Malawi and Global Fund R7 Len Bijl – van der Hoeven Malawi

Country Background HIV: 14% of adults aged years are reported as infected with HIV, with more women then men infected, Young people are reported as most affected. There is also very high prevalence among pregnant women. Maternal Mortality Rates are high at 984/100,000; due to many factors, one of which is the high rate of complicated abortions (due to unwanted pregnancies in young people) Sexual activity in teenagers is 15% for girls and 14% of boys. Condom use during sex is 39% for girls and 60% for boys. More than 70% of men presenting at the STI clinic with GUD in Lilongwe, were co-infected with HIV. The youth experiences high barriers to accessing SRH care, such as access to family planning, STI treatment and life- skills education.

Global Fund History Malawi is recipient of Round 1, 5 and now 7; R5 is mainly about health system strengthening (HR for service delivery). Total funding: R1 $178 million, R5 $31 million, R7 58 million (HIV $15 million)

Geneva December 2006 Small Malawi Delegation –FPAM –IPPF –Interact worldwide / MoH –NAC was unavailable

Geneva December 2006 The plans we made during this meeting were to share the outcome of the meeting at individual level with key players, and to conduct presentations at the CCM and the Reproductive Health Coordinating Committee and HIV in health forum.

Main Gains Returned, equipped with the knowledge that at global level, all stakeholders agreed on the urgency to see SRH and HIV integrated in the GF proposal, even the GF people. Upon my return from Geneva, I contacted the Ministry of Health’s HIV and RH units; the DFID health advisor, the RH officer from UNFPA and the NAC, and shared my experiences and my wish to be part of the development of the R7 proposal.

R7 process unofficially informed about the first workgroup meeting to discuss rejection of R6 and proposal direction of R7. Attended this meeting, without invitation (which was appreciated). Mentioned the Geneva meeting and the necessity to integrate SRH and HIV in the R7 proposal, I was shocked to learn that none of my collaborating partners provided any support (UNAIDS, WHO, UNFPA, USAID, NAC). If fact I was told by the DD NAC that ‘integration of SRH is great, as long as our attention is not diverted from the real issue: HIV.’ I was shocked, but continued my one-on-one lobbying for SRH integration. At some point I believe the partners had finally received the meeting report, because the tune changed, and everybody was all of a sudden advocating SRH integration.

R7 proposal The overarching goal of Malawi’s Round 7 proposal is “to reduce the prevalence and incidence of HIV infection through scale up of behaviour change communication (BCC) interventions, sexual and reproductive health and rights (SRHR) and non- biomedical HIV prevention services for young people”. The entire proposal addresses the needs of young people. The proposal highlights: –youth-friendly SRH services, including HIV counselling and testing, –family planning (prevention of pregnancy) and –STI treatment. –Trained young people will be supported as community-based distribution agents for male and female condoms and BCC materials. –Empowerment of women, implementation of policies that protect young people’s rights, promote women’s rights, –combat stigma and discrimination and protect adolescents from sexual abuse

It is a very good integrated SRH/HIV proposal, completely focusing on the young people of Malawi. I was not involved in the actual writing of the proposal, so I feel my contributions were minimal, although speaking to key people at individual level certainly helped. Repeating the same message at meetings also helped. I did feel empowered having participated in the Geneva meeting with some partners which play a very important role in Malawi, such as DFID, UNFPA and UNAIDS. When I encountered lack of enthusiasm with UNFPA and UNAIDS I referred them back to their head offices, to get more information. I think this worked!

Lessons learned I recommend that your first step is to notify your key country players in SRH and HIV. Make them aware about these meetings, and give them time to reflect and contact their head offices to gain more knowledge of the situation of SRH integration. Generally the CCM is a difficult forum to get into, but try and speak to individual CCM members and persist on dissemination the message over and over again.