Aids in Malawi
Introduction
An epidemic of deadly proportions is taking place in Malawi. Out of a population of 14 million, almost one
million people are living with HIV. AIDS is the leading cause of death among adults in Malawi, and is a major
factor in the country's low life expectancy of only 44 years.
The Malawian Government has mounted an impressive, comprehensive response to the AIDS epidemic in recent years.
The Government and international donors have both made commendable efforts to increase access to treatment and to
improve preventative treatment. However the scale of the epidemic and the shortage of skilled human and financial
resources available have hindered progress.
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History of AIDS in Malawi
Malawi's first case of AIDS was reported in 1985. In response, the Government implemented a short-term
AIDS strategy, but it wasn't until 1989 when a 5 year AIDS plan was announced, that the Government began to show
any serious commitment to tackle the problem. It was only in 1994 when the new president of Malawi, Balili Muluzi,
took office and made a speech in which he publicly acknowledged that the Country was undergoing a severe AIDS
crisis and emphasized the need for a unified response that the population was allowed to discuss and educate
themselves about the deadly disease with out fear of persecution. The subject had been 'taboo' when Dr. Hastings
Banda was President.
However, by this time AIDS had already damaged Malawi's social and economic infrastructure. Farmers could not
provide food, children could not attend school and workers could not support their families, either because they
were infected with HIV or because they were caring for someone who was. In 2002, Malawi suffered its worst food
crisis for over 50 years. The rains failed and with HIV recognized as a major contributor to the famine. Data
showed that 70% of hospital deaths were AIDS related.
AIDS in Malawi in recent years
Malawi continues to suffer from the interrelated problems of poverty, lack of food, and AIDS. However intensive
efforts have been made in recent years to increase awareness about HIV and to prevent its spread . These efforts
appear to have had a positive effect.
In 2001 the National AIDS Commission(NAC) was set up to coordinate Malawi's response to AIDS and was further
intensified in 2004 with the election of President Bingu wa Mutharika who launched the first National AIDS policy
and appointed a Principal Secretary within the Government as well prevention and treatment programmes were scaled
up.The national HIV prevalence has stabilized at around 12 %.
Who is affected by AIDS in Malawi
All sectors of society in Malawi have been affected, but certain patterns have emerged as the epidemic has
progressed.
• The majority of HIV infections occur through heterosexual sex.
• There is a higher rate of HIV prevalence among woman than of men. About 60% of adults living with HIV are
female.
• The majority of HIV infections occur among young people, particularly those between the ages of 13 and 24.
• The epidemic has heavily affected children. In 2009 an estimated 111,510 children were living with HIV and about
500,000 children had been orphaned by AIDS. There are about 5,000 children known to Mzuzu Town who are orphaned.
St. Marks have 250 orphans.
• HIV prevalence in urban areas is about 17% and in rural areas about 11% ; statistics show stabilizing at this
level in urban areas , whereas rural incidents are rising.
• There is a high prevalence among certain labour groups in Malawi, including sex workers(71%), female police
officers(32%) and male primary school teachers(24%).
HIV Prevention in Malawi
There are 6 main languages spoken in Malawi and within each language group there are different, culturally
appropriate ways of conveying preventative messages on HIV. Therefore preventative efforts have been difficult to
implement and while awareness of HIV has been generally high, change has been slow due to social, practical and
financial problems. This, coupled with a lack of skilled health workers and a somewhat inflexible administration
have so far failed to curtail the AIDS epidemic in Malawi.
Voluntary counselling and testing (VCT)
Although VCT started in 2 sites in 1992, rapid blood testing for HIV, which allows people to find out their
status the same day they are tested, was only introduced in Malawi in 2000 and significantly helped in spread of
information and verification to the public. VCT sites have grown quickly and by the end of 2009 there were over 700
sites in operation.
Prevention of mother- to- child transmission of HIV(PMTCT)
Since the establishment of the VCTs, the Country has rapidly expanded HIV testing for pregnant woman, What
started in 2004 with about 8% of pregnant woman tested, by 2008 this figure had risen to about 68%. As a matter of
routine pregnant woman are offered HIV testing at all antenatal clinics and hospitals as well, but again there is
some concern about the quality of the testing due to lack of skilled human resources. There is demand for testing
which shows that the message about HIV is getting through to the woman in the Country.
