Climate change, crop loss, and mobility among men living with HIV in Malawi: a qualitative study

Climate change affects health outcomes of people living with HIV in sub-Saharan Africa via extreme weather events and changing crop yields, both of which may lead to mobility, a known risk factor for antiretroviral therapy (ART) interruption. We conducted a qualitative sub-study using in-depth interviews with a stratified random sample of participants in two trials (ENGAGE and IDEAL), aimed at improving ART outcomes among men living with HIV (MLHIV) in 24 health facilities in Malawi. Eligibility criteria for parent trials were: MLHIV; >15 years; and not actively on ART at the time of enrolment. Interviews were analysed using narrative analysis. Of 35 MLHIV interviewed, more than two-thirds were affected by extreme weather events. Floods led to crop loss and about one-third of participants lost their homes. Poor harvests were common and attributed by participants to climate change. Men coped by seeking temporary work, which often required travel. Mobility decision-making was paradoxical: travel for income-generation was the solution for lack of food, but men were uncomfortable travelling unless there was enough food to sustain families. Several participants lost medication in floods; most re-initiated quickly. Building a climate-resilient health system in Malawi will require attention to loss of livelihoods, mobility, and ART interruption.