By Ellie Feinglass
Stella's eyes are tired, her face weary and aged beyond its years. She was born in rural Malawi to a poor family of subsistence farmers. At age 11, she went to live with an uncle in hopes that he would support her education. After enduring sexual and psychological abuse, She dropped out of primary school and ran away to Zalewa, a trading center, where she found work as a "waitress" in the Ufulu Night Club and Bottle Shop.* It was there that she began engaging in commercial sex work. She was barely 14 years old at the time. Her life continued to be filled with trauma. Once, she was abandoned in neighboring Mozambique by a truck driver who had hired her for the week. Penniless, alone and terrified, she made her way back to the border, only to be raped by four men in a roadside guesthouse. She ultimately returned to Ufulu--the closest thing to a home that she knew.
Zalewa trading center lies on the edge of rural Neno District. It is situated at the crossroads between Lilongwe and Blantyre, Malawi's two largest cities, and the country's western border with Mozambique. The corridor is a major trucking route for the region and is estimated to house over 1,000 commercial sex workers, the highest concentration in the country. Human trafficking is prevalent both within and beyond national boundaries, and Zimbabwean women now account for nearly half of the commercial sex workers operating in the area.
Poverty and gender inequality are woven into these women's life stories. Few have had the opportunity to pursue an education, which would have given them the skills and means to find other ways to economically support themselves and their families. Nearly all have been bribed or assaulted by the same men who in one moment condemn them and in the next are their regular clients. The language of individual blame and immorality that many, including the women themselves, use to describe those who practice commercial sex work fails to recognize the structural violence that lies at the core of its existence.
The national response to the HIV/AIDS pandemic in Malawi has focused primarily on testing and treatment, with a stated focus on vulnerable populations. However, the needs of this population have been largely neglected--in part a reflection of the stigma attached to the women. Aside from the individual risks of exploitation and violence to which the women themselves are regularly subjected, the public health consequences posed by the commercial sex work industry are dire in a country with one of the highest rates of HIV on the planet.
In January 2008, Abwenzi Pa Za Umoyo (APZU), PIH's partner organization in Neno, began collaborating with Development Aid from People to People (DAPP), an NGO that was operating a health center in Zalewa, to work with a group of commercial sex workers in an effort to strengthen health services and help them find alternative forms of employment. In February of last year, the center hired 15 of the women to work as community health educators in three busy trading centers. The center provided them with ongoing training focused on counseling sex workers and their clients on sexual and reproductive health, making referrals for HIV testing and counseling and, more recently, cervical cancer screening. In the first few months after establishing this partnership, HIV testing at the center increased by over 125 percent. The number of commercial sex workers in the catchment area who have started antiretroviral treatment at PIH-supported sites has also increased substantially.
On October 2008, DAPP unexpectedly closed the Zalewa health center citing lack of funding, despite the success of its programs. PIH/APZU stepped in and assumed the salaries of the former DAPP employees, as well as all other operational expenses. In January 2009, the center began offering daily adult literacy training in three sites along the trucking route. The classes were open to all commercial sex workers in the area; 56 women enrolled. In February, APZU held an intensive 7-day training on business management. Based on the training, the participants developed a business plan for opening a restaurant co-operative in Zalewa. Renovations of the building and outdoor dining area are currently underway, and they expect to open for diners next month.
PIH/APZU hopes to develop the Zalewa site as a women's empowerment center that gives commercial sex workers in the region the tools to find safer ways to support their families by addressing the women's medical, social, and educational needs. In addition to strengthening women's health services, including family planning and risk-reductioncounseling, antenatal care, HIV care, prevention of mother-to-child-transmission (PMTCT) of HIV, STI detection and treatment, and cervical cancer screening, the site plans to increase opportunities for adult literacy, vocational training and small-business development. APZU/PIH will also expand the scope of the community education component; by early 2010, the goal is to triple the number of community health workers providing health information in the trading centers along the trucking corridor.
"There has been a tremendous improvement in my life, because this time I am no longer risking my life," says Stella. "When I was doing commercial sex work, I didn't know what might happen that night. It was always my wish to [...] not to have to do that work, but with such poverty, I was desperate and needed cash." One year ago, Stella could not sign or even recognize her own name. She now attends literacy class five afternoons a week, and at 35, she has finally learned to read and write. When Tiyanjane Restaurant opens its doors in a few weeks, Stella will be ready to take orders as a real waitress, notepad in hand.
*Name has been changed.
[posted June 2009]