Condom distribution
Various NGOs have promoted the use of condoms in Malawi, as well as internal institutions have carried out a
marketing programme to make condoms more accessible. Results from data gathered in 2004 showed that the campaigns
have been quite successful. This is an ongoing programme with the men being targeted in barber shops and variety
stores.
HIV and AIDS treatment in Malawi
Antiretroviral drugs(ARVs)which delay the onset of AIDS in people living with HIV, were first made available
through the public sector at 3 sites in Malawi in 2003. In 2004, following a grant from the Global Fund, the
Government began to distribute ARVs widely in the public sector to hospitals and clinics around the Country.
Substantial progress has been achieved in recent years. In 2004 only 13,000 Malawians were receiving ARV therapy.
By 2009 just under 200,000 were receiving the drug. The government estimates that about 300,000 are eligible.
Reaching the target for universal access is high on the Government agenda, but although there are enough ARVs
available for those who test positive and whose condition is serious enough, there are not enough staff to
administer the drugs. Access to treatment is particularly limited in rural areas because lack of transportation
prevents many people from reaching clinics. In later stages of HIV when people's resistance is low like malaria or
other infections, there is a common shortage of medicine to treat these opportunistic infections.
International support for Malawi
Malawi's efforts to overcome poverty, AIDS and famine are heavily dependent on international donors. In the past
there were concerns about political corruption and mismanagement of funds, which caused a number of donors in 2001
to suspend support. However since President Mutharika took office in 2004 and vowed to take a zero-tolerance
approach to corruption, international support for Malawi has resumed.
Donor countries that give direct support to Malawi among others are the USA,UK, Canada,Norway and the EU. In
terms of assistance for HIV prevention and treatment, important donors and supporters include:-
• The World Bank around $400 million( 45% credits & remainder grants).
• The Global Fund around $ 375 million.
• The World Health Organisation (WHO) and UNAIDS which have both supported the scale-up of ARVs in
Malawi.
• The US Presidents Emergency Plan for AIDS Relief(PEPFAR) which has committed over $25 million in fiscal year
2009. PEPFAR funding has gone towards VCT, condom distribution and PMPCT.
Major Issues in Malawi
Human resources
Lack of skilled human resources available in the Country is probably the largest problem Malawi faces in its
fight against AIDS. Attempts to increase access to HIV testing and treatment have been severely contained by
shortage of staff. Malawi has one doctor to 50,000 people, and the National Association of Nurses estimates that 4
nurses are lost to HIV and AIDS related illness every month.
AIDS impacts all sectors of Malawi's workforce. President Bukuli revealed that his brother died of AIDS in 2001 and
challenged the Country to be open about AIDS/HIV. In 2000, it was revealed that 28 members of parliament had died
of AIDS in the last 4 years.
Gender inequalities
As is the case in many African countries, woman in Malawi are socially and economically subordinate to men. This
inequality fuels HIV infection, as traditional gender roles allow men to have sex with a number of partners and put
woman in a position where they are powerless to encourage condom use. Many woman are taught never to refuse sex
with their husbands, and sexual abuse and coerced sex are common . In some communities, traditional practices allow
a widow to marry a relative of her husband on his death, may also increase the risk of HIV transmission if he died
of AIDS. Such rituals have been condemned by the Malawian government and AIDS organizations working in the
Country.
Nevertheless tribal traditions which have been around for generations are very hard to change.
HIV related stigma
HIV is still a taboo subject in many communities within Malawi and discrimination is common. As a result, few
people with HIV make their status known, many have difficulty discussing the subject with their families, and some
support groups do not meet openly.
Some community leaders have come out and said that whoever discriminates against people living with HIV shall be
heavily fined or expelled from our villages. This is perhaps a hopeful sign that the rural communities are becoming
more open about the epidemic.
CONCLUSION
HIV/AIDS crisis is only one of many problems faced by Malawi, alongside poverty, food shortages, malaria and
other diseases. These problems are interlinked in various ways. For instance, programmes to increase access to HIV
treatment must run parallel with campaigns that address malnutrition, as ARVs must be accompanied by a good diet to
be effective. Equally, efforts to strengthen the country's economy need to be co-ordinated with the fight against
AIDS, as the most significant economic problem faced is the lack of skilled workers caused by AIDS deaths.
by Hugh Wilmer
on behalf of
St.Peter's Outreach Program in Africa
St.Mark's Anglican Church, Mazuzu, Malawa
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