Fighting HIV Among Sex Workers And Truck Drivers In A Doctors Without Borders Program In Mozambique : Goats and Soda It's part of a pilot program from Doctors Without Borders in a part of Mozambique where roughly 1 in 10 adults is infected with the virus.
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Fighting HIV In Two High-Risk Groups: Sex Workers And Truck Drivers

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Fighting HIV In Two High-Risk Groups: Sex Workers And Truck Drivers

Fighting HIV In Two High-Risk Groups: Sex Workers And Truck Drivers

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KELLY MCEVERS, HOST:

This week, many of the world's top HIV researchers are in Durban, South Africa for the biannual International AIDS Conference. Health officials say global efforts to stop new HIV infections have stalled. And in the absence of a cure or a vaccine, UNAIDS has called for intense new prevention campaigns that specifically target people at high risk of getting HIV.

NPR's Jason Beaubien looks at one of these efforts in Mozambique.

JASON BEAUBIEN, BYLINE: This is the port city of Beira. It's a relatively small, pretty port, but it's very significant to this region. The docks just down this road are offloading cargo from ships on the Indian Ocean. And long-haul trucks are constantly moving in and out of here. They're carrying loads of sugar. There's tanker trucks for gasoline. They're carrying those big shipping containers.

And a beat-up highway from here connects this port with central parts of Africa - parts of Zimbabwe, Malawi, Zambia, even the Democratic Republic of Congo. And it's not just cargo that's moving along these roads. It's also HIV. Not far from the port, there's a trash-strewn alleyway that at night becomes a hub of prostitution. Women and girls in tight skirts lean against the cement wall.

They're soliciting clients including truck drivers who are waiting for their next job. One of the women is clutching a glass of beer. She's drunk and can barely stand up.

UNIDENTIFIED WOMAN #1: (Foreign language spoken).

BEAUBIEN: She triumphantly declares she's going to sleep with 20 men tonight. Some of the sex workers are locals from Mozambique. But so many of them are from neighboring Zimbabwe that the area is called Robert Mugabe. It's 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 them are now here selling their bodies on the street. Theodora Tongowashe from the medical charity Doctors Without Borders is walking through the alley. She's chatting with the women about HIV while handing out chocolate-and-banana-flavored condoms.

THEODORA TONGOWASHE: (Foreign language spoken).

UNIDENTIFIED WOMAN #2: Thank you.

BEAUBIEN: Tongowashe also encourages them to get tested. Her team even does HIV tests on the spot in the back of their Land Cruiser. If the results are negative, she offers to get them onto a pilot prevention program in which women are given anti-AIDS drugs to protect them against HIV. If the results come back positive, the women are referred to a local clinic for treatment.

There are no takers this night for HIV tests. But Tongowashe stages a demonstration of proper condom use.

TONGOWASHE: First thing you have to do, you have to (unintelligible).

BEAUBIEN: A tall woman with her face powdered white and thick black eyebrows drawn over her eyes comes to the backdoor of the vehicle. She asks Tongowashe when she's supposed to return to the HIV clinic.

TONGOWASHE: Tuesday, Tuesday, Tuesday.

UNIDENTIFIED WOMAN #3: On Tuesday, OK.

BEAUBIEN: This part of Southern Africa has been hit harder by HIV than any other place in the world. In Mozambique, roughly 10 percent of all 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.

Doctors Without Borders' program here focuses on sex workers and another group at high risk of infection, truck drivers. One of the innovative things here is the use of pre-exposure prophylaxis or PrEP. Sex workers who are HIV-negative are put on daily regimens of anti-AIDS drugs. Studies have shown that the same drugs that treat HIV can also block new infections.

But this prevention method is still very new. Two of the women who've started taking the PrEP pills here in Mozambique are hanging out at Robert Mugabe. We're not using their names for reasons that will become obvious.

UNIDENTIFIED WOMAN #4: I don't want to be infected with HIV (laughter). No, I don't want to get sick. That's why I'm taking PrEP.

BEAUBIEN: Her friend from Zimbabwe says she has three children, and she came her simply because she heard she could make money in the sex trade.

UNIDENTIFIED WOMAN #5: For money - we're looking for money. In our country, there are no jobs, you know? Especially me, I'm married. My husband doesn't work. But if he gets job, I will stop this business.

BEAUBIEN: Are your kids and your husband back in Zimbabwe?

UNIDENTIFIED WOMAN #5: Yeah, they are there in Zimbabwe. But him, he doesn't know that I'm doing this business (laughter).

BEAUBIEN: These women say they charge roughly $7 for sex. And they say on a good night, they will get three or four clients. Both, however, say those clients often try to avoid using a condom.

UNIDENTIFIED WOMAN #5: They don't care about HIV. If you ask him, would you don't - are you not afraid of HIV? You don't know me. We just met today, but you're asking me to sleep with you without protection. They say, (foreign language spoken). It doesn't matter (laughter).

BEAUBIEN: These two women insist that they always use condoms. They say PrEP serves as backup protection against HIV in case the condom breaks or a client turns vicious on them 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.

JOSE CARLOS BEIRAO: And they are mobile also. They can during a certain time in different place, so it can spread more easily the infection. So...

BEAUBIEN: Just like the local truck drivers, sex workers can easily move along the highway that extends from here into Central Africa. Beirao says making sure these women stay HIV-negative can mean far fewer infections throughout the region. Jason Beaubien, NPR News, Beira, Mozambique.

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