Access to HIV Treatment and Care Amongst Commercial Sex Workers in Malawi

Malawi has over the years intensified its fight against AIDS, through policies, guidelines, services and programmes. Some policies explicitly mention the need for focus on services for commercial sex workers because of their susceptibility to HIV infection and the potential risk they have of spreading the virus. The challenge remains to translate these policy commitments into practice, especially given the illegal nature of commercial sex work. One important concern is that commercial sex workers (CSW) themselves have not been included in designing, developing, designing, implementing, and evaluating new policies and programmes affecting them. This study aimed to explore and address barriers to coverage and uptake of HIV prevention and treatment services among CSWs in Area 25 Lilongwe district, Malawi, using Participatory Reflection and Action (PRA) methods. We set out to introduce and test the power of bottom-up approaches, and particularly community (sex workers) participation and involvement as an approach to increase access to HIV and AIDS services. The research explored barriers to accessing HIV and AIDS treatment and care services amongst CSWs and, in a participatory manner, ways of overcoming the barriers that includes empowerment of a group of CSWs in the study location. The work was implemented within a programme of the Regional Network for Equity in Health in east and southern Africa (EQUINET) that aimed to build capacities in participatory action research to explore dimensions of (and impediments to delivery of) Primary Health Care responses to HIV and AIDS. The programme was co-ordinated by Training and Research Support Centre (TARSC) in co-operation with Ifakara Health Institute Tanzania, REACH Trust Malawi and the Global Network of People Living with HIV and AIDS (GNPP+). TARSC and REACH Trust in particular provided peer review support and mentorship to this work.