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Bernadette lost both parents when she was 7 years old and was taken in by her grandparents, who would send her to school without food. In Malawi, where poverty and unemployment remain high, many women like Bernadette turn to sex work — offering sexual services in exchange for payment of some sort - to support themselves and their families. With much lower access to health information and healthcare than their counterparts in the general population, sex workers are over five times more likely to contract HIV and face much higher risks of unwanted pregnancy and STI infections.

Sex workers report stigmatising attitudes and often violence in their daily lives — from police, clients, bar owners, and even partners. While these risks are seen by many as part of the job, empowering sex workers with knowledge and prevention methods is key to protecting their health.

Recognising these gaps, MSF has been working with the Ministry of Health to provide services that meet the specific needs of sex workers. To connect with sex workers in the towns of Dedza, Mwanza, Zalewa, and Nsanje, MSF has trained sex workers like Emily and Alice as community health workers as they have themselves experienced the challenges and dangers associated with sex work.

This shared experience enables them to discreetly link with other sex workers, understand their health situation, and explain the medical services they need. Medical staff in the project have also been given sensitivity training to provide friendly services for sex workers. Margret, an MSF community health worker in Mwanza, explains this way of working. In a single visit, clinicians provide services like HIV testing, treatment and counselling; TB screening and referral for care; and sexual and reproductive health care, including screening and treatment for STIs, access to choice contraception, cervical cancer screening, and treatment for sexual violence, which is either delivered on the spot or through referral.