Gender in HIV Policy: Examining how gender shapes the dissemination of HIV policies in southern Malawi

Background: Men use HIV services less often than women, resulting in excess male morbidity and mortality due to AIDS. A growing body of literature draws attention to HIV policies that largely exclude men, arguing that current policies contribute to men’s poor uptake of HIV services because men are not targeted by large-scale strategies. However, it is unclear how female-focused policies influence local healthcare services. I examine how men and women are represented in the dissemination of Malawi’s national HIV policies in Zomba, Malawi and how local healthcare personnel interpret these representations. 

Methods: 181 documents were collected and analyzed using discourse analysis: 102 national HIV documents, 11 strategic plans for Zomba District, 22 HIV training materials for healthcare providers, and 46 education materials used in clinics. 30 in-depth interviews (IDIs) were conducted with national, district-level and clinic-level key informants. Constant comparison methods were used.

 Results: Women were mentioned more frequently than men across every document type, even when excluding PMTCT references. National HIV documents were predominately female focused. Education materials focused on women's vulnerability and responsibility. While provider trainings were clinical, IDIs showed that trainings relayed the same prioritization of women and portrayed men as unfaithful and unresponsive to health services, although this emerged predominately from facilitators and group discussions rather than approved training materials.

Conclusion: A female-focused discourse dominates Malawi’s national HIV policies and is disseminated to local healthcare providers who offer HIV services. Further research is needed to understand how this framing influences the type and quality of HIV services provided to men.