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Engaging city councillors to address social and structural drivers of HIV in Blantyre City: a formative study

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BACKGROUND: Blantyre City has the highest HIV prevalence in Malawi. The 2021 HIV epidemiological estimate in Malawi reported that Blantyre City records the highest number of people living with HIV (10%), despite its contribution to only 4.5% of the national population in Malawi. Rural-urban migration, poverty, under-employment, lack of basic social amenities, and under-regulated industries such as bars are some of the major drivers for HIV transmission in the city. However, interventions aimed to address HIV risks are largely biomedical, with little focus on addressing the structural drivers of HIV. Elected city councillors have the potential to provide oversight of HIV programmes in their wards and can address the structural drivers of HIV. However, they are not optimally utilized.
Objectives: To identify opportunities and gaps for engaging councillors to address social and structural drivers of HIV in Blantyre City.
METHODS: Between November and December 2021, we conducted a qualitative study in Blantyre City, involving 58 purposively sampled participants: 22 city councillors; 14 representatives from the District HIV and AIDS coordinating committee (DACC) and City AIDS coordinating committee (CACC); 7 partners from various non-governmental organizations (NGOs) working on HIV programmes; and 15 community leaders. Data were collected through in-depth interviews, transcribed verbatim and analyzed thematically with the aid of MAXQDA software.
RESULTS: DACC and CACC members, as well as NGO partners were knowledgeable about HIV/AIDS including the current trend. Councillors and community leaders had limited knowledge about HIV/AIDS.
Councillors reported that they play critical roles in community development programmes in their wards including formulation of bi-laws and mobilization of resource. However, they were not actively engaged in HIV/AIDS programmes.
Poverty, easy access of alcohol and other substances from unregulated bars, prostitution and early marriages were key structural drivers of HIV infections reported by all participants. Gender based violence, HIV stigmatization, poor access to healthcare facilities and low HIV sensitization were said to hinder uptake of HIV preventive methods.
CONCLUSIONS: Stakeholders involved in the fight against HIV/AIDS should invest more on capacity building the councillors through training and provision of HIV/AIDS information to enable them initiate HIV risk reduction changes in their communities.