Numerous epidemiological and biological studies report male circumcision (MC) to have a significant protective effect against HIV-1 acquisition. This study assesses the acceptability of MC in four districts in Malawi, a country with high HIV-1 prevalence and low prevalence of MC. Thirty-two focus group discussions were conducted with 159 men and 159 women ages 16-80 years. Acceptability was lower in the north where the practice was little known, higher in younger participants and higher in central and southern districts where MC is practiced by a minority Muslim group (Yao). Barriers to circumcision included fear of infection and bleeding, cost, and pain. Facilitators included hygiene, reduced risk of STI, religion, medical conditions, and enhanced sexual pleasure. If MC services are introduced in Malawi, acceptance is likely to vary by region, but many parents and young men would use the services if they were safe, affordable and confidential.

This paper reports the process evaluation of a peer group intervention for human immunodeficiency virus (HIV) prevention which had positive outcomes for three target groups in Malawi: rural adults, adolescents and urban hospital workers. The six-session intervention was delivered to small groups of 10-12 participants by 85 trained volunteer peer leaders working in pairs. A descriptive, observational mixed methods design was used with a convenience sample of 294 intervention sessions. Using project records and a conceptually based observation guide, we examined five aspects of the implementation process. The context was favorable, but privacy to discuss sensitive issues was a concern for some groups. In study communities, program reach was 58% of rural adults, 70% of adolescents and nearly all hospital workers. Session records confirmed that all peer groups received the intended six sessions (dose delivered). The dose received was high, as evidenced by high participant engagement in peer group activities. Peer leaders were rated above the median for three indicators of peer group content and process fidelity: session management skills, interpersonal facilitation skills and whether more like a peer group than classroom. Documenting that this HIV prevention peer group intervention was delivered as intended by trained peer volunteers supports widespread dissemination of the intervention.

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Malawi has a maternal mortality rate of 675/100 000 with 85% of the population living in rural areas. To reduced maternal mortality in Malawi, the government prioritised midwifery training. Therefore, a community midwifery module was developed by Kamuzu College of Nursing as part of their Bachelor of Science Nursing and Midwifery (BSCNM) programme. After clinical experience for this module, students presented reports on their experience and the problems facing eight peri-urban communities. This article describes aspects of this module, the activities the students engaged in, and problems the communities voiced. Their reports were subjected to basic content analysis and the following three themes were identified: ‘community use of reproductive health services’, ‘resources’ and ‘healthcare delivery systems’. This article focuses on the ‘community use of reproductive health services’ theme, and its three sub-themes (attitudes, knowledge and accessibility) in light of current research based in sub-Saharan Africa.