The overarching goal of the United Nations Development Assistance Framework (UNDAF) on HIV and AIDS is to provide unified support and leverage UN funding to scale up the national response to HIV and AIDS to achieve universal access to prevention, treatment, care and support. The UN works in collaboration with Government of Malawi (GoM) and partners to support the nationally defined priorities, develop strategies in HIV for addressing financing sustainability and cost-efficiency, stigma and discrimination, and health system strengthening and HIV and AIDS-related education outreach.
The UN supports the national effort to ensure that key and most-at-risk populations – which continue to evolve with the HIV epidemic in Malawi, but currently include sexually active youths and adults, sex workers, sexual minorities including men who have sex with men (where HIV prevalence is as high as 21 percent), persons engaged in highly mobile occupations, orphans, vulnerable children, women and young girls, amongst others – have universal and equitable access to and uptake of quality gender sensitive HIV preventive services. Prevention efforts supported by the UN will focus on provision of quality services where new HIV infections are arising including Prevention of Mother to Child Transmission (PMTCT), sexually active youth and adults, age disparate sex, and couples (including discordant couples) in the general population.
In particular, the UN focuses on capacity development of national institutions in the use of new and innovative technologies and evidence-informed best practices to deliver cost-effective, quality, gender-sensitive combination of HIV prevention services to the key populations, including quality HIV testing and counseling services. National institutions’ capacity to deliver comprehensive PMTCT services to pregnant women in all districts is a key UNDAF priority. The UN supports national and district level action to change the traditional PMTCT programme focus from coverage of ARV prophylaxis to focus instead on the health of mothers and the HIV-free survival of children. This is done by closing the gaps in access to and utilisation of PMTCT services – including primary prevention of HIV among women of childbearing age, family planning, counseling and testing, and antiretroviral treatment of eligible mothers with new and more effective ART regimens.
Parallel to this, the UN works with government and civil society stakeholders in developing enabling policies, operational guidelines and tools towards the new targets leading to the elimination of MTCT. In addition, the UN continues to advocate for an increase in the met needs for paediatric ART, as well as strengthen the national and district health teams’ capacity for better coordination, planning, and integration of services at district level. This includes the use of new and innovative technologies to increase early infant diagnosis, follow up of the results and rapid access to ART for those who are eligible.
The UNDAF includes support for new approaches that aim to reduce stigma and vulnerability amongst marginalised groups and women, as well as the use of combined biomedical and behavioural prevention interventions such as the promising new interventions of microbicides and male circumcision.
Strengthening the national procurement system and supply-chain management so that quality HIV prevention commodities, including male and female condoms, can be procured, delivered and made available to all key populations is a key UN priority under the UNDAF outcomes. This includes ensuring that national institutions have the capacity to forecast, procure, supply HIV and Opportunistic Infections drugs and commodities and can deliver quality antiretroviral therapy to all eligible adults and children living with HIV.
The UN provides direct support to increase the number of vulnerable households with people living with HIV (PLHIV) and orphans and vulnerable children (OVC) accessing basic social services, safety nets and livelihood development opportunities. Similarly, working through the national structures, the UN supports expanded provision of psychosocial services to PLHIV, OVCs and their households. UN support for the provision of infant and young child feeding counseling, nutrition counseling, care and support to PLHIV, and TB patients in local and district health facilities is a key UNDAF priority.
At the institutional level, the UN addresses gaps that continue to impede the effective national response to HIV and AIDS including the use of evidence-informed decision-making, national coordination mechanisms, and supportive legal and policy environments. The UN uses its analytical expertise in qualitative information and analytical research to build national capacity and skills to develop and implement human rights and gender-appropriate HIV and AIDS related legal frameworks, policies, plans and strategies.