This study aimed to explore and address barriers to coverage and uptake of HIV prevention and treatment services among commercial sex workers (CSWs) in Area 25, Lilongwe district, Malawi, using Participatory Reflection and Action (PRA) methods. It explored barriers to accessing HIV and AIDS treatment and care services amongst CSWs and, in a participatory manner, ways of overcoming the barriers, including empowerment of a group of CSWs in the study location. An initial baseline survey in 20 health workers and 45 female CSWs showed high knowledge but poor rating of access and uptake of HIV prevention, testing and treatment services, due to barriers both in the community and in the services themselves. A PRA process drew out further detail and experiences of the barriers faced, with priorities identified as: lack of early treatment seeking practices amongst CSWs; ill-treatment of CSWs at health facilities by health practitioners; and lack of adherence to treatment by most CSWs. Based on these results, an intensive intervention was implemented, involving door to door counselling, engagement at places of work, formation of joint committees between CSWs and health workers and sensitization of health workers; it was steered and reviewed by the team with the CSWs and health workers themselves. In a follow-up survey, both health workers and CSWs reported improvements in most areas, the CSWs reporting slightly greater improvements. Recommendations are made for building on the results of this study.
A Participatory Reflection and Action(PRA) Project Report, published by REACH Trust and Equinet. 25 pp.