Director of The Center for Global Health Policy Christine Lubinski recalls her recent trip to South Africa and Zambia, where she and other Center staff hosted five congressional staff members on tours of U.S. government funded programs to address HIV and TB.
While visiting Livingstone, Zambia, several of us had the opportunity to visit Family Health International’s (FHI) Corridors of Hope program, a community-based prevention program aimed at sex workers. Our visit took us to the heart of an impoverished community where this group meets weekly outdoors to discuss challenges and problems associated with their lives — from negotiating condom use to remaining adherent to their HIV medications. Most of the weekly groups focus on a particular topic.
On this particular day, some 35 women came out to meet with our group of American visitors. They ranged in age from late teens to middle age. They represented a mix of clients of the program and peer educators—many of whom were retired sex workers who had been trained by FHI staff. Many had babies and young children in tow, and virtually all of them reported being mothers. In fact, about half of them indicated that in addition to their own children, they were raising the children of others who had died from AIDS. A number of them were responsible for raising as many as five children. Children played in the dust around their mothers, some of them with empty condom wrappers that were ubiquitous in the compound.
The women clearly found the program and the support group a help and a respite from challenging lives. Many spoke about wanting to continue their education. Unplanned pregnancies had clearly interrupted the education of some. Now, the care of children and the fees associated with even public education seemed an insurmountable barrier for many in the group.
The program provides these women with HIV and TB screening, sexually transmitted infection diagnosis and treatment, and linkages to HIV treatment. It also provides the group support that empowers them to demand that their clients use condoms. FHI staff and their peer educators also work to assist the women in identifying other ways to earn a living, although it was clear that job opportunities are slim in this community. These energetic, articulate women reminded us all that structural interventions, which respond to the poverty and vulnerability of these women and their families, are also key to reducing the toll of HIV on these young women and their children.
The program is funded by the President’s Emergency Plan for AIDS Relief (PEPFAR) through a grant from the U.S. Agency for International Development to FHI.