Identifying what rural health workers in Malawi need to become HIV prevention leaders.

Health workers have high potential as HIV prevention leaders, but health system and individual barriers limit their impact. This descriptive qualitative study identified the HIV prevention needs of rural health workers to use as a basis for tailoring an HIV/AIDS risk-reduction intervention. Data included interviews with 9 health administrators, 22 focus groups with 200 health workers, and 12 observations of caregivers in two rural districts. Health system barriers identified included lack of essential supplies, staff shortages, overcrowded facilities, and lack of training. Individual barriers included hopelessness, stigmatizing attitudes, knowledge gaps, and risky personal behaviors. Health workers also expressed willingness to be HIV prevention leaders and role models. Most results agree with previous African studies. Personal risky behaviors and willingness to be HIV prevention leaders have not been previously reported. Results provide insights for developing effective interventions and health policies to address health workers' HIV prevention needs.