In Blantyre, an innovative HIV strategy targeting the city’s specific challenges is providing a blueprint for partners and implementers, including a youth-focused programme using grassroots soccer to build demand for HIV testing, voluntary medical male circumcision (VMMC) and other services.
A city-specific HIV strategy
HIV prevalence among adults in Blantyre City is the highest in Malawi at 16.4%, compared to the national average of 8.7%. Blantyre also lags behind in terms of services, including HIV testing and linking people living with HIV to treatment. The most recent estimates in 2021 indicate that 15% of Blantyre’s people living with HIV are undiagnosed, with only 88% of those diagnosed receiving treatment, of whom 91% are virally suppressed (meaning they cannot transmit HIV). This is substantially lower than the estimated national achievement of 91% diagnosed; 94% on treatment; and 94% virally suppressed.
Blantyre has developed a city-specific strategic plan for HIV for 2021 to 2025, as well as an action plan to implement the strategy. With support from the Joint UNAIDS-IAPAC Fast-Track Cities project, a consultant was recruited to organize broad and inclusive stakeholder consultation meetings and facilitate the development of the Strategy alongside the Blantyre City HIV and AIDS Strategy Taskforce. The Taskforce included a wide range of stakeholders from the municipality; communities – including non-governmental organizations (NGOs), civil society organizations and faith-based organizations, representing (among others) people living with HIV and young people; the private sector; UN entities; and international NGOs.
The Strategy was led by Blantyre City Council. While it is aligned with Malawi’s National Strategic Plan 2020-25, it responds specifically to the city’s unique context and challenges and its Fast-Track City commitments. The document outlines priority HIV interventions and service delivery approaches to be used by all stakeholders as the blueprint for the design and implementation of their own HIV programs. This will make the city’s approaches coherent, prevent the wasteful duplication of efforts and ensure investments in the HIV response are used as efficiently and effectively as possible.
The Strategy is a “living document”. It includes a monitoring and evaluation framework to monitor progress, assess impacts and inform modifications. The City Council will rely on the commitment and dedication of city and district partners and stakeholders implementing HIV programmes to contribute data that will help to refine the Strategy. Support is needed for these partners to strengthen their data collection and analyses systems and align their data collection tools with those approved by the City Council or relevant national authorities.
The Strategy is being used to mobilize additional resources for the city’s response, and to increase commitment from stakeholders. For example, the city is working with the Malawi Business Coalition on AIDS (MBCA) to promote access to and use of HIV services in both formal and informal workplaces. The MBCA is also reviewing its own strategic plan to broaden its mandate from large, private-sector organizations to small- and medium-term enterprises and the informal sector. It will coordinate HIV interventions across these sectors, and provide expert advice to the city to implement and improve workplace policies.
Young people and HIV in Blantyre
The development of the Strategy provided evidence that catalysed action. For example, young people living in the city are at particular risk of contracting HIV.  While a large proportion of young people aged 15 to 19 engage in high-risk sex (90.7% and 50.7% of young men and women, respectively), condom use during such sex was low (58.3% and 60.4%, respectively). More than one in 10 (12.4%) young people aged 15-24 years had their first sex before the age of 15. Awareness of HIV status is also particularly low among young people living with HIV, with 57% of young men aged 20-24 and 58% of young women aged 15-19 unaware of their status. Adolescent girls and young women are even more vulnerable than young men: HIV incidence is seven to eight times higher among those aged 15-24 than among their male peers, and HIV prevalence almost five times higher.
Meanwhile, access to and use of sexual and reproductive health services by adolescent girls and young women is poor. In Blantyre city, poor health facility infrastructure and overcrowding are serious obstacles to the delivery of quality, youth-friendly health services.
“Keeping the Dream Alive” for young people
Thanks to the “Keeping the Dream Alive, Fast-Track Cities Malawi” project, there has been a significant increase in demand for HIV testing among sexually active young people aged 13 to 25 in Blantyre. In-person activities in Blantyre are complemented by awareness-raising and advocacy through social media platforms and prominent influencers, which have also created demand in the cities of Zomba, Lilongwe and Mzuzu. The project uses grassroots soccer and peer support to promote healthy lifestyles and behaviour change, provide mobile HIV testing services and create further demand for testing.
The five-month project began in August 2021 with a physical HIV testing campaign in Blantyre and a virtual campaign across the country. It is implemented by the Forum for AIDS Counselling and Training (FACT), a local youth-led organization that works with adolescents and young people. FACT uses a peer model to deliver information and services in the field of sexual and reproductive health and rights.
For the project, FACT travels to colleges to hold multi-activity sporting events that function as community behaviour change campaigns, and provide young people with the opportunity to access HIV testing and counselling services. These services are also available at the FACT youth-friendly HIV testing centre in Chilobwe, Blantyre, and the organization has trained 25 young people both as peer educators and HIV pre-testing counsellors. Meanwhile, four social media influencers are promoting HIV testing on their platforms and spreading messages about youth friendly HIV testing, ART adherence and sexual and reproductive health and rights. FACT also uses its own social media platforms, including Facebook (FACT Malawi), Twitter (fact_malawi) and Instagram (fact.malawi), to promote the project and its aims.
So far, 213 young people have been tested thanks to the programme, of whom 14 tested positive, with a further 7,000 receiving individual peer-delivered pre-test counselling. The programme targets those who are sexually active, reaching out to relationship partners and using index testing more widely. Over 300,000 young people have been reached through social media and one-on-one sessions with FACT peer educators. The two college tours, alongside six focus group discussions with young people on treatment adherence, are helping to promote healthy behaviours among young people.
FACT has supported the establishment of two support groups for young people living with HIV, with over 30 members joining in the first two months of operation. These innovative “comfort corner platforms” provide a safe environment for young people living with HIV to engage with each other, provide mutual emotional support and build confidence. This also helps them to start and adhere to treatment. The comfort corner platforms are part of the project’s networks of young leaders living with HIV and youth organizations engaging in the HIV response.
FACT is planning to do research to find out why young people shy away from HIV testing services before or after becoming sexually active. The research will engage the young participants in FACT networks and activities and contribute to future good practice – modifying and guiding policy that will increase their access to services. FACT will also compile the experiences, knowledge and skills gained through the grassroots soccer campaign in a training manual that can be used by other youth organizations in Malawi and elsewhere.
1 Among adults aged 15 and above. https://aidsinfo.unaids.org and https://fasttrackcitiesmap.unaids.org/wp-content/uploads/2021/04/City-Profile_Blantyre_20.09.21.pdf
4 AVERT, 2018.
5 Ministry of Health, Malawi. Malawi Population-based HIV Impact Assessment (MPHIA) 2015-2016. 2018. Adults aged 15-64.
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