and support as well as impact mitigation,” Kadzokoya said.

He added that quite noticeable are interventions targeting the male folk through; medical male circumcision, sex worker targeted activities by Pakachere and Yoneco, reduction and modification of harmful cultural practices by World Vision and Yoneco and MSM interventions by Cedep.

“We have identified hot spots for the sex workers like Makawa Trading Centre and we have tailor made interventions targeting the same. Makawa is the hotbed of sex work in Mangochi simply because it is a fishing beach and this makes most of the community members to have disposable income and at the same time a home to a number of hotels which host a number of workshops,” he said.

But Makawa Trading Centre is just one of the Trading Centres in the country where sex work is rampant.

Other few places include Zalewa Road Block, Devil Street, Kamuzu road, Lunzu, Nchalo, Dwangwa, Karonga, Chitipa, Liwonde, Zomba, Chigwirizano and Bwandilo just to mention a few.

It is therefore important to target all sex hotspots if fighting HIV/AIDs is to be complete.

Executive Director for Social Economic Enhancement and Enterprise Development (SEEED Malawi), Aggrey Mfune said Makawa Trading Centre is next to Lunzu and Mponela where nightlife has thrived in Malawi.

“Various partners have had interventions at the place like Tourism Department, Information Department, Population Services International, YONECO, SEEED Malawi and Dignitas International,” he pointed out.

Mfune said SEEED is targeting all sex workers in Mangochi including hot Makawa with different strategies based on their project concept.

He said SEEED is more interested in rehabilitating those who showed hopelessness and were willing to return to their normal lives.

“So we focused on Women and Girls Empowerment including the most disadvantaged. Due to their mobility, the initiative suits those that are resident and the migrating ones. Others were involved in ARV compliance and others messaging,” the Executive Director added.

According to information sourced from National AIDS Commission (NAC), Malawi is one of the very first countries to embrace the ambitious global strategy to end AIDS by 2030 by adopting the 90:90:90 target in its National HIV and AIDS Strategic Plan (NSP) for 2015 to 2020.

In the NSP, Malawi plans to have 90 percent of People Living with HIV (PLHIV) tested for HIV and know their  sero status; 90 percent of those known to be HIV positive be initiated on Antiretroviral therapy (ART); and 90 percent of patients on ART be retained in care and adhere to ART by the year 2030.

Reaching this 90-90-90 target in 2030 will result in 760,000 (73%) of the projected 1,042,000 PLHIV being virally suppressed, leading to a dramatic reduction in sexual and vertical transmission at the population level.

Malawi’s rapid and successful ART scale-up from 2004 to 2014 has critically influenced the HIV epidemic, reducing mortality, morbidity, and transmission.

However, all this will be meaningless if people like Maria Banda are not targeted in the places where they ply their trades.

Newly released findings from national HIV surveys in Zimbabwe, Malawi, and Zambia reveal extraordinary progress in confronting the HIV epidemic. These three countries in Southern Africa have been heavily affected by HIV and now there are encouraging signs that the epidemics are going in the right direction.

The findings, presented on February 16,2017 Conference on Retroviruses and Opportunistic Infections (CROI), are from the PEPFAR-supported Population-based HIV Impact Assessment (PHIA) Project surveys.

The surveys are led by each Ministry of Health, with technical assistance from ICAP at Columbia in collaboration with the U.S. Cenres for Disease Control and Prevention (CDC).

Compared with previous estimates, the PHIA data shows that the rate of new infections (incidence) is stabilizing or declining.

In addition, more than half of all adults living with HIV, regardless of use of antiretroviral medication, have a suppressed viral load and for those on antiretroviral medication, viral suppression is close to 90 percent.

“Taken together, these findings tell a coherent and remarkable story of progress,” Principal Investigator in the survey Dr. Jessica Justman hinted adding, “We can see that Zimbabwe, Malawi, and Zambia are on track to hit the UNAIDS 90-90-90 targets by 2020.”

The Malawi PHIA (MPHIA) survey began in November 2015 and survey teams visited approximately 15,000 households across Malawi to interview consenting participants and provide them with HIV counseling and testing.

Fieldwork for MPHIA concluded in August 2016, and preliminary results were released in December 2016.

According to 2008 research findings by the Community Health Department at the University of Malawi; up to 83 percent of prostitutes in Malawi are known to depend solely on sex work for their livelihoods; 95 percent of them have children and 69 percent are divorced.

Prostitution is deemed unacceptable in Malawi but the sex trade continues to thrive.

Large numbers of women like Maria Banda are seen loitering around street corners, near hotels, bars and other entertainment places like Makawa, a situation that is worrisome in government’s plan to fight HIV/AIDS.

Moreover women, like Maria who lacks negotiation skills and assertiveness in practicing safer sex, many other prostitutes put more Malawians particularly men at risk contracting the virus that causes AIDS.

It is therefore high time that stakeholders should target hot places like Makawa in ensuring that others sex workers are not left out in the fight.

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