a) HIV Prevention, Treatment and Viral Load Suppression

NAPHAM believes that for people to prevent HIV transmission they need to be knowledgeable about it and also know their status. Hence NAPHAM, through its support groups, goes out into the community to provide education on HIV and AIDS. This includes basic information on transmission, prevention and how to manage oneself if found with HIV.

NAPHAM mobilizes the people to go for HIV testing so that they know their status. For those found HIV positive, they are encouraged to join the support groups. Where they can access a lot of support to help them with the management of HIV condition..

NAPHAM has also established the Wellness Centre at its Head Office in Area 14 the following services:

• Supportive counselling and guidance. Most often, the counselling is on issues such as denial, guilt and anger that comes when one is found HIV positive, challenges associated with discordancy among discordant couples, and treatment adherence issues. The supportive counselling is usually given through
  • Walk-ins into the Wellness Centre, and
  • A Hotline managed at the Wellness Centre.
• HIV and AIDS education campaigns in the work places that include companies, organizations and colleges. This is done through training and orientation sessions. HIV testing services are also provided during these encounters in the work places and training institutions.

b) Maternal and Neonatal Health

Apart from helping people to prevent horizontal transmission of HIV, NAPHAM also helps people to prevent vertical HIV transmission. The Government of Malawi implements a Prevention of Mother to Child Transmission (PMTCT) through initiatives such as Option B+. NAPHAM is complementing such efforts by supporting the HIV positive mothers and their spouses to adhere to advice and guidance which include adherence to treatment and early infant diagnosis (EID). NAPHAM does this through the work of the Peer Mothers, Expert Clients and the support groups as a whole.

In addition, mothers and the members in general, are also oriented on and advised to access sexual and reproductive health and rights services. These include access to services such as modern family planning methods, screening for cervical cancer, antenatal and postnatal care, and sexually transmitted infections (STIs).

c) Care and Psychosocial Support

Through group therapy sessions in the support groups NAPHAM provides psychosocial support to its members. The relevance of the group therapy session has withstood the test of time. It has proven effective in provide supportive counselling and guidance at support groups level to those PLHIV going through crises due to HIV. Experienced members provide peer support and counselling to their fellow members and this has helped many to adhere to treatment and live a life free of worries. This has contributed greatly to the health and wellbeing of PLHIV at community level. The group therapy sessions have also continued to make NAPHAM support groups relevant.

a) PLHIV Involvement and Active Participation

NAPHAM believes that in all issues that affect PLHIV, the PLHIV themselves need to be involved. This is in line with the Greater Involvement of People living with AIDS (GIPA) principle. Their involvement is key in decision making processes that include involvement in relevant structures such as Village Development Committees, Area Development Committees, Health Centre Advisory Committees, and District AIDS Coordinating Committees. However, their involvement is most often compromised due to stigma and discrimination. NAPHAM empowers the PLHIV to engage authorities at national, district and community levels to address challenges PLHIV face.

b) Health Governance

Access to health care services remains very crucial in the life of a PLHIV just like any other citizen. PLHIV go to the health facilities to access ARVs, Viral Load testing apart from other general health care services. In the event pf poor service delivery, PLHIV suffer most. As such NAPHAM through the members, engages authorities at national, district and community levels to address challenges relating to poor access of health services. This is mostly done through the Community Score Cards and interface meetings. NAPHAM has Support Group Leaders Committees at every district level to support such engagements.

a) Poverty reduction and economic empowerment

NAPHAM strives to ensure self-reliance for its members. This is done through building their capacity in the following areas:

• Managing village Savings and loans (VSL)
• Farm and Business Management
• Poultry production and livestock management
• Sanitation, Hygiene and Nutrition
• Participatory Action Learning System (PALS). Under NAPHAM members are taught to plan for their future. They develop plans that would transform their lives and implement those plans in about two years. Implementation is done using resources that they have.
• Smart Agriculture Technologies such practising Conservation Agriculture which will enable them to keep their land fertile hence do not use more fertiliser which leads reducing more inputs to farming which could be costly.

a) Early Infant Diagnosis

NAPHAM facilitates access to Early Infant Diagnosis for exposed infants. This is done through the work of Peer Mothers and Expert Clients. The Peer Mothers provide support to the mothers during pregnancy and after delivery. During pregnancy they are urged to adhere to treatment and ensure health facility delivery. After delivery, they are followed up to ensure they remain on treatment and they bring the infant to the health facility for testing until the child is discharged from PMTCT program

b) Psychosocial support and Sexual and Reproductive Health and Rights

Young people living with HIV usually have questions and worries regarding their sexual and reproductive health life. Questions such as “Can I marry? Should I disclose my status to my fiancé(e)? How do I disclose? Will he or she not abandon me? Can I have a child?” And many more. NAPHAM is aware of all these challenges and provides psychosocial support to them. This is done through youth groups that are organized at community level and also teen clubs at health facility level. They are provided with information on HIV and AIDS and also sexual and reproductive health.

To young children NAPHAM also targets their parents and guardians. Using a Paediatric Tool Kit, parents and guardians are assisted on how to manage their young ones who are HIV positive. Issues of disclosure of the status are challenging and parents and guardians are assisted on how to handle them.

c) Economic empowerment

Young people living with HIV who are out of school are empowered economically through vocational skills trainings. These trainings are either facility based or community based. For the facility based, they go to training institutions and are certified at the end of the training. However, due to high costs involved, very few are enrolled. On the other hand, the community based are through apprenticeship and the costs involved are on the lower side and many are enrolled. In addition, these are hands on and after the training the young people do not have a lot of problems to penetrate through the markets since they are trained on the job. In either case, NAPHAM strives to provide them with start-up tool kits.

HIV and AIDS has been known to be one of the causal factors for gender based violence. For instance, when a spouse, especially women, has been diagnosed with HIV, she suffers different forms of gender based violence at the hand of the husband. This leads to some people not disclosing their status to their spouses and then enrolment on and adherence to treatment becomes a challenge.

NAPHAM members come from communities which practise harmful social beliefs and norms that perpetuate Violence to women and Girls. Community members and Support group members are trained to understand Gender based violence and role of women, girls and community to end gender based violence. NAPHAM Members take lead in conducting community education campaigns sensitizing the masses on dangers of gender based violence.

To address this challenge, NAPHAM has over the years been carrying out a number of activities to address the gender based violence in the communities. Among others NAPHAM does the following:

• Sensitizing chiefs and local leaders on their role in ending gender based violence.
• Sensitizing community as well as some government structures on how to address cases of gender based violence.
• Building capacity of traditional tribunals on how to handle cases of gender based violence.
• Empowering women on how to fight against gender based violence.
• Training people to understand difference between Gender and Sex

NAPHAM has played a pivotal role in the HIV and AIDS national response and has contributed a lot to the achievements made so far. NAPHAM’s key role in the national response has been coordination and implementation of HIV and AIDS programmes at district and community levels through support groups.

In the realization of the 90:90:90 targets as stipulated in the 2015-2020 National Strategic Plan for HIV and AIDS (by 2020, 90% of all people living with HIV will know their HIV status; 90% of all people living with HIV will receive sustained antiretroviral therapy; and 90% of all people receiving antiretroviral therapy will have viral suppression), NAPHAM’s roles are as follows:

• Demand creation at community level through mobilization of people to go for HIV testing and counselling (first 90).
• Advocacy to improve service delivery and reduction of stigma and discrimination (second and third 90).
• Treatment literacy, adherence, and retention on care through the support groups and the work of NAPHAM volunteers such as Health Promoters, Mentor Mothers and Expert Clients (third 90).