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

Articles in Press

Document Type : Original Article

Authors

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

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

International Journal of Health Policy and Management

Articles in Press, Accepted Manuscript
Available Online from 12 May 2025

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History

  • Receive Date: 20 April 2024
  • Revise Date: 02 May 2025
  • Accept Date: 10 May 2025
  • First Publish Date: 12 May 2025

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