She’s a sex worker. She’s clutching a glass of beer. She’s drunk and can barely stand up.
She triumphantly declares she’s going to sleep with 20 men tonight.
The woman is one of the many sex workers in the city of Beira in Mozambique — and one of the targets of a new pilot program set up by Doctors Without Borders to prevent the spread of HIV. The initiative focuses on sex workers and another group at high risk of infection — truck drivers.
This part of southern Africa has been hit harder by HIV than any place in the world. In Mozambique roughly 1 in 10 adults are infected with the virus. And according to UNAIDS sex workers are 10 times more likely than the general population to be HIV positive.
The city is a relatively small gritty port on the Indian Ocean. Trucks constantly move in and out of docks hauling cargo in to parts of Malawi, Zimbabwe, Zambia and the Democratic Republic of Congo.
Truckers spend weeks, even months, on the road ferrying loads of sugar, gasoline, auto parts and other loads of cargo between Beira and Central Africa. But it’s not just cargo that moves along these transportation routes, it’s also HIV.
Not far from the Beira docks, there’s a trash-strewn alleyway that at night becomes a hub of prostitution. Women and girls in tight skirts lean against a cement wall waiting for clients. Some of the sex workers are from Mozambique. But so many of them are from neighboring Zimbabwe that the area is called Robert Mugabe, in an ironic nod to the long-ruling Zimbabwean president. Mugabe is constantly saying how he’s doing so much for his people yet many of his citizens are now here selling their bodies on the street.
The Doctors Without Borders program offers weekly HIV testing and counseling for truckers all along the highway up to the border with Malawi. They also distribute free condoms at truck stops – and to sex workers.
On the night that I visit, Theodora Tongowashe from Doctors Without Borders is walking through the alley. She’s chatting with the women about HIV while handing out chocolate- and banana-flavored condoms.
Tongowashe also encourages the sex workers to get tested for HIV. Her team even offers to do tests on the spot in the back of their Land Cruiser. If the results are negative she offers to get them on to a pilot prevention program, called PrEP, in which the women at high risk of HIV infection are put on a daily regimen of anti-AIDS drugs to block the virus. PrEP stands for pre-exposure prophylaxis.
PrEP is still a fairly new method to try to stop the spread of HIV but studies have shown that it can greatly reduce someone’s chances of getting infected. If the result of the test comes back positive, the women are referred to a clinic for treatment. There are no takers this night for HIV tests but Tongowashe stages a demonstration of proper condom use in the back of their Toyota Land Cruiser.
She warns against tearing the wrapper open with sharp fingernails that could puncture the condom inside.
Two of the sex workers who’ve started taking the daily PrEP pills are hanging out at Robert Mugabe. One’s from Malawi and the other’s from Zimbabwe.
They don’t want their names published because their families back in their home countries don’t know that they’re working as prostitutes.
The 35-year-old from Malawi says she jumped at the chance to get on PrEP.
“I don’t want to be infected with HIV. No. I don’t want to get sick. That’s why I’m taking PrEP,” she says.
Her friend from Zimbabwe says she has 3 children back home in Zimbabwe and wants to give up working in the sex trade soon. And she says she wants to be healthy and HIV free when she does. She says she came to Mozambique only to make money in the sex trade.
“In our country there’s no jobs,” she says. “Me, I’m married. My husband he doesn’t work. But if he gets a job I’ll stop this business.”
These women say they charge roughly $7 for sex and on a good night will get 3 or 4 clients.
Both, however, say those clients are rarely concerned about HIV and usually try to avoid using a condom.
“They don’t care about HIV,” the Zimbabwean says of her clients.
Despite the high rates of HIV here sex workers say many of their clients don’t believe that HIV is something that will ever affect them.
These two women insist that they always insist that their clients use condoms. They say PrEP serves as backup protection against HIV in case the condom breaks or a client turns vicious and rapes them.
Jose Carlos Beirao is overseeing the PrEP pilot program for Doctors Without Borders in Beira. He says because sex workers have so many sexual contacts, they have the potential to amplify the virus in the community.
“They are mobile. They can be in different times in different places, so they can spread more easily the infection,” he says.
The medical charity offers weekly HIV testing and counseling for truckers all along the highway up to the border with Malawi. They also distribute free condoms at truck stops.
Just like the local trucker drivers, sex workers can easily move along the highway that extends from Mozambique into Central Africa. Beirao says making sure these women stay HIV negative can mean far fewer infections throughout the region.
The sex worker from Malawi who I met on the street with her friend from Zimbabwe says eventually she plans to quit this job, find a nice guy to marry her and have some children. And when that opportunity comes along, she wants to be HIV free.