By Felix Chinguwo
A two-year program in Malawi aims to educate people, especially men and boys, about HIV, reduce transmission of the virus, help people to know their HIV status and start and stay in treatment. The approach combines the authority and respect accorded to faith leaders in Malawi with the fact that many men and boys don’t have all the facts about HIV and, frequently, don’t have a place to talk about HIV openly. This lack of information was thought to be one of the reasons that men and boys were less likely than women to know their HIV status and to access and stay in treatment.
As an HIV technical advisor for Health Policy Plus (HP+) in Malawi, a project funded by the U.S. Agency for International Development and the U.S. President’s Emergency Plan for AIDS Relief, I have been a part of the Faith and Community Initiative that has been working with Malawi’s religious mother bodies on HIV since 2019.
As of May 2021, through their work with HP+, the religious mother bodies have supported 24,360 people to access conventional HIV testing, 2,369 people to return to care, distributed 47,609 HIV self-test kits and provided 18,344 people with antiretroviral therapy adherence support.
In our culture, we listen to our religious leaders and give credence to what they tell us. The challenge was that churches and mosques are not where you expect to hear information about HIV. In some traditions, talking about HIV was taboo.
We knew that we could change that. We could help religious leaders to be sources of accurate and helpful information about HIV for men and boys if the leaders themselves were informed of the facts and trained to talk about HIV with their congregants. These educational messages would, we hoped, motivate more men and boys to get tested and to begin or resume ART.
At the start, the Malawian government was skeptical that religious leaders would understand and accurately pass on this information. However, from previous HP+ work with the faith community, we knew that turning to the six religious mother bodies — each one representing one of the primary religions in Malawi — would be critical. (The six groups are the Evangelical Association of Malawi, Qadria Muslim Association of Malawi, Pentecostal and Charismatic Network of Malawi, Episcopal Conference of Malawi, Seventh Day Adventists/Adventist Development and Relief Agency and Malawi Council of Churches.)
Early on, it was difficult to dispel some myths. For example, some religious leaders were perpetuating stigma against people living with HIV, or even promoting “faith healing” whereby they discourage people from accessing ART or tell them to stop treatment — either of which could put their lives at risk. It has taken a lot of training, meetings and mentorship to get to where we are today.
We began to see progress after we adapted PEPFAR’s “Messages of Hope” to the Malawian context. HP+ worked with stakeholders to develop, test and validate more than 40 companion messages to “Messages of Hope,” linked to verses from the Bible and the Qur’an, to help faith communities see the link between HIV prevention, testing, care and treatment and their beliefs.
With PEPFAR funding, HP+ was able to support the religious mother bodies with grants to implement key activities and increase their organizational capacity. We started co-creation workshops with the religious bodies that had secured the grants. We showed them data on HIV prevalence in their districts and the projected gap between the people who had been tested and the large portion of people who had not. In these workshops, I saw the passion from the religious leaders who now understood the extent of HIV in Malawi.
As the program got underway, religious leaders, government stakeholders, HP+ and its funders discussed ways to deliver messages and drafted work plans. The religious leaders communicated in church and mosque services and through other structures such as men’s groups and youth groups. When COVID-19 caused restrictions on gatherings and travel, the religious groups adapted their work plans to communicate remotely or in small groups, including disseminating messages on radio, television, SMS, Skype and WhatsApp.
HP+ worked to build relationships between religious leaders and health care providers and local clinics. Together they linked people to care, supported client retention and reenrolled those who had stopped taking medication.
We took several approaches to overcome hesitancy, especially among men and boys, to go to a health facility and ask for an HIV test. That takes a lot of courage. One approach that is particularly effective is expert clients within churches and mosques. These champions worked within their congregations to encourage men and boys to get tested and to adhere to ART. The expert clients were able to allay fears by saying aloud that they themselves were on treatment.
At the same time, religious leaders were trained by the government of Malawi to distribute HIV self-test kits. The leaders let their congregants know that they could privately get a kit and administer the test at home. We saw a tremendous uptick in the use of test kits, because people trusted that their privacy would be protected.
Across Malawi, religious leaders are passionately supporting efforts to understand and talk about HIV and access HIV testing and services. It’s an honor to work with these dedicated leaders to support and strengthen our communities.
Felix Chinguwo works as an HIV Technical Advisor for Health Policy Plus Malawi. Most recently, his work has focused on supporting religious leaders as champions for HIV testing and treatment through Malawi’s Faith and Community Initiative.