Meet Fanny, a sex worker and community health worker in Malawi

Doctors Without Borders/Médecins Sans Frontières (MSF) opened a medical project for sex workers in Malawi in 2014. The focus was on testing and treatment for HIV and tuberculosis and providing sexual and reproductive health care, including treatment for sexual violence.

A key aspect of the program was using trained community health workers like Fanny—a fellow sex worker who could gain the trust of the people we wanted to reach and provide them with important health information and services. “What the girls go through, I go through the same,” says Fanny. “They look at me as their helper because we counsel and guide each other and share the problems we are facing.” Community health workers also offer direct services to beneficiaries, including contraception. “I distribute condoms, I give health talks. I distribute PEP (post-exposure prophylaxis to protect against HIV) and I am able to do pregnancy tests. I also accompany fellow sex workers to the hospital when they need to meet a doctor.”

Over seven years, the project reached more than 7,000 women and provided a successful model for reaching a neglected population and helping put the power of self-managed care into women’s hands. MSF’s project helped bring down the rates of HIV in the community and worked with local hospitals to improve their treatment of sex workers; it also addressed mistreatment of sex workers by police.

“MSF changed the narrative. We are well informed,” Fanny says. “The trainings and groups have helped. We are now able to demand justice for ourselves.” In December 2020, MSF handed over the project to local community organizations and the Ministry of Health.