In December of 2011, staff from The Fenway Institute collaborated with Johns Hopkins School of Public Health and the Centre for the Development for People to train Health Care Workers and Peer Educators in Malawi on working with MSM and preventing HIV in this vulnerable population. Fenway Health’s Medical Director of Behavioral Health, Kevin Kapila, shares his experience.
When I first learned about the possibility of conducting trainings for medical providers in Malawi, like many Americans I did not know much about this landlocked country in southeast Africa. I knew, like most gay men, that Madonna had adopted a child from Malawi, and was also aware of the gay couple that was sentenced to 14 years hard labor for having an engagement ceremony.
I did some research and found out that Malawi faces a lot of challenges—it is the second poorest country in the world, 11% of its population is infected with HIV, and over 50,000 people a year in Malawi die from HIV/AIDS. Malawi is also known as the “warm heart of Africa,” because of the kindness of its people, which from our experience there is most definitely true.
A view from the car on trip from Lilongwe to Blantyre
The Fenway Institute was invited to take part in trainings in Malawi that took place in early December of 2011. The trainings focused on educating health care workers and peer educators to meet the needs of men who have sex with men (MSM) and help prevent HIV in this vulnerable population. As one of Fenway Health’s medical providers, I was honored to be part of these trainings that will hopefully create positive change for Malawi’s MSM. The trainings were done in collaboration with Johns Hopkins School of Public Health and The Centre for the Development of People (this is a human rights organization focused on the needs of the LGBT community in Malawi.) The trip was funded by a grant from AmFAR. The team from Fenway included Rodney VanDerwarker, MPH (Administrative Director of The Fenway Institute); Marcy Gelman NP,MPH (Associate Director for Clinical Research); and Kevin Kapila, MD (Medical Director of Behavioral Health and primary care provider.)
Preparation for these trainings started months in advance, with multiple conference calls with Johns Hopkins and our colleagues in Malawi. We were able to put together a two-day training program for health care providers and a one-day training for peer educators. There were many challenges that had to be overcome, including the lack of resources and many negative perceptions about men who have sex with men.
The team meets in Lilongwe after two long days of travel
We left Boston and after almost two days of travel landed in Lilongwe, the capital of Malawi. We met Stefan Baral from Johns Hopkins and Gift Trapence from CEDEP and began the five-hour drive from Lilongwe to Blantyre. This was not an easy drive on this two-lane highway that was populated by cars, bikes, pedestrians and goats. The trip did allow us to appreciate the beauty of the country and connect with each other and discuss the upcoming trainings.
The first day of the trainings was attended by over 20 representatives from different health service providers in Malawi. Stefan Baral presented on human rights and epidemiology. Rodney VanDerwarker talked about the Fenway Health model of care. Marcy Gelman gave a presentation on how to take a sexual history from MSM, which was followed by role-playing exercises. Marcy had a difficult challenge, as this was is the first time many of the providers had been exposed to some of this information in a culture where gay and bisexual men are not accepted. We were prepared for the possibility this would not go over well, but Marcy’s extensive preparation in regards to the cultural issues, well thought out presentation, and stellar execution of the material went over very well. There was active participation from the audience and the first day ended well.
Marcy and Rodney preparing on Day One.
Marcy started the second day of training with continued education on identifying, screening, and treating the different sexually transmitted infection that commonly occur in MSM. I was the presenter for the second half of the morning and the afternoon sessions, and started with going over the use of condoms and lubricants, which are in short supply in Malawi. The talk was followed by small group sessions where participants role-played how to talk with gay and bisexual men about using condoms and lube. In the afternoon I talked about risk reduction counseling and mental health issues facing MSM. There are not a lot of counseling services for anyone in Malawi, and the providers were very receptive to learning about some risk reduction skills they could use in their clinics. The day ended with Rodney presenting the training certificates to the participants. The certificate presentation ceremony was amazing, as everyone realized that training on this subject was a major step forward for the LGBT movement in Malawi.
The last day of the training involved a group of peer educators. These are brave young men who put themselves at risk to provide peer level interventions to other MSM in Malawi. They come from all types of backgrounds and different levels of education. We were able to have dinner with them the night before the training and were all impressed by the challenges they face. They were very excited to know Rodney and I were able to live and work openly as gay men.
Kevin doing a role-play interview with Gift Trapence
The trainings with the peer educators were less formal lectures and involved a lot more question and answer. This was the most emotional day for us because many of the questions highlighted the many challenges that face these young men including internalized homophobia, lack of information on what is safer sex, as well the lack of resources (condoms and lubricants) to engage in safer sex. Despite these challenges these young men showed up and were motivated to help create change. Their strength, along with the amazing speech Hilary Clinton gave on International Human Right Day about LGBT rights, which overlapped with our visit, gives hope that life will be better for these amazing people we had the privilege of meeting.
I have always considered myself fortunate to be a part of the Fenway Health team and the excellent clinical care we provide to our community. This trip made me appreciate much more the work that Fenway does to help others, and the financial and emotional support we have from the LGBT community in Boston to make real change happen.