In Malawi, a new civil society charter to tackle HIV and TB is prioritising gender-based messages to help change people's behaviour.
Malawi is the third country to set up such a charter in response to the Global Fund's new funding model.
Working with men
According to the Malawi Demographic and Health Survey, data shows that in 2013 men were disproportionately likely to report having more than one sexual partner (9.2%) compared to women (0.7%).
To address this, non-governmental organisations well placed to promote community dialogue and carry out activities involving theatre for development, role models, and working with families, schools and churches.
The primary target group for such activities is men, but there will also be a focus on raising awareness of the risks of having multiple sexual partners with girls and young women.
Civil society intends to measure the impact of this activity through an increased number of men testing for HIV, men who seek circumcision, couples testing together and men using condoms.
Empowerment of women and girls
Poverty greatly affects the ability of young women to make choices about their behaviour. The charter prioritizes a two-pronged strategy to support young women through access to information and economic empowerment.
This means combatting issues of early child marriage, gender-based violence and transactional sex, which are all shown to be related to poverty and the economic circumstances of young women.
Civil society organisations supporting the charter intend to scale up activities relating to village savings and loans associations for women.
This work will focus on young women aged 15 to 24. The charter has identified border towns and some lakeshore towns as hot spots where support for affected communities are needed and where impact will be greatest.
The impact of this activity will be measured in the short-term through the number of women engaged in village savings and loans schemes and fewer child marriages, and in the longer term through bylaws restricting child marriages.
In Malawi, 80% of new HIV infections occur among partners in stable relationships (National AIDS Commission, 2012). This can be explained, in part, by negative perceptions about condom use within long-term relationships.
Work to address this issue will focus on rural women, as the issue of gender norms and power imbalances make it difficult for women to negotiate or introduce condom use within their relationship, especially the female condom.
The charter recommends the activities to be carried out in remote rural areas, as a three year programme from May 2014 - May 2017 with gathering people to sensitize on condom promotion, media reporting, education and communication campaigns, peer education as some of the activities.
One of the ways in which civil society will measure impact of this intervention will be through monitoring the number of rural women using the female condom.
Availability and accessibility
Condom use is higher in urban areas than it is in rural regions of Malawi and this can be partially explained by the fact that health centres and hospitals are some of the only places where condoms can be accessed in rural areas, yet evidence shows bottle stores are much more popular places to get condoms, especially among groups most at risk of HIV such as sex workers (FPAM & UNFPA, 2011).
Civil society intends to increase condom distribution points and lobby different community and religious leaders around accepting use of condoms.
It will also pair access to condoms with lubricants, particularly for key populations such as men who have sex with men. A three year programme is expected to start from 2014 up to 2017, with focus on marginalised people such as rural women and people with disabilities.
There is a need to scale up existing programmes targeting groups most at risk of HIV. Creating demand for health services among such populations is a high priority because data shows HIV prevalence among sex workers in Malawi is 70.7% (National AIDS Commission, 2012) and 15.4% among men who have sex with men ("HIV among men who have sex with men in Malawi" Wirtz et al., 2013).
Civil society is best placed to access people most at risk of HIV through peer education and outreach work. The target group will be primarily men who have sex with men and sex workers, though prisoners are also identified as a key population in this context, especially in connection to their vulnerability to TB. People with disabilities and refugees were also identified.
The outcome will be measured by reductions in HIV prevalence and increases in health seeking behaviour among key populations.