Malawai: A Primary Health-Care Model for HIV Prevention
“Mzake ndi Mzake (Friend to Friend) Peer Group Intervention for HIV Prevention
: a PHC model” is a multisite project that enables the primary care
system and volunteer health workers to work on HIV prevention with adults
and adolescents in rural areas.
The project was developed and implemented by nursing faculty at the University
of Malawi Kamuzu College of Nursing and the University of Illinois
at Chicago College of Nursing (United States). Nurses and community health
workers play a crucial role as peer leaders in their communities, and as trainers
of peer leaders.
To date the service has been funded through research grants from donors,
including the Fulbright Scholarship Program (1999–2000), the United States
National Institute of Nursing Research (2001–2008) and the World AIDS
Foundation (2003–2005). Local funding is being sought to continue and
extend the intervention to other sites.
The intervention delivery system is built on the primary care model of health worker–community collaboration. It integrates social-cognitive learning for
behavioural change with cultural tailoring and gender sensitivity. It is organized
and evaluated by the two faculties and delivered by trained health workers
and community adults who work in pairs as peer leaders. Six interactive
group sessions are convened to discuss the need for HIV prevention, human
sexuality, how HIV and other infections are sexually transmitted, prevention
strategies, partner negotiation, correct condom use, and how to spread the
message in the community.
The team has trained 855 health workers in the urban referral hospital, 333
district health workers, 60 community leaders, 2,242 adults and over 1,500
young people in the rural communities. In terms of outcomes, improvement
is evident in all groups with respect to: HIV-related knowledge; attitudes to
condoms and testing; self-efficacy for practising safer sex and talking with
partners about HIV prevention; and community HIV-prevention activities.
All adults show more favourable attitudes to the use of condoms. Risky sexual
behaviour has decreased among district health workers and adults, and
condom use has increased among sexually active adults and adolescents.
Urban and district health workers show improvements in universal precautions
and client teaching, but urban health workers show no change in safer
Explore the entire Compendium of Primary Care Case Studies (2009) published by the World Health Organization.