One Community Project

One Community’s strategic approach focuses on building strong HIV-competent communities, families, and individuals. It is based on a socio-ecological model that links the actions of individual children, adolescents, and adults to the actions of families and communities, the services available to them, and the norms, policies, and social structures that govern them.

One Community’s approach is operationalised through three core activity areas:

• increasing the uptake of HIV prevention, care, and support services;
• increasing positive behaviours that reduce the impact of HIV on communities; and
• strengthening the capacity of Malawian partners to lead and implement this work.

Project activities include the following (with those related to social and behaviour change discussed in more detail):

Case Management & HIV Testing

The Case Management approach follows the most vulnerable individuals, households, and groups across service points to assess their comprehensive health and social service needs, advocate for services, plan the service provision structure, facilitate linkages to service providers, and evaluate impact created by the services. HIV prevention, mitigation, care, and treatment is the primary objective of the Case Management approach. Nevertheless, individuals are assessed holistically and linked to a variety of socio-economic empowerment services where the need is identified. The objectives of the HIV Testing Services (HTS) are to: identify people with HIV; effectively link individuals and their families to appropriate HIV treatment, care, and support, as well as HIV prevention services, based upon their status; and support the scale-up of high-impact interventions to reduce HIV transmission and HIV-related morbidity and mortality.

Social and Behaviour Change

An array of targeted social behaviour change activities are employed to deepen HIV knowledge, reduce stigma and discrimination, and facilitate uptake of protective behaviours and available HIV services. One Community also facilitates wider community action against gender inequalities and gender-based violence. This is accomplished through the following:

• Working with community leaders/advocacy - At the community level, the project is working with community leaders and different community groups to identify norms that promote safe and positive behaviour while advocating against the harmful practices that increase HIV vulnerability, for example for women, young girls, and children. So far, the project has accomplished the following:

1. Conducted consultations with traditional authorities, group village headmen, Area Development Committees, Village Development Committees, faith leaders, and community-based organisation representatives in 37 catchment areas.
2. Gained the full support and commitment of 37 traditional authorities.
3. Engaged 58 traditional authorities and 77 faith leaders in advocacy sessions to examine and discuss gender norms and HIV risk reduction.

• Community fairs - Community fairs seek to create demand for existing HIV and AIDS services including condoms, HIV testing and treatment, and voluntary medical male circumcision (VMMC). Community fairs also provide a platform for creating community awareness on HIV-related stigma and discrimination, as well as negative cultural practices and gender-based violence. They are conducted in geographic locations with high concentrations of individuals at high HIV risk including vendors, estate workers, and fisher folk. Community fairs employ entertainment-education approaches through song, dance, and drama, as well as role modelling through satisfied user testimonies to motivate community members to not only acquire new HIV and AIDS information, but to take preventive measures. Through the fairs, One Community also hopes to:

1. Inspire and support individuals and groups in taking action that prevents gender-based violence and discourage negative cultural/gender norms and practices.
2. Coordinate activities and involvement of various groups within the community to support positive change.
3. Maintain momentum for community-wide change by recognising both small and large efforts of individuals and groups while providing plenty of positive feedback.

• Community action sessions - involve the local community in activities that publicly demonstrate their commitment to preventing gender-based violence and other negative cultural/gender norms and practices.

• Small group sessions - are a community discussion platform that seek to bring together One Community priority groups and create a space for them to talk about issues that affect their lives in order to adopt positive health behaviours that will reduce their risk to HIV. The group members are mobilised by the Community Resource Persons (CRP) to attend the sessions in their respective communities. At the end of each 5-day session, participants are provided with condoms and linked to other necessary services including HIV testing, VMMC, and family planning and other reproductive health services as may be required.

Capacity Strengthening

Activities include strategy development and planning process, implementation, monitoring, and data analysis. As part of this, the project is training resource persons in the community to deliver the core HIV/AIDS prevention, care, and support packages. The community resource persons are trained and provided with job aids and tools and are mentored so that at the end of One Community each community will have HIV-competent individuals who can provide service to their communities. As of 2017, 416 Community Engagement Facilitators and 2,000+ Community Resource Persons were recruited and engaged. These two groups will be the “boots on the ground” of One Community implementation.

DREAMS (Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe)

Through a partnership with the DREAMS initiative [PDF], this programme uses Go Girls! Clubs as a platform to mentor adolescent girls and young women. DREAMS offers a core package of interventions to reduce vulnerabilities, prevent new infections, and increase access to, and uptake of, high-impact HIV prevention and impact mitigation services, as well as high quality reproductive health and family planning services among out of school adolescent girls and young women (AGYW). Presently rolled out in Machinga and Zomba, the Go Girls! Clubs expose adolescent girls and young women to an array of topics and services around: HIV prevention, care, and treatment; sexually transmitted infections; gender based-violence; positive gender roles; positive parenting skills; and financial literacy and economic strengthening. The goal of the Go Girls! Club is to increase social assets (knowledge, efficacy, risk reduction skills) and ultimately prevent infections among its members.

HIV/AIDS, Children, Youth

According to the Malawi 2015 Spectrum estimate, nearly 1 million people in Malawi are infected and living with HIV, more than 125,000 of whom are children under the age of 15. According to Malawi Demographic and Health Survey 2010, Malawi has an estimated incidence of 34,000 new infections and more than 29,000 HIV-related deaths each year. A high proportion of the prevalence of HIV infections is in the South and Central districts of Malawi.

In Malawi, more than 50% of the population is 18 years old or younger, and more than 16% of those children and adolescents are orphans or otherwise vulnerable. Nearly 1 million children have lost one or both parents to AIDS. Adolescents living with HIV face difficulties in accessing HIV care services. Orphans and those caring for them face distinct challenges, as these children are less likely to access health care, less likely to remain in school, and are more vulnerable to abuse and neglect.