# ‘You don’t need schooling—just take the pills and don’t stop.’: Pathways between formal education and chronic HIV care in Malawi

## TL;DR

This study explores how people in Malawi manage chronic HIV care without formal education by using community and family resources.

## Contribution

The study reveals that education-related resources for HIV care can be acquired outside formal schooling, challenging prior assumptions.

## Key findings

- Education-related resources for HIV care are not exclusively gained through formal schooling.
- HIV clients use family and community support to compensate for limited personal resources.
- These insights help explain the weak link between education and HIV care in some African regions.

## Abstract

Research on chronic care management from other settings indicates that people’s formal education (e.g., primary, secondary, and tertiary schooling) may confer important cognitive skills and material resources to help them manage their chronic HIV care and treatment. However, recent population-level findings from southern and eastern Africa suggest no statistical relationship between education and chronic HIV care. To gain additional insight into these puzzling findings, we draw on in-depth interviews with HIV care clients in Malawi to understand how people acquire education-related resources and how they use such resources to support their HIV care. These interviews suggest that education-related cognitive and material resources are central to HIV care management, but such resources are not necessarily gained through formal schooling. Importantly, HIV clients use a variety of strategies to overcome their limited skills and resources, often relying on the literacy and material resources of their family and community to facilitate their HIV care. Taken together, these findings provide new insight into the mechanisms that link or attenuate education-health relationships in different contexts globally. Further, this work informs the development of more equitable chronic care interventions for meeting the needs of people across different education levels.