Exploring preferences of market traders on the type and delivery methods of HIV services in Lilongwe, Malawi

Abstract

Background: Reaching all people with HIV services, including traders in the informal economy, is critical to meeting UNAIDS' 95-95-95 goals. However, traders prioritise their business over attendance at health facilities. This limits their access to health services. This study explores market traders' preferences for the potential type and delivery methods of HIV services at Lilongwe Central market.Method: The study used an exploratory qualitative study design in Lilongwe, Malawi. Sixteen in-depth interviews were conducted among traders at Lilongwe Central Market between June and September 2022. In the same period, we also conducted four key informant interviews involving three officers responsible for HIV services at the district and council levels, and the market chairman.Results: HIV services preferred by market traders include HIV testing, antiretroviral therapy, condom dispensation, voluntary medical male circumcision and HIV awareness campaigns. These services should be offered daily or when the market is less crowded, and they could be delivered in the market. These services can be provided by both lay and health workers, depending on traders' preferences, and must be integrated with other health services to mitigate unintended HIV status disclosure concerns.Conclusion: The achievement of UNAIDS' 95-95-95 goals by 2030 requires that HIV services should be available to all those who require them at times and locations that are convenient for them, through providers they have chosen either as integrated or standalone, depending on the target group perception of the role of these two models in mitigating stigma. This will necessitate the development of new approaches targeting underserved groups, such as traders in markets.

Keywords: differentiated services; health workers; informal economy; peers.