Nkhatabay, Malawi— Every evening at seven, 19-year-old Angella Mkosi* (not real name) dresses up and walks to a liquor shop in Nkhatabay town where she waits for clients. By midnight, she hopes to have made enough to support herself and her five-year-old child.

“I normally have sex with ten to fifteen men per night,” Angella shares. “Previously I used to sleep with most of them without a condom.”

Originally from Ekwendeni, Angella did not plan to become a sex worker but as a single mother with no stable income, she opted to start sleeping with men in exchange for money.

What she did not expect was the risk it would bring to her health.

“I used to accept unprotected sex for MK 25,000.00. It was good money,” she says. “But one morning I woke up very sick. I had no idea I had contracted a Sexual Transmitted Infection (STI).”

She avoided going to the hospital until one afternoon when she attended a Moonlight outreach clinic supported by UNFPA.

Angella explains:

I was diagnosed with gonorrhoea during that visit. The nurses treated me and encouraged me to go for follow-ups.

The outreach clinic she attended also provided a range of Sexual and Reproductive Health (SRH) services, including contraception and cervical cancer screening.

“Considering the challenges I faced during my child’s pregnancy, I chose the injectable contraceptive method because I can not afford to get pregnant again,” she says.

With funding from the government of Sweden, UNFPA is implementing HIV Moonlight Services under the 2gether4SRHR programme, which expands access to sexual and reproductive health services contributing to increased awareness and uptake of both HIV and SRH services.

The project is implemented to reach key populations like sex workers who often face challenges related to access and usage of HIV and SRH services with the aim of reducing the spread of HIV and AIDs, unplanned pregnancies and other reproductive health problems.

The clinics offer free information on HIV and Sexual and Reproductive Health (SRH), counselling, provision of condoms, lubricants, HIV testing, STI treatment, contraceptives and referrals.

“Even though I am also on PrEP [Pre-Exposure Prophylaxis], a condom bursting could mean a pregnancy and contracting STIs,” Angella adds. “Now, I insist on condoms.”

In the past, Angella would take the risk if the offer was high, but after counseling she realised the money is not worth exchanging with her health which now comes first.

Previously the need to access HIV and SRH services at separate times added the risk on women and adolescent girls like Angella. UNFPA-supported outreach clinics now provide all necessary services in one place and at the same time, enabling sex workers to access comprehensive information and care in a single visit.

“There was a time when I had to buy condoms for MK 500 or travel to the hospital,” she says. “And I feel more confident getting help here than going to the hospital.”

Thanks to the outreach clinics, Angella now receives condoms, lubricants, STIs screening and HIV testing for free without having to travel to the hospital where she feels uncomfortable and reluctant to visit.

*Not her real name

Nicholas Phiri, Communications Consultant