MARKING 50 YEARS OF WORKING FOR DEVELOPMENT IN MALAWI.

The United Nations and HIV and AIDS in Malawi

When the United Nations (UN) started work in Malawi 50 years
ago, HIV and AIDS was not yet identified. It was in 1985, 20 years
after the UN first started operating in Malawi, that the first case of
HIV was confirmed here. Today, Malawi is one of the most HIV
affected countries in the world.
Since the diagnosis of the first case, HIV prevalence increased
sharply through the 1980s and 1990s and in 2000 peaked at 17.5
percent for adults aged 15 to 49 years old. Today, 10.3 percent of
the population is HIV positive meaning Malawi faces a
generalized HIV epidemic.
HIV and AIDS impacts not only the health of Malawians but the
capacity for national sustainable development and as such HIV
and AIDS is a key UN programme priority area under the joint UN
partnership with Malawi Government. The UN has formed a Joint
Team on HIV and AIDS to Deliver as One on the HIV Response
ensuring inter-agency coordination which allows each UN
agency to take a lead on the part of the HIV Response where their
expertise, mandate and comparative advantage lies.
UNAIDS is the secretariat of the Joint Team. UNAIDS is the oldest
Delivering as One platform within the UN and indeed its origins lie
in the cross cutting nature of HIV and the need for a multi sectoral
approach in the HIV Response.
The facts
In Malawi, HIV prevalence varies substantially by sex, age,
urban-rural geographic and socio-economic characteristics. The
epidemic has a female face in Malawi with women and girls
disproportionately affected due to gender inequalities born from
low socio economic status, harmful cultural practices such as
widow inheritance chokolo and initiation ceremonies fisi and
disempowerment, negating the ability of women to negotiate
safer sex. HIV is more prevalent in urban communities compared
to rural communities and the Southern Region has a prevalence
of 14.5 percent, which is twice as high as that in the Northern and
Central Regions.
In order to tailor the HIