Why Sex Workers in Mozambique Double as Health Professionals

The peer educators teach truck drivers and also other sex workers about family planning, HIV, and how to use condoms.
Dec 19, 2015·
Fellipe Abreu is a Brazilian photojournalist focused on social issues, conflict, the environment, human rights, and culture in Latin America and Africa.

As we approach Moatize, a small town in Mozambique, the number of trucks increases. With no street lighting along the road, the only lights other than headlights are from the few merchant stalls on the roadside. When we finally arrive in Nthunzi, another small town, the side of the road is almost completely occupied by dozens of trucks lined up one beside the other.

Most of the men are heading into a dark alley next to the bar. Alongside the trucks, women stand, waiting for their next customer. It is so dark that it is difficult to walk on the bumpy path. In one of the few stretches that are minimally lit, a group of 20 men are crowding around a small 14-inch television to drink beer and watch a Jean-Claude Van Damme fight movie. From the alley, narrow corridors lead to conglomerated huts. That’s where most of the women live by day and work at night. Cristina is one of them.

“I came to Tete, Mozambique, in 2012 after losing my job in Zimbabwe due to the economic crisis. A short time later, my husband died in an accident. I did not know what to do to support my children, and I decided to come to try the luck as a merchant here, but business was not very well,” recalls Cristina, who asked not to be identified by her real name. She was told she could make money as a sex worker. So she decided to try.

MSF professionals make a routine visit to a house where nine sex workers from Zimbabwe live. All of them are HIV positive. (Photo: Fellipe Abreu)

“In 2010, a very large reserve of coal in Tete was discovered, specifically in the Moatize district, which generated a huge economic boom in the region, attracting many foreigners, and hence high-risk audiences,” explains Igor Damiani, the Médecins Sans Frontières coordinator in Tete.

“We began to see a flood of women of other nationalities, mainly from Zimbabwe, but also Zambia and Malawi,” adds Humberto Jassitene, MSF manager of patient support in Tete.

In 2011, MSF began distributing condoms and giving lectures about HIV treatment in the area. In the years since, the inflow of immigrants has intensified, and many women in vulnerable situations are arriving to work in the sex industry, running a serious risk of contracting diseases.

“I’m sure when I got here I did not have HIV, but I had a new test last year, and it was positive. It affected me a lot, because I know that I got infected during my work,” Cristina says.

Esmeralda Rosa, a community health educator, and Jaime Manuel, a counselor, conduct HIV tests with truck drivers in the city of Beira. (Photo: Fellipe Abreu)

She goes on, “Sometimes customers want to spend all night with me. And I have to take HIV drugs. So I’d rather not accept it than having problems with my treatment. For me it is impossible to carry out the work without the use of condoms. In addition to infecting others, I will worsen my own condition. No matter how much they offer me. I respect my life.”

Says Damiani, “We have noted that here in Tete, the prevalence of HIV among sex workers that have been tested is approximately 50 percent. And both they and truckers tend to move around a lot between cities and neighboring countries, following the best economic opportunities.”

To be effective, HIV treatment needs to be done regularly and without interruption.

So that no person working in the sex industry on the route between Zimbabwe, Mozambique, and Malawi has to stop treatment when moving to other cities for work, MSF created the Corridor Project, which provides medicine along the way.

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In addition to ensuring access to medicine and clinical care for this high-risk group, the project also includes education and awareness training, especially for sex workers.

At first, MSF had two mobile teams of clinicians and counselors who went to the main points of prostitution in Tete and Moatize. While the counselors conducted awareness work with the sex workers and truck drivers, clinicians remained in the mobile unit to carry out HIV testing.

“But we still had a hard time reaching out to sex workers, who were afraid to face our team, due to the severe discrimination that they often suffer here. We needed someone who was able to create a link between sex workers and Doctors Without Borders [MSF],” says Jassitene.

The Peer Educator program was born. It is made up of women who are sex workers at night but double as health workers for MSF during the day.

MSF counselor Iarissivaia Deolinda Muassinle explains to sex workers from Zimbabwe how to use the female condom. (Photo: Fellipe Abreu)

Like many other women in the area, Marta Njanje came from Zimbabwe in search of better opportunities. She began to work as a prostitute to send money to her daughter and younger siblings, who live in Zimbabwe (her parents are dead). “When I came here, I was very young and did not know anything. I did not even know how to use a condom. During this period, I got infected with the HIV virus,” she says.

Njanje works for MSF from 8 a.m. to 1 p.m., then returns home for lunch and to get some rest. Around 7 p.m., she heads out to make money as a sex worker. Because she has to wake up early each day, she tries to return home by 1 a.m., except for Fridays and Saturdays, when she stays out working on the streets.

“In my work as Peer Educator, I explain to the girls the proper way to use condoms, including the female one; I suggest the use of lubricant gel for non-condom breakage during sex; talk about family planning and talk about the importance of not interrupting antiretroviral treatment, among other things,” she says.

And the results do not lie. The work was so successful that MSF decided to create four new Peer Educator jobs in the coming months.