Using Photovoice to Learn About the Lived Experiences and Realities of Female Sex Workers in the Context of Hiv Self-Testing

Globally, female sex workers (FSWs) are amongst the high-risk groups for human immunodeficiency virus (HIV) infection. In Malawi, HIV prevalence amongst FSWs is estimated at 25%, compared to 12.9% in women in the general population. The purpose of this study was to understand the lived experience of FSWs in the context of HIV self-testing through photovoice in Blantyre, Malawi.

We recruited eight FSWs (22-32 years old) who were either home-, bar-, or street-based. Participants attended a 1-day workshop to learn basic photography and introduction to photovoice, power and ethics. Each participant was then given a digital camera to take 50 photographs over 5 days documenting their daily life experiences.

Themes emerged that illustrated the participants’ lived experiences in the context of HIV self-testing: (1) perceptions of HIV risk in the context of HIV self-testing; (2) the reality of life on ART as a sex worker; (3) sanitation; (4) need for independence and freedom. Photovoice data is potentially beneficial for both researchers and participants by providing FSWs with a voice and a means of making sense of their past, present and prospects for the future. 

Submitted by:
Wezzie Lora


This photo depicts seven used condoms. It generated discussion about HIV risk perception. They discussed that as female sex workers they recognised their vulnerability to HIV but said that it was inevitable for them to get HIV due to poverty which limited their ability to protect themselves against HIV infection.

Photographer: Participant 04, venue-based female sex worker

The reality of life on ART as sex workers

“No-one here takes these medicines daily, it is impossible and it can never happen. At the hospital, they tell us to take the medicine and sleep but here we don’t sleep. We sometimes feel dizzy when working in the bar."

Photographer: Participant 03, venue-based female sex worker

Venue owners blamed for poor sanitation

“This photograph is showing our bedroom. This is not a hygienic place and sometimes clients are turned off because of this. The owners don’t care. We sleep 3-4 people in one room. We give each other turns during business hours.”

Photographer: Participant 05, venue-based female sex worker

Need for independence and freedom

“I want three things in life; a house, a car and a respectable marriage, and then I will leave sex work for good…This is telling you that I have plans to leave this place and be independent.”

Photographer: Participant 06, street-based female sex worker