Nkhata Bay, Malawi — For Ruth*, the clinic used to feel far away. Then the clinic came to her.

“I was a bit scared at first to talk to the health staff as my job exposes me to a lot of diseases,” says Ruth who works as a sex worker at Chintheche in Nkhata Bay district. “I was comfortable living without knowing my health status.”

She eventually mustered courage and met an HIV counsellor, a decision that changed her life. The counsellor told her the benefits of knowing her status, and the next day, Ruth went to the hospital to get tested for HIV. She tested positive and was put on life saving Antiretroviral therapy (ART).

Since she began treatment, her health has improved significantly.

I used to feel weak and often had mouth sores, but that stopped after I began treatment

Ruth work comes with many risks. These include sexually transmitted infections, unplanned pregnancy, and difficulty in accessing regular sexual and reproductive health services.

With support from UNFPA under the 2gether4SRHR programme funded by Sweden, “Moonlight” outreach services in Nkhata Bay are bringing sexual and reproductive health services to sex work hot spots.

So far, the project has reached out to 265 sex workers in six hot spots with services such as HIV testing, cervical cancer screening, testing for tuberculosis, STI treatment, among others.

Standing firm against pressure

To ensure sustainability, the outreach clinics include training sessions, which empower participants like Ruth to be peers’ counsellors. These peer counsellors encourage fellow sex workers to get tested, follow up those on ART treatment to avoid defaulting.

“I use my own experience to advise friends who fall sick and sometimes escort them to the hospital if the outreach clinic is not nearby,” says Ruth.

Despite these efforts, not every client respects her choices. Some try to convince her to have sex without a condom or to accept less pay.

“Because I am often drunk at night, some clients assume my judgment is impaired,” Ruth says.

Choosing protection, on her terms

Today, Ruth is a changed person. She is now more careful and hopes to stay safe as she has a young family that looks up to her.

“I lived a reckless life, but looking back, I feel like I didn’t make the right decisions,” she said. “I got pregnant, and have a young baby, and I also HIV positive. The knowledge I have now is helping me make better decisions.” 

Nicholas Phiri, Communications Consultant

*Name changed to protect privacy.