Spiwe Chikwawa (49), a sex worker from Mutare has been in the sex work business for two decades now. However, a few years ago, Spiwe developed a rare Sexually Transmitted Infection (STI). In her own words, she says this particular STI takes the trophy in the history of all stubborn STIs as it became resistant to treatment at some point only to disappear after it had resurfaced for the third time.
By Michael Gwarisa in Mutare
Due to a prolonged period with the STI, she also developed a pungent and repulsive odour which resulted in her peers and friends stigmatising and ostracizing her. To compound her woes, all her clients also stopped coming to get services from her, a development she says dealt a major blow to her income streams as her only source of livelihood was now under siege from an STI.
However, despite all this suffering, one thing she loathed the most was seeking health services from clinics or public hospitals due her not so pleasant experience with healthcare workers from council and public health facilities. Her condition worsened until someone, a relative advised her to visit one of the Centre for Sexual Health and HIV/AIDS Research Zimbabwe (CeSHHAR) clinics in Mutare city.
The first time I came here at the Forbes CeSHHAR Clinic, i received some treatment, medication and injections and somehow, my symptoms subsided. However, after some time, the STI came back again and I returned here and got treated again. When it resurfaced the third time, I received treatment and this time the treatment worked and that was the last time I had that STI,” said Chikwawa.
She added that she received counseling and HIV testing from nurses and health workers at the CeSHHAR facility. CeSHHAR runs two sites in Mutare urban, one along the road leading to Forbes boarder post and anther one in Sakubva.
“One thing I like about this facility is that the nurses are trained to deal and handle us as sex workers. They don’t threaten us but treat us as human beings. I remember I once had an incident at one of the Hospitals here in Mutare when I went to seek treatment for an STI back in the day. The nurses shouted at me demanding to know why I always came through with STIs. You don’t get such treatment here. Here, you are treated and counseled in a more dignified manner that is not demeaning.”
Spiwe is now a Microplanner working under CeSHHAR. Microplanners are part of the foot soldiers implementing peer to peer sex work programming in districts under CeSHHAR as part of the National ‘Sisters with a Voice’ programme for female sex workers which is run by CeSHHAR on behalf of Ministry of Health and Child Care (MoHCC) and the National AIDS Council (NAC). The sex work programme is peer led with sex workers taking the lead in delivery of HIV prevention programmes to their peers.
Just like Spiwe, several other sex workers have been initiated into the microplanners program which has to a greater extent led to behaviour change in sex workers through empowering them with Sexual Reproductive Health (SRH) knowledge which involves correct and consistent Condom use, adherence to Pre-Exposure Prophylaxes and building resilience through self-help livelihoods projects.
Precious Rushwaya who is also sex worker and microplanner under CeSHHAR says they each have between 40 and 50 sex workers under their supervision.
“This place, the CeSHHAR clinic is friendly because they don’t use derogatory terms to address us. They address us as sex workers. I started off as a peer educator and my responsibility was mainly to track sex workers in various hotspots. We go to the roads, bars, highways and even churches. Our aim is to ensure sex workers are safe and they continue using protection so as to avoid new HIV and STI infections,” said Precious.
Speaking to HealthTimes on the sidelines of a National AIDS Council organised Media Tour of the CeSHHAR facilities in Mutare, Beauty Dhliwayo, the Site Manager for CeSHHAR Forbes facility said they are now receiving close to 400 sex workers at the CeSHHAR Forbes site and they are using a community footprint to reduce new HIV infections.
“Our clinic started in June 2018 and when we started, we would see at least 80 sex workers at this clinic and the services that we offer at our clinic include HIV Testing and Counseling Services (HTS), Pre-Exposure Prophylaxes (PrEP) initiation, STI treatment and management, Gender Based Violence (GBV) services, counselling, HIV and AIDS treatment and care, Family Planning Services. We offer all these services for free at our clinic.
“When we started our clinic, I have seen quite a number of sex workers changing from the behavior that we first saw them in. They have now changed and they are now doing better in terms of condom use and in terms of how they conduct themselves in the communities. Most of the sex workers we are seeing here are no longer relying much on sex work but they are doing self-help groups so that they support themselves in terms of sending their children to school and even buying food and paying rent where they stay without relying much on sex work.”
She added that they do outreaches in communities where they offer ongoing health education, including condom distribution and demonstration and create demand for programmes. Through these activities sex workers are encouraged to test for HIV, attend quarterly STI screening visits and adherence support is offered. Community outreach is vital for mapping and validation of hotspots to ensure that the programme is reaching out to its target population where the need is greatest and is able to respond to changes in the nature and location of sex work.
“When we do these outreaches, we go to where they are because some of them are not willing to come here. We do these outreaches with help of microplanners. We visit them in the communities. The microplanner project has assisted us because the microplanners are able to track the sex workers in the community and they encourage them to come, visit the clinic on a quarterly bases so that we screen them for STIs.
“Since they see a lot of sexual partners in their line of business, this screening goes a long way in preventing STIs to their partners who also include married men. So that if they get infection from these girls, they will then infect their wives back home and also to ensure they do not infect their children with HIV.”
Meanwhile, Jean Mukoyi, the National AIDS Council (NAC) Mutare urban District AIDS Coordinator (DAC) said Sex Workers remain one of the hardest hit and marginalised sub population groups when it comes to HIV and AIDS programming.
“As NAC, we are complementing the efforts of the government to reduce new HIV infections by 2030, we are doing this by coordinating the multi sectorial response to HIV and AIDS in the country. We are also coordinating activities of all HIV implementing partners in the country and this also includes CeSHHAR which is running a key populations programme in the district.
“We are trying to ensure they are offering Key Population (KP) friendly programs in the district to the KP community to ensure that no one is left behind. In particular, they providing services to female sex workers, sex workers are the sub population of the population who have been previously marginalised and ignored in terms of HIV and AIDS service providing so at the end of the day, we find that new cases of HIV continue to increase in the sub-population,” said Mukoyi.
She also said the KP program in the district targets various sub population groups including Men who have Sex with Men (MSM), truck drivers, sex workers, people who live in closed settings such as prisoners among other high risk groups.
In Zimbabwe 54% of female sex workers are HIV infected and incidence is estimated at 10% per annum.
