A growing practice known as wa visa, in which sex workers engage in unprotected sex with trusted, higher-paying clients, is emerging as a key driver of Malawi's HIV epidemic, health experts and advocacy groups have warned.
The practice is common along major transport corridors and trading centres, including Zalewa, a busy junction linking Malawi to Mozambique and other parts of southern Africa. Sex workers say wa visa clients--often long-distance truck drivers, soldiers, businesspeople, or married men--pay significantly more and provide ongoing financial support in exchange for condom-free sex.
According to the National Aids Commission (NAC), nearly half of female sex workers (49.9 percent) were living with HIV in 2022, a rate seven times higher than the national adult prevalence of 7.1 percent at the time. Public health officials say wa visa arrangements are helping move infections beyond key populations into the general public.
Interviews with sex workers in Karonga, Mzuzu, Nkhata Bay, Nkhotakota, Salima, Balaka, Neno, Blantyre, Mangochi and Nsanje indicate that many deliberately prioritise wa visa clients over casual customers because of financial stability and perceived trust.
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A sex worker in Salima said she charges up to three times her normal rate when clients reject condoms, while others reported abandoning safer-sex practices entirely for long-term wa visa partners.
Health authorities say this dynamic creates a bridge of transmission, exposing unsuspecting spouses and regular partners. NAC data show that as early as 2010, married women ranked among the most HIV-affected groups in Malawi, surpassed only by female sex workers and policewomen.
A married man who described himself as a wa visa client said unsafe sex was driven less by ignorance than by emotional and economic exchange. "Men want companionship and escape. Sex workers want security," he said.
The Female Sex Workers Association (FSWA) says the practice is widespread and difficult to control due to secrecy, economic pressure and power imbalances.
"We encourage condom use, but money talks," said FSWA president Zinenani Majawa. "People are operating in secrecy, and survival needs often override health risks."
In response, service providers are expanding access to condoms and pre-exposure prophylaxis (PrEP) among sex workers. However, experts caution that biomedical interventions alone cannot address the behavioural and social drivers of infection.
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A regional One Love study conducted in 10 southern African countries found that multiple and concurrent sexual partnerships are a major factor behind persistently high HIV rates in the region, creating interconnected sexual networks where individuals are often unaware of their exposure.
Health experts say wa visa is one of several practices sustaining this network.
"What happens on highways and in trading centres does not stay there," one public health official said. "It follows people home."
As Malawi intensifies efforts to end HIV as a public health threat, authorities warn that confronting wa visa and similar practices will be critical to protecting families and reversing new infections.
