Malawi is the only country where co-location of the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and USAID’s Food for Peace resources has taken place at scale. This study looks at co-location through two CRS-led community-based programs: the Wellness and Agriculture for Life Advancement (WALA) and the Integrated (HIV Effect) Mitigation and Positive Action for Community Transformation (IMPACT) programs.
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Integrated HIV, food security and livelihoods programming has been an aspiration pursued by NGOs, donors and host-country governments for more than a decade with varying degrees of success. While the conceptual logic behind integrated programming has been obvious for decades, the “how to” of combining the requisite resources has been less so. Due to its exceptional circumstance of geographic overlap between HIV burden and food/livelihoods insecurity, Malawi is the only country where co-location of the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and USAID’s Food for Peace (FFP) resources has taken place at scale.
This study looks at co-location through two CRS-led community-based programs, the Wellness and Agriculture for Life Advancement program (WALA), a five-year (2009–2014), $81 million FFP/Title II program that works to improve nutrition and livelihoods and the Integrated HIV Effect Mitigation and Positive Action for Community Transformation (IMPACT), a four-year (2010–14), $13 million PEPFAR supported program designed to improve the well-being of orphans and vulnerable children (OVC) and enhance access to treatment and care for PLHIV. Both programs implement many of their interventions through support to community structures and formation and strengthening of community groups such as care groups; VSL groups; Producer, Irrigation and Agribusiness groups and PLHIV support groups.
This study examines the bi-directional effects of two co-located programs to determine the following: 1) how IMPACT delivers benefit to WALA, e.g., communities gain access to HIV services; and 2) how WALA delivers benefit to IMPACT, e.g., PLHIV gain improved access to livelihoods opportunities. Importantly, the study delves into the influence of stigma, discrimination and self-stigma as potential barriers to participation in WALA activities. Finally, it questions the ongoing necessity for HIV exceptionalism as a targeting/ programming strategy in Malawi’s current context.
Among the findings, this research suggests that there is still a widely-held view that PLHIV have inferior health and physical strength compared to non-PLHIV. Although some individuals present for HIV treatment late in their infection (and are therefore ill) and episodic illness remains, PLHIV who participate in WALA fervently disputed the opinion that they are frail or lacking in physical stamina, contending that they are frequently healthier and physically stronger than other members of their communities. WALA activity leaders concurred, noting the many PLHIV in WALA leadership roles.
The vast majority of barriers cited by PLHIV were not HIV or stigma related. Instead, poverty, lack of self-confidence, risk aversion, illiteracy and lack of land topped the list. The only two HIV-related barriers were self-stigma (self-imposed feelings of being incapable or unworthy) and health concerns during the early stages of antiretroviral therapy (ART).
Focus group participants in all four study districts articulated a significant decline in stigma and discrimination over the past decade, which calls into question the ongoing necessity for HIV exceptionalism as a programming and targeting strategy. Using the VSL groups as a platform for that exploration, this study found that while separate/parallel VSL programming (for PLHIV) is not imperative, PLHIV-only VSL groups do provide extra protection and comfort to more marginalized PLHIV, allowing them to experiment with new activities in a less threatening environment. The findings support advancing efforts toward “normalization” while acknowledging the value of providing extra, perhaps temporary, assistance to “more vulnerable” members of any group, irrespective of their HIV status.
Fortuitously, this research revealed an exceptionally qualified cadre of PLHIV who now, after more than two decades of training and exposure to learning, have the potential to become a tremendous resource for their communities. The findings from this study challenge the development community to leverage PLHIV support groups and position PLHIV to train, lead and capitalize on their abilities, expediting the development of the Malawian communities where they reside.
Finally, this study concludes with lessons learned for future co-location or integration efforts, as well as suggestions for ensuring PLHIV inclusion, HIV mainstreaming and HIV normalization in the current funding environment, where complementary HIV wraparound funding often is not available.
Publication detailsPublisher: Catholic Relief Services (August 2014)
Report: 48 pages
Posted on August 26, 2014