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Lifting up key populations voices and increasing quality of HIV services in Malawi: using community led monitoring to strengthen services for KPs and people living with HIV

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BACKGROUND: Over the last 10 years, access and uptake of HIV testing services and antiretroviral therapy (ART) in Malawi has improved,though HIV incidenceamong key populations, such as men having sex with men, female sex workers, and transgender people (MSM, FSW and TGs, respectively) remains high.Community-led monitoring (CLM) is an important evidence-informed approach to reaching key populations; it ensures that their voices are heard by duty-bearers to ensure improved HIV service delivery shifts that will increase access and utilization.
DESCRIPTION: Liu Lathu, 'Our Voices' in Chichewa, is the Malawi CLM Program established in 2020,currently being implemented in 29 health facilities across 6 districts in Malawi. It is led by a coalition of civil society organizations representing key populations, people living with HIV and AGYW. During the first year of implementation, six District Coordinators and 18 Community Monitors were trained in qualitative and quantitative data collection methods and have so far completed three cycles of data collection. In total, 867 PLHIV interviews were completed and 240 focus groups with KP were conducted.
LESSONS LEARNED: The interviews with PLHIV helped uncover issues that cannot be captured by routine health facility monitoring including: FSWs reporting being discriminated by medical personnel (e.g. being called prostitutes) and being denied access to ARVs. Additionally, numerous MSM reported negative health care provider attitudes towards them once their sexual identities were revealed. KPs interviewed recommended among other health care provider training on Sexual Orientation, Gender Identity and Expression (SOGIE)as well as clinics to assign KP-specific health facility personnel as a solution to address this issue.
CONCLUSIONS: Health Facility Managers committed to monitor and confront stigma, discrimination, and denied access to commodities and services for KP. In Year 2 of CLM implementation, Liu Lathu will follow up with facility managers and track which commitments were implemented.