International Journal of Health Policy and Management

International Journal of Health Policy and Management

Engaging Councillors to Address Structural and Social Drivers of HIV Infections in Blantyre City: A Formative Study

Document Type : Original Article

Authors
Edna N. Bosire 1, 2
Victor Mwapasa 3
Emily Mendenhall 4
Sara Allinder 2
Deborah Hoege 2
Pilira Chirambo 3
Emmanuel Kanjunjunju 5
Gift Kawalazira 6
Yohane Kamwigira 7
Tione Chilambe 7
Charles B. Holmes 2
1 Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
2 Center for Innovation in Global Health, Georgetown University, Washington, DC, USA
3 Department of Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
4 Edmund A. Walsh School of Foreign Service, Georgetown University, Washington, DC, USA
5 Blantyre City Council, Blantyre, Malawi
6 Blantyre District Council, Blantyre, Malawi
7 National AIDS Commission, Lilongwe, Malawi
10.34172/ijhpm.8550
Abstract
Background 
Blantyre city is among the jurisdictions in Malawi with the highest rates of people living with HIV and new HIV infections, driven by numerous structural factors. The Malawi National AIDS Commission hypothesized that local elected officials may be uniquely positioned to understand and address structural drivers of HIV infection in their communities. However, these leaders have been disengaged in HIV prevention efforts over time. This formative study aimed to explore city councillors’ understanding of the HIV landscape in Blantyre, including structural drivers of HIV, and to identify opportunities for engaging elected city councillors to address these drivers.
 
Methods 
Between November-December 2021, we conducted a descriptive qualitative study in Blantyre city, involving 59 purposively sampled participants: 23 city councillors, 14 technical experts, 7 implementing partners, and 15 community leaders. Data were collected through in-depth interviews and analysed thematically using MAXQDA software.
 
Results 
HIV technical experts and implementing partners were generally knowledgeable about the current HIV epidemic in Blantyre while most councillors and community leaders were not. Nearly all participants referenced structural drivers of HIV transmission in the city, including migration between districts, poverty, substance abuse, and transactional sex. Councillors noted their successes in mobilizing people and identifying resources for projects. However, they reported limited knowledge and training in HIV, no involvement in related programmes in their wards, and had minimal access to HIV data. They suggested access to trainings and data would equip them to better engage with HIV programs.
 
Conclusion 
Elected leaders in Blantyre have limited access to HIV data and training. However, they demonstrate well-established relationships with ward residents and possess motivation and interest in enhancing their knowledge and capacity to address structural and other drivers of HIV infection—key factors for designing interventions for local leaders.
Keywords
Structural Drivers
HIV and AIDS
Councillors
Blantyre City
Malawi
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International Journal of Health Policy and Management
Volume 14, Issue 1
2025
Pages 1-10

  • Received Date 20 April 2024
  • Revised Date 02 May 2025
  • Accepted Date 10 May 2025
  • First Published Date 12 May 2025
  • Published Date 01 December 2025