From November 25th (International End Violence Against Women Day) through December 10th (International Human Rights Day), USAID joins the international community for 16 Days of Activism Against Gender Violence. During this time IMPACT will highlight USAID’s work to combat gender-based violence.
Mpiluka is a 29-year-old bar worker in Iringa, Tanzania. A single mother to an 11-year-old girl, she supplements her low monthly salary by selling charcoal and sex. Mpiluka fears the heightened risk of HIV, Sexually Transmitted Infections (STI), and unwanted pregnancy that she knows exists among female sex workers. But the harsh realities of sex work in this setting – the social, economic, and physical complexities of the negotiation of sex – make it difficult for her to use condoms as protection. Some men dislike condoms, offering double or triple the price for sex without. Others become violent if she insists. Recently, when Mpiluka confronted a client on condom use, she was beaten with a rock and robbed. The likelihood that Mpiluka has faced violence from her husband or boyfriend and that her daughter might also face violence in her life is significant.
Thank you for following our #16Days campaign.
Mpiluka’s story is not uncommon, and reveals the complex intersection of violence, reproductive health, and HIV faced by sex workers around the world. Historically, female sex workers of reproductive age have been considered a key population for HIV prevention, care, and treatment programs, and are 13.5 times more likely to be living with HIV than other women of reproductive age. While some prevention and treatment programs for sex workers do exist, they focus primarily on individual-level risk factors for HIV acquisition and transmission. Unreliable access to contraception and reproductive health services remains a significant challenge for many sex workers, like Mpiluka, who face high levels of sexual and physical violence. Evidence has shown that these factors are related to increased risk of HIV.
Over the past five years, the Research to Prevention (R2P) project, funded by PEPFAR through USAID, has demonstrated a clear need for policies and programming that address the multiple levels of influence on HIV risk among female sex workers, including their risk of violence and need for comprehensive reproductive health services. One study of female sex workers in four West African countries revealed high levels of sexual and physical violence experienced across these settings, including 45 percent in Togo to over 70 percent in Burkina Faso. Fifty-one percent of female sex workers in Togo who did not want to become pregnant were not accessing a reliable method of contraception, often due to discrimination and fear experienced by the women seeking health services.
The recently launched WHO guidance on prevention of HIV and other sexually transmitted infections for sex workers in low-and middle-income countries is informed by evidence for interventions that address these broader needs. Interventions that address violence and empower sex workers are primary recommendations for sex worker programming, and reproductive health is a standard component of the clinical package outlined in global implementation guidance. The guidance harmonizes and strengthens a robust response for sex workers globally and forms the basis for USAID and PEPFAR programming.
As we mark the 16 Days of Activism Against Gender Violence, it is important that we remember women like Mpiluka. It is not enough for HIV programs to address individual-level factors in HIV transmission among female sex workers; they must also acknowledge the high risk of violence and varied reproductive needs of these populations around the globe.
