‘Moonlight’ Services: Bringing life-saving care to Malawi’s Sex Workers
The Moonlight mobile clinic is bringing sexual and reproductive health and family planning services closer to women like Ruth. ©UNFPA/Malawi
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Malawi: In a lakeshore district in Malawi, the sunset does not signal the end of the day, it marks the beginning of a shift. For women like Ruth*, the bustling fishing and tourism industry in her area has created a ‘hot spot’ for transactional sex work.
Behind these high-demand areas, however, lies a hidden issue: limited access to - and utilization of - sexual and reproductive health care.
For a long time, Ruth lived in the shadows.
"I was a bit scared at first to talk to health staff as my job exposes me to a lot of diseases…I was comfortable living without knowing my health status."
Irregular working hours and the fear of judgement or lack of privacy has kept many sex workers away from accessing health care, but their work comes with many risks: increased sexually transmitted infections, unplanned pregnancy, and HIV. In a country like Malawi where HIV prevalence among sex workers is estimated at 50 per cent, staying away from a clinic can be a life-altering decision.
Everything changed, however, when health services started to come directly to women like Ruth. Under 2gether 4 SRHR, a joint United Nations regional programme, UNFPA began supporting ‘moonlight’ outreach services - mobile clinics that travel directly to sex work hotspots to provide on-site sexual and reproductive health care.
Ruth eventually met with an HIV counsellor, a decision that changed her life. After testing positive for HIV, she began life-saving antiretroviral therapy (ART), and her health began to improve significantly. “I used to feel weak and had mouth sores, but that stopped after I began treatment,” she recalls.
These ‘moonlight’ services are growing in scale and impact. Since June of last year, 265 sex workers have accessed vital services, including HIV testing, cervical cancer screening, testing for tuberculosis, and treatment for STIs.
Standing firm against pressure
Given her positive experience, Ruth has shifted from a recipient of care to a lifeline for others. As a trained peer counselor, she is now one of 20 women encouraging her peers to get tested for HIV and continue ART treatment. “I use my own experience to advise friends who fall sick,” says Ruth. As a mother with a young family, her perspective and decisions have shifted. She is informed, empowered and making healthier decisions.
Across Malawi, ‘moonlight services’ are not just delivering life-saving health services, they are ensuring women like Ruth are not left in the dark.
"The knowledge I have now is helping me make better decisions."
*Name changed to protect privacy.
