Science Gives Sexually Abused Women in Malawi Hope in Fight Against HIV
Patuma is a commercial sex worker. She ekes her living through sex. She says her work is dehumanizing. This is because decisions in her work are mostly made by her clients.
She is one of the many women that suffer from unimaginable violence that is concealed in commercial sex rooms in Malawi: a story of women suffering in silence.
Such women are forced into sex without condoms, for example, in situations where the women are drunk or where the husband’s sexual behaviors are known to risk the lives of their wives, which puts the women in the harm’s way of injury and disease.
In this special investigation, Innocent Kumchedwa encounters not only sex workers like Patuma but spouses as well who lament the dominance of men on matters of sex and its effects.
Innocent, further ponders on the opportunities some newly invented scientific means to prevent sexually transmitted infections provide for these vulnerable women.
The vulnerability of women
Patuma operates from Nsungwi in Area 25 in Lilongwe city.
She says all female sex-workers experience violence.
The fact that sex work is not legalized scares most female sex workers from reporting what they endure to police for legal action.
“You may go to a room with a client having a proper agreement. They may agree to pay you, but once you get to the room, they change; becoming violent, beating you, taking their money back or even stealing from you.
“And there are some men who take advantage of female sex workers who are drunk. You know there are some of us who feel cannot work well without taking a few bottles,” she says.
It is such violence that qualifies sex workers as vulnerable when it comes to the risk of sexually transmitted infections (STIs).
Ordinarily, one would be tempted to think that the female sex workers pay for the violence they face.
But it is not only sex workers who face this violence. Women in marriage, too.
We shall this woman Pilirani. She has been married for 14 years. For most part of the years, she was in a violent marriage.
In those years, her husband was clearly unfaithful. But Pilirani could not even demand the use of condoms when they made love. She had no say about the sex life of their family.
“When he (my husband) infected me with a sexually transmitted infection, I asked him that we seek medical treatment, because I knew that when one has signs for STIs they have to immediately seek medical care. But he did not accept it.
“So, I just had to go on my own to the hospital. Even if I got the medication, the STI would not end completely because he was still asking me for sex. I would ask him to use protection, but he would not accept that. I tried to report the matter to church, but the authorities there said; using condom was a sin before God,” laments Pilirani.
Veronica Banda is Lilongwe Urban Coordinator for a local movement known as Our Body Our Life (OBOL) that helps women such as Pilirani to speak out against violence linked to sexuality and sex life.
Pilirani is now a member of this grouping.
“We focus on five main pillars; the first one is encouraging women to have a healthy life; that once they feel that they have been infected with any STI, they must prioritize getting medical treatment.
“We emphasize that everything depends on them having a healthy life. Other than that, as OBOL women, we encourage them to join groups where they can report and share the problems which they face,” says Banda.
Can science give women hope?
Although there are many methods available and accessible to help protect one from STIs such as HIV, women and sex workers still remain without power to negotiate for safer sex.
However, scientists - local and foreign - have for a while now been engaged in a variety of research programmes to find solutions.
Dapivirine vaginal ring and Injectable Prep are two methods the World Health Organization has approved for HIV prevention.
Tchangani Tembo, Study Coordinator for the University of North Carolina (UNC) Project, explains the methods and how they work:
“The vaginal ring, for it to work, is inserted in the vagina. It releases a drug known as dapivirine. So, this drug, once it is available in the vigina when a woman meets a man who has HIV, the HIV fails to enter the human cell because of the process called reverse transcription.
“This term means that for a virus to be able to replicate or to multiply must change itself into a viral DNA, so the drug prohibits this transformation.
“As for the Cabotegravir injectable, it is an Anti-Retroviral (ARV) also but inform of an injection. Likewise, this drug is in the group of protease inhibitors; when someone is injected with this drug, the drug works for a period of two months, inhibiting the process of the virus transforming itself into viral DNA,” says the scientist.
Ephraim Banda, is a resident of Blantyre. Here is how he reacts to the new HIV prevention technologies meant to empower women to take control of their sexual life.
“If we are not safe in these days, having sex you cannot expect anything good. Even children coming out of that sex are at a higher risk.
“So, if there are some technologies where both women and their spouses are protected, I mean I have no problem with that technology, it is a very welcome development,” he says.
Malawi opts for HIV injection prevention method
Malawi plans adopting and implementing use of injectable prep as a means for HIV prevention from end this year. Already, 12,000 doses of the injectables are in the country, courtesy of donors.
Rose Nyirenda is Director of HIV in the ministry of health.
“The US government has procured injectable prep for 12 000 clients and this has been donated to Malawi. So, we are going to work together with George Town University who are the implementing partner for Bill and Melinda Gates Foundation. This is going to start towards the end of the year. Injectable Prep is one of the very effective HIV preventions,” says Nyirenda.
She adds that the ring method will not be adopted: “So government has not adopted the Dapivirine ring because is not as effective. The effectiveness is at around 50%. One of the criterions which we use to select interventions, particularly those for prevention, is the impact.”
Advocates want more choices for women
Some stakeholders such as SRHR Africa Trust prefers the ring to injectables. The trust argues that the ring serves women better and suits their prevalent situation.
Robert Mangwazu Phiri, who is the country director for the trust, says he would have loved if government had taken all the two new methods on board.
“We thought it is very specific for women. As you know, women are the most vulnerable ones, therefore, that is why we were making a lot of engagements, a lot of advocacy to say, please, allow this method, because this specifically targets women especially those that are HIV negative so that they don’t get it.
“As you know in Malawi women are the most vulnerable to getting HIV because of the power dynamics that we have in our society,” he says.
Dr. Noel Dzinenani Mbirintengelenji lectures in HIV at the Kamuzu University of Health Sciences (KUHES).
His choses injectable prep as the best option of the two methods.
“As you know that some women already, they do not like such issues that are related to insertions into the vagina. Therefore, it is very difficult for women in the country to be using that method.
“And you can see, even the utilization rate at international level is low and the effectiveness, at about 54%, is not good. In Malawi, with our level of understanding of that issue, it is very difficult for the government to adopt that method,” says the scientist.
Whatever happens from now, the position is that, at last, there is an option to mitigating the effects of sexual violence in Malawi.
With the adoption of any of the available HIV preventive methods, some liberty is accorded to women, sex workers included, to participate in decisions regarding safe sex.
World Health Organisation’s approval of the methods means that the ring and the injectables will soon find way onto the shelves in public and private pharmacies, giving women a say in their sexual life.
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