Women & Gender

A couple from Malawi receives counseling from a Community-Based Distribution Agent (CBDA)

In Kasungu District, Malawi, trained Community-Based Distribution Agents (CBDAs) gather for their final and perhaps most challenging training: couples counseling.

With HIV, couples often do not freely discuss issues and concerns. “Where communication has been a problem for couples, CBDAs in underserved areas will help in risk reduction,” explains Jane Ngwira, MSH’s Kasungu District Coordinator.

Lucia Afiki and Esther Goodson are living positively with HIV. They are counselors for family planning and HIV & AIDS at Salima District Hospital in Malawi, where they openly tell their clients that they are HIV-positive. “When we are open with them about our status,” says Afiki, “people say, ‘Come closer, we want to learn from you.’” Goodson adds: “They say, ‘What should I do to look as good as you?’” The counselors tell them to visit a doctor and join a support group. This is an approach that saves lives. It also transforms social norms about health and gender.

Fatima preparing bean cakes for her business, Nigeria


HIV-positive women in Nigeria are the primary caregivers for their own families and other people living with HIV. This disproportionately high burden of care has detrimental effects not only on their health but also on their economic well-being.

The MSH-led, USAID-funded, Prevention Organization Systems AIDS Care and Treatment (ProACT) project in Nigeria has helped establish HIV support groups whose participants are 80 percent women. These groups have started providing income-generating opportunities for participants through savings and loan associations, registered with the Nigerian State Ministry of Commerce and Cooperative Societies.

Mary's 120 square foot house, purchased in 1992 (Mala Persaud/GHARP II)

Mary* was married at the young age of 13 in her hometown, Crabwood Creek, Region 6, Guyana. At age 15, after she gave birth to her first child, her husband deserted them. Mary was left to provide for herself and her child. She tried a few odd jobs, but they did not work out. In 1989, at age 15, she turned to commercial sex work. At this time, Mary had never heard of condoms and had never used one. Her earnings were adequate, as much as $300 some weeks. However, heeding the advice of many of her older friends, she chose to leave sex work in 1992, spent her savings on a 120 square feet house, and started fishing to support herself and son.

GNU Fellow Marzila Mashal (far right) of Afghanistan attends Leadership Development Program in Egypt

Editor’s Note: Marzila Mashal, an Administrative Coordinator working in Kabul, Afghanistan, was awarded a month long fellowship that is awarded to two MSH staffers each year. The Fellowship was established in honor of Carmen Urdaneta, Amy Lynn Niebling, and Cristi Gadue who on February 3, 2005, died in a plane crash outside Kabul, Afghanistan. The Gadue-Niebling-Urdaneta (GNU) Memorial Fund was established to further the work to which these remarkable women dedicated their lives. Each year, the GNU Fellowship provides MSH employees based in the US and the field with an international public health opportunity at another MSH location.

If you grow up in places like Kasungu district in rural Malawi, you learn that when your wife is pregnant, you should not have sex outside marriage---because you will lose the “expected gift” through miscarriage. Male promiscuity during a partner's pregnancy is a taboo that many believe will bring a curse on the family.

Patricia Patrick says that after she miscarried in November 2008 “People talked in the village, and people talked within the household. My relatives asked me suspicious questions.” They wondered whether sexual misbehavior by her husband caused the tragedy. She remembers her husband telling his side of the story to prove his innocence, but nobody believed him.

Mother and children, Salima, Malawi, April 2011

Malawi leads the developing world as the first to propose an approach to prevention of mother to child transmission (PMTCT) of HIV that addresses the health of the mother. Recently my MSH colleague Erik Schouten and his colleagues in Malawi wrote a commentary in the Lancet about Malawi’s innovative, public health approach to PMTCT. Malawi calls its model “B+” because it complements the World Health Organization’s (WHO) B option, whereby a mother’s CD4 cell count, a measure of the volume of HIV circulating in her blood, determines her eligibility for lifelong antiretroviral therapy (ART).

Blog post updated Dec. 27, 2011.

Nursing Officer in Charge Nancy Thiong'o checks on a mother and her new baby


In 2003, after dwindling funds, low staff morale, and accusations of patient neglect had eroded community confidence in Kiriaini Mission Hospital in Kenya, the Catholic Diocese of Murang’a decided to shut it down -- leaving locals to seek treatment at the distant provincial capital of Nyeri.

Six months later five Franciscan nuns arrived from India to reopen the hospital. They hired new staff, renovated the dilapidated structures, and restored much needed services to the rural community. Eight years later the hospital is a clean, efficient, well-run facility with 70 beds, friendly staff, and multiple in-patient and out-patient services.

I’d like to call attention to an important set of articles in the recent HIV/AIDS themed issue of The Lancet. Erik Schouten of Malawi Basic Support for Institutionalizing Child Survival (BASICS) has published a commentary (free registration required) about Malawi’s push to be the first country to implement a “B+” approach to reducing mother to child transmission.

Safoura Amadu and her son Ibrahim

Safoura Amadu is the 19 year-old mother of Ibrahim, who was born preterm on March 8, 2011 at 1.46 kg (3.2 pounds). Baby Ibrahim did not grow well in his first days of life. Safoura was very worried---her first child had died at birth---and she did not want to lose Ibrahim, her second child. Safoura sought help and when Ibrahim was ten days old she and the baby were admitted to the new Kangaroo Mother Care (KMC) center at the Maternité Issakha Gazoby in Niger. Ibrahim’s weight had dropped to 1.07 kg (2.35 pounds).

The KMC center cared for Safoura and her child by showing Safoura how to take two simple, lifesaving measures: provide skin-to-skin contact for Ibrahim, by wrapping his unclothed body directly to her bare chest, and breastfeeding him exclusively. After 47 days at the KMC Centre, Safoura and two month-old Ibrahim were released to go home. Ibrahim weighed 2.12 kgs (4.67 pounds).


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