Female sex workers living with HIV in Malawi: major gaps in condom use, STI screening, and ART initiation and retention

FSWs living with HIV face substantial challenges in accessing HIV care and treatment services, including difficulties attending routine care, internalized stigma, and poor service quality. Several studies from sub-Saharan Africa have demonstrated improved HIV treatment outcomes, such as increased uptake of HIV services, retention in care, and enhanced dignity and quality of life, by utilizing community health platforms. Project SOAR, in collaboration with the USAID-funded LINKAGES Project, is conducting an implementation science study to investigate the feasibility, acceptability, and effects of a community-based antiretroviral treatment (ART) service delivery model using drop-in centers for FSWs in Blantyre and Mangochi, Malawi. The study's baseline survey was administered to a cohort of 190 HIV-positive FSWs enrolled in the study. Eligible participants were identified through HIV testing and counseling services provided through community outreach activities, drop-in center walk-ins, and referrals of HIV-positive FSWs who had either never initiated ART or had been in default for three or more months. The majority of participants (59 percent) were from Blantyre, with the remaining 41 percent from Mangochi. Key findings from the baseline survey indicate that a significant proportion of FSWs had not started treatment or had been in default for three or more months. Only a third of women were screened for STIs in the last three months, yet nearly all were diagnosed with one or more infections. Condom use was low, particularly with non-paying partners whose HIV status was not known to most women. The study's results highlight the need for targeted efforts to expand STI testing and treatment, as well as the importance of timely HIV diagnosis and treatment. The findings also underscore the significance of community-based ART service delivery models in improving HIV treatment outcomes among FSWs. The study's results have implications for the development of effective interventions to address the unique needs of FSWs living with HIV in Malawi. The study's methodology involved the administration of a baseline survey to a cohort of 190 HIV-positive FSWs enrolled in the study. The survey collected data on participants' demographics, HIV diagnosis and treatment status, sexual behavior, and access to HIV care and treatment services. The study's results are based on the analysis of data from the baseline survey.