How USAID is Helping Mothers in Tanzania Overcome Stigma, Violence, and HIV
June 21, 2017 | Global Health Fellows Program II | This announcement first appeared on the Global Health Fellow website.
GHFP-II Interns are exposed to diverse working experiences during their placements at USAID's Bureau for Global Health based in Washington, DC. Many Interns participate in Temporary Duty (TDY) hosted overseas with a USAID implementing partner and/or Mission. In the blog below, Allison Ficht, Prevention of Mother to Child Transmission and Pediatric HIV Intern, gives a first-hand account of her TDY in Tanzania working with the Sauti Project, a key populations (KP) project in partnership with the Ministry of Health and Social Welfare. Learn more about GHFP-II's Internship opportunities here.
USAID funded Key Populations (KP) and Orphans and Vulnerable Children (OVC) partners
working together to address children of Femal Sex Workers (FSWs).
Photo courtesy of Allison Ficht, GHFP-II Intern placed at USAID.
In the parking lot of an auto garage in northern Tanzania sits three popup tents. Except for a sign in front of the tents, they are relatively inconspicuous. Mechanics on the lot glance over at the tents from time to time, but otherwise go about their work. Inside these tents, 20 young women hold small children in their laps and attentively listen to their peer educator. These women are at their workplace too, but they aren’t mechanics. This auto garage functions as a “hotspot,” a site where female sex workers (FSWs) meet a majority of their clientele. As the peer educator, an FSW herself, speaks to the women, smiles cross their faces when they see our USAID team enter the tent. We are here with Sauti, a project funded by USAID through the President’s Emergency Plan for AIDS Relief (PEPFAR) and implemented by Jhpiego, to address key populations. Our aim is to better understand barriers to accessing services for FSWs and their children and hear directly from them about the challenges they face. On this day, the peer educator, supported by Sauti, is halfway through a core curriculum of ten classes designed for FSWs that focus on family planning, STI services, and HIV testing and counseling.
FSW-friendly HIV services in Tanzania are essential; in Dar es Salaam, the nation’s capital, HIV prevalence among FSWs is 38%, compared to the national prevalence of 4.7% . Children of key populations are at a disproportionately higher risk of contracting HIV; when children of HIV-infected FSWs are tested, the positivity rate is about 10% per program data from Sauti. This is alarmingly high compared to the national positivity rate for children of 1.1%. Given these concerning statistics, Sauti has begun to address this vulnerable population and asked FSWs to bring their children for HIV testing and ensure they are linked to orphans and vulnerable children services. When asked if they will provide consent to have their children tested, the FSWs respond reluctantly. A positive test for the child likely means a positive test for the mother, something that many of these women do not want to confront. The stigma against HIV runs high in this community, and disclosure of a positive HIV test could potentially ruin business for an FSW and therefore disrupt the main source of income for her family.
Mobile tents such as the one pictured above provide care, support, and education for FSWs in Tanzania.
Photo courtesy of Allison Ficht, GHFP-II Intern placed at USAID.
The following day, Sauti organizes a group of FSWs and their children in a dark room that serves as both their classroom and a brothel. We ask questions. A lot of questions. The FSWs are extremely forthcoming with the struggles they combat every day. It almost seemed therapeutic for them to have someone, anyone, who will listen to their concerns. They talk to us candidly about their exposure to extreme vulnerabilities and stigma within the community for both themselves and their children. They cite food insecurity and paying rent as their two major challenges, along with violence and lack of childcare. One woman informs us that she was physically abused the night before; her client did not want to pay the initial amount agreed upon and she told us, “I didn’t get cash money, but I got beaten.” FSWs feel they have no recourse and avoid seeking assistance from the police, both because of the illegality of their sex work and concerns with reporting a client.
Stigma runs rampant through this community, affecting both economic opportunities and access to HIV testing and treatment services. Some FSWs attempted to quit sex work through the creation of a savings and lendings group, but failed when their community refused to patronize their businesses. The sense of urgency is clear, as one FSW vowed, “If you empowered me, I would quit sex work today.”
Children of FSWs also face high levels of stigma, often doubly burdened by their mother’s HIV status and because of association with an FSW mother. Some FSWs self-stigmatize and hide their work from their children, leaving them unattended at home. Concerns for fire, rape by intruders, and kidnapping are particularly high, yet FSWs believe this is their only option as there are no child care services available.
Much of what we learned about barriers to accessing services for FSWs and their children in Tanzania were consistent with other countries. Because FSWs experience stigmatization in healthcare facilities, they are reluctant to seek antenatal care. Missing out on standard HIV screening and Prevention of Mother to Child Transmission (PMTCT) services significantly increases their child’s chance of acquiring HIV, and without proper diagnosis and treatment, these HIV-exposed infants experience high rates of mortality. As I progress through my year-long GHFP-II internship at USAID and my career afterward, I’ll be applying what I learned in Tanzania to support programs and models of care for these children and their mothers. Sensitive, confidential, tailored services that protect FSWs while addressing their children are essential to saving these young lives and breaking the transmission cycle of the virus. Projects like Sauti present an opportunity to take an innovative holistic family approach to care, support, and treatment services. My time at USAID and exposure to programs that are putting families first has instilled a passion and drive to ensure that the needs of FSWs and their children are prioritized in future HIV programming.
ABOUT THE AUTHOR
GHFP-II Prevention of Mother to Child Transmission and Pediatric HIV Intern
USAID Global Health Bureau Office of HIV/AIDS
Prevention, Care and Treatment Division
The Global Health Fellows Program II (GHFP-II), led by the Public Health Institute, seeks to improve the effectiveness of USAID's population, health and nutrition programs overseas by developing and increasing the capacity of health professionals. GHFP-II helps USAID address its immediate and emerging human capital needs by developing a diverse group of global health professionals to support and sustain the effectiveness of the Agency's current and future health programs.