Culturally Sensitive Approaches

Malawi: Mobilizing Religious and Traditional Leaders in the Fight against HIV/AIDS

The faith community and traditional leaders in Malawi represent a vast, largely untapped resource that must be effectively supported through awareness-raising and capacity-building programmes if HIV/AIDS is to be successfully combated at all levels of society.

According to the World Health Organization, 60 per cent of Africans seek health advice and treatment outside the public sector, including from faith-based organizations in rural and urban areas. Including such organizations— as well as traditional healers and other cultural leaders—in the fight against HIV/AIDS could substantially increase the likelihood of success.

In Malawi, religious and faith-based organizations have been on the front lines of the HIV/AIDS crisis since the disease took hold some 15 years ago. Four out of five Malawians follow the Christian faith, and the Church is vocal and influential on matters ranging from politics to development and health. Collectively, the Church has an infrastructure that is even more vast than that of the government. It covers every district, town and village in the country and is a major source of educational, health, agricultural and financial information and services. The Church and various Christian organizations provide an estimated 40 per cent of all health services in Malawi.

In addition to the Church, traditional authorities (former chiefs) also wield power in Malawian society as administrators of local government and the perceived custodians of local culture. In some areas governed by these traditional authorities, as many as a quarter of the population are estimated to be living with HIV or AIDS. The repercussions have been devastating. Communities are overwhelmed and unable to cope with the situation. The number of orphans is rising steadily. The sick are unable to work, and many of those who remain healthy are taking care of others. While traditional authorities are well aware of HIV/AIDS, they lack basic information about how to prevent it. Moreover, in some cases, traditional practices that were part of the culture well before the onslaught of HIV/AIDS are inadvertently spreading the infection.

Since the efforts of government and most NGOs are concentrated in urban areas, where prevalence rates are highest, rural areas have been neglected altogether. With few exceptions, religious organizations have not sought the help of traditional leaders in fighting HIV/AIDS, despite their influence in local communities. But without paying attention to deeply entrenched cultural precepts, many projects are doomed to fail.

A case in point is attempts at using condom distribution to curtail the spread of HIV in Malawi. Over the past several years, governments and NGOs have distributed millions of condoms in that country. But they were frequently passed out without proper instruction, to almost anyone, anywhere. Condoms often ended up in the hands of young children who used them as toys. In rural areas particularly, community leaders have come to believe that condoms are actually increasing the spread of HIV by giving users confidence in their safety that is not real.

These leaders have become adamant in their opposition to condoms and are seeking other solutions, while the rates of HIV infection and prevalence continue to soar.

So far, UNFPA's assistance to Malawi in the area of HIV/AIDS has focused mainly on support to the public sector through the Ministry of Health. However, the Fund recognizes the enormous potential in partnering with religious and cultural leaders on sexual and reproductive health. The comparative advantages are clear: UNFPA could bring its wealth of experience and resources while local leaders could provide the human resources, infrastructure and credibility among their followers that is all important in fostering long-term behaviour change.

WHAT COULD WORK