1. “T HERE IS HUNGER IN MY COMMUNITY ”: F OOD SECURITY AS A CYCLICALLY DRIVING FORCE IN SEX WORK IN S WAZILAND Rebecca Fielding-Miller, MSPH 1, Zandile Mnisi 2, Nonhlanhla Dlamini 3, Stefan Baral, MPH MD 4, Caitlin Kennedy, MPH PhD 4 1 Emory University, Rollins School of Public Health, 2 Swaziland Ministry of Health and Social Welfare, SNAP, 3 Swaziland Ministry of Health and Social Welfare, 4 Johns Hopkins Bloomberg School of Public Health

2. Background, Objectives, and Methods Background: Swaziland has the highest adult HIV prevalence in the world (26%). Sex work in Swaziland is highly stigmatized and de facto illegal. Nearly a quarter of Swazis were in need of food aid from WFP in 2009. Overall study objective: Describe the positive health, dignity, and prevention needs of female sex workers living with HIV in Swaziland. Methods –In-depth interviews conducted with 20 female sex workers living with HIV in Swaziland –Each woman was interviewed twice –Interviews were conducted in siSwati by female Swazi research assistants 2

3. Results 3 Reduced social support Healthy food to manage HIV+ status HIV infection Sex work Hunger / Poverty Reduced social support Healthy food to manage HIV status HIV infection Sex work Hunger / Poverty Reduced social support Healthy food to manage HIV status HIV infection Sex work Hunger / Poverty Reduced social support (Healthy) food to manage HIV status HIV infection Sex work Hunger / Poverty “I am able to carry on with my life because they advised me on what to eat at the hospital. I eat some fruits and things like spinach, pears, peanuts, I just eat healthy food. […] I eat paw-paw and the things I am supposed to eat. I also eat Swazi traditional food.” “At one point one of us told us her story that she is not welcome at her marital home […] you see […] she continued to tell us that she is not given food at her marital home […] we had to help her by donating some money so she may be able to buy some mealie meal for her children.” “Something is missing. It doesn’t help to get medication while you don’t have anything to eat.” “I never started this out of joy. It was because I have kids. … these children had to eat.”

4. Conclusion  When asked what their most pressing needs were, our informants told us clearly: “At home poverty is written all over, you don’t have anything to give, not even soft porridge. There is hunger in my community.”  Hunger, sex work, HIV, and the need for social support form a complex reinforcing cycle in our informant’s lives.  Understanding the context and relationship between these themes is imperative when designing services for female sex workers living with HIV in Swaziland. 4

5. 5 The USAID | Project SEARCH, Task Order No.2, is funded by the U.S. Agency for International Development under Contract No. GHH-I-00-07-00032-00, beginning September 30, 2008, and supported by the President’s Emergency Plan for AIDS Relief. The Research to Prevention (R2P) Project is led by the Johns Hopkins Center for Global Health and managed by the Johns Hopkins Bloomberg School of Public Health Center for Communication Programs (CCP).