Meaningful Participation of People Living with HIV in Addressing HIV Transmission, Harmful Cultural Practices and Stigma in Malawi: Evidence from the STAR Circles Participatory Empowerment Model
Abstract:
People Living with HIV (PLHIV) in Sub-Saharan Africa continue to experience intersecting biomedical, social and cultural challenges that increase vulnerability to HIV transmission and undermine treatment outcomes. These challenges include stigma, discrimination, gender inequality, poverty and harmful cultural practices such as widow inheritance and sexual cleansing. Despite extensive HIV programming, meaningful participation of PLHIV in deci sion-making processes remains limited. The Societies Taking Action for Rights (STAR) circles were introduced as a community-led, rights-based empowerment intervention designed to enhance the agency of PLHIV. This paper pres ents findings from a descriptive mixed-methods and quasi-experimental evaluation of the STAR circles programme implemented by ActionAid Malawi between 2012 and July 2013 across 60 communities in Malawi. Programme monitoring data, retrospective baseline data and qualitative narratives were analysed using descriptive statistics, correlation analysis, regression modelling, difference-in-differences estimation and mediation analysis. A total of 1,860 PLHIV participated, of whom 58.6% were female. The intervention led to increased self-confidence, lead ership participation and community engagement, significant reductions in harmful cultural practices, decreased stigma and discrimination, and improved access to social protection and economic opportunities. Empowerment was confirmed as a significant mediating pathway linking participation to stigma reduction. These findings demonstrate that meaningful participation of PLHIV using rights-based participatory approaches produces measurable social, cultural and economic outcomes and should be institutionaliized within national HIV responses.
