USAID cuts compound crisis for eSwatini sex workers

Funding freeze threatens health services as economic desperation drives more women into survival sex work in Matsapha, eSwatini’s industrial hub and home to the University of Eswatini (UNESWA).

By Nokukhanya Musi – Aimienoho

Just like clockwork, when the hour strikes 5 pm on a regular day, Matsapha Town reawakens. At just about the same time as the hundreds of female factory workers leave their work premises and flood the streets after gruelling shifts, a different workforce emerges. Young women in revealing clothes start to flood the streets. Easily identifiable in revealing clothes regardless of weather conditions, they take up positions near shopping centres and busy roads, offering sex to survive. The busy roads near New Village, Magevini and Mahhala have become their prowling spots for clients.

The contrast highlights a deepening crisis in this industrial hub, where recent US funding cuts have eliminated crucial health services just as more women turn to sex work to escape poverty.

“We used to offer PrEP (pre-exposure prophylaxis) to our members through mobile clinics, which helped us support women’s health in a big way,” says Sihle Dlamini, communications officer for Voice of Our Voices (VOOV), a sex worker advocacy organisation. “Since the Trump administration decided to stop USAID funding, we no longer have access to those important resources.”

The funding freeze, implemented in January 2025, terminated HIV programmes across eSwatini that supported over 215,000 people on treatment. For sex workers in Matsapha—where an estimated 1,500 work in the broader Mahlabatsini area—the cuts could not have come at a worse time.

Survival, Not Choice

Lindiwe Mlotsa*, 22, moved to Matsapha from her Vuvulane village, dreaming of stable employment to support her family. After months without success, mounting bills forced her into sex work.

“I never thought it would come to this,” she says. “But when you have no food and nowhere to turn, you do what you must to survive.”

Her story mirrors that of Thando Jele*, 19, of Maphungwane area, who came to Matsapha hoping to save money for university tuition. “I tried finding work as a waitress or in shops, but the competition was tough,” she explains. I thought sex work might help me save enough to go back to school, but that never happened.”

Both come from the Lubombo region, which has the highest poverty rate, at 71.5%, followed by the Shiselweni region, at 67%. Hhohho and Manzini also have significant poverty rates, at 60.9% and 57.7%, respectively.

According to a 2024 United Nations Development Programme (UNDP) report titled ‘We Belong to Africa – Young Key Population (YKP) Inclusion Project’, approximately 7,000 sex workers operate across eSwatini, with Matsapha representing one of the highest concentrations. One in five sex workers in eSwatini operates in Matsapha. Many are school dropouts, orphans, or women supporting families—demographics that have expanded since the COVID-19 pandemic.

“We’ve seen a steady rise over the last five years, especially among young women aged 16-25,” Dlamini notes. “Many dropped out of school, are orphans, or care for family members.”

Health Crisis Deepens

The healthcare implications are severe in a country where 27% of adults live with HIV—the world’s highest prevalence rate. Sex workers face even greater risks, with HIV rates among this population estimated at over 60.8% or three in five sex workers. Only one in two sex workers use condoms as a prevention measure.

In an interview, Nuha Ceesay, the UNAIDS Country Director for eSwatini, shared his concerns that the funding cuts affect HIV services and the healthcare system. He points out that HIV testing services, which are key to starting treatment, are getting harder to access. The number of new infections could exceed the current 4,000, putting even more pressure on treatment resources.

“With these cuts, we’ll likely see shortages of antiretroviral meds, lab test kits, and condoms in just a few months. Prevention services like PrEP, education campaigns, and voluntary medical male circumcision—which help reduce the risk of HIV—are being scaled back or even stopped,” Ceesay says.

VOOV previously distributed PrEP and Dapivirine vaginal rings through US-funded programmes. “We used to provide the Dapivirine vaginal rings, starting people with a month’s supply and then checking in over the next couple of months,” Dlamini explains. “Sadly, we don’t have any rings left right now.”

The organisation can still distribute condoms and lubricants through project-based funding, but the loss of comprehensive health services leaves many women vulnerable.

However, a bright spot emerged in February 2024 when Doctors Without Borders opened the Sitsandziwe (“You Are Loved”) sexual health clinic in Matsapha, offering free Sexually Transmitted Infections (STI) testing, HIV services, and family planning specifically for sex workers, factory workers, and lesbian, gay, bisexual, queer and intersex (LGBTQI+) individuals.

Legal Limbo

Eswatini’s legal framework around sex work remains murky. While the Sexual Offences and Domestic Violence Act of 2018 does not criminalise prostitution itself, police still use an 1889 law prohibiting “loitering for prostitution” to harass sex workers.

“Sex work carries a lot of stigma, often seen as a moral issue or associated with crime and disease,” Dlamini says. The criminalisation pushes women further underground, making them more vulnerable to violence and exploitation.

VOOV reports increasing exploitation by older, wealthy men who lure young girls with financial promises. “We’re working closely with community leaders and police to raise awareness, report abuse, and support victims,” Dlamini emphasises.

Municipal Response

Newly elected Matsapha Mayor Lindiwe Dlamini is developing a multi-pronged response to address root causes. She plans to establish a task force of social workers, law enforcement, and community leaders while launching youth forums and mentorship programmes.

“I want to give young people a chance to share their thoughts and create job opportunities through skills training and entrepreneurship,” the mayor says. “No girl should feel forced to trade her body for survival.”

Her strategy includes trauma-informed counselling, healthcare access, life skills education, and increased police presence with gender-sensitivity training.

Economic Solutions Needed

Mahlabatsini community police officer Sikelela Micah Dlamini warns that support programmes often fall short due to funding constraints. “Many still find it hard to get the money they need to kickstart their businesses, which pushes them back to sex work to make ends meet.”

He advocates for financial assistance programmes similar to those supporting single mothers in other countries and community dialogue to address cultural factors contributing to the crisis.

Matsapha Town Council’s public relations officer, Sihle Sihlongonyane, mentions efforts to involve young people in waste recycling programs and establish business funding through the Matsapha Business Forum. However, the community police acknowledges that “economic struggles in places like Mahlabatsini keep trapping young women.”

Lucky Dlamini of the Swaziland Unemployed People’s Movement (SUPMO), a grassroots social justice movement advocating for the rights of the unemployed, slams government for failing to provide them with a basic income grant of E1,500 to cover their necessities. He calls for transforming exclusionary policies so the unemployed can access the economy. 

“SUPMO’s view is that the unemployed people, especially the majority, feel neglected and abandoned because the government has no political will to address the unemployment crisis. Truly, there is no clear job creation plan, with clear timelines, other than politicking about this matter,” he laments.

When asked about the government strategy to tackle poverty and unemployment amongst the growing number of unemployed young sex workers in Matsapha, the communication officers in the Ministries of Commerce and Industry and Sports, Culture, and Youth Affairs had not responded at the time of publication.

*Not their real names