Lake Chilwa health workers: Stopping HIV in Malawi's fishing communities, one referral at a time

A critical part of the global effort to end the AIDS epidemic is educating communities. Around the world, volunteers, activists and social workers share information in schools and churches, on street corners and during house-by-house visits. This important work is often what persuades people to take action – to get tested for HIV, to explore PrEP, to begin and stay on antiretroviral therapy. But what happens next? Strong clinical services and dedicated health workers must be there to receive these life-saving referrals.

At local health centers near Malawi’s Lake Chilwa, they are. With funding from PEPFAR, Pact’s FISH project helped to reach a key local group in stemming new HIV infections: fishermen, who are at a higher risk because of their mobile lifestyle. Once they receive education, fishermen often make the choice – referral slip in hand – to visit a local health center to take the next step. When they do, they find health facility staff like Florence, Jonathan and Christopher, ready to support them.

“For many who come to get tested, it is their first time coming to us. Many men refuse to come to health centers but when they are given the referral they feel that it is a must and they come. They sometimes don’t want to come because they are busy with fishing. When fishermen come with the referrals, we try to treat them faster because we know they are busy and want to get back to the lake.” –Florence, Likangala Health Center
“Before I joined (the health facility), lots of my friends were positive but didn’t know their status. Now I mobilize communities to go for testing and tell them the benefits of knowing. Now my friends have been tested and are healthy. There used to be a lot of stigma but it has decreased because of communication and education. People know the benefits of testing and disclosure.” –Jonathan, Likangala Health Center
“More people are coming to the health center now that they are getting these referral forms. We do what the client is referred to do on the form. Look at the box! There are many for one month.” –Christopher, Likangala Health Center
“It is important to target fishermen and people who work in fishing because they move around and can easily spread HIV. They need to know their status. There used to be not that many fishermen coming here, but now they come in numbers! We test clients, we tell them the results, we counsel them. If they are HIV-positive, we link them to care. If negative we counsel them how to prevent HIV.” –Christopher, Makwapala Health Center
“Each of us is affected by HIV. Every person. We all must reduce transmission. We are working for a day when we have a generation free of HIV.” –Blessings, Makwapala Health Center
“Working in HIV is everyone’s responsibility. Everyone needs to take part in prevention because it helps communities reduce exposure. A fisherman may be gone for a long time from home, and his wife will be left alone for a long time. They are both at higher risk for HIV. It is important that they get tested.” –Henry, Makwapala Health Center
“The main change we have seen is that fishermen who are of sexually active age are now coming to our health center with referral slips. Most fishermen didn’t come before but now they are.” –Raphael, Namasalima Health Center
“Fishermen need condoms more than other groups because they travel around. I like to help people who have not gotten tested. They should know their status and get treatment before they are sick. Those who are negative need to have proper education to stay negative. I am most proud when people have accepted their status.” –Patricia, Namasalima Health Center

All photos: Maggie Dougherty/Pact

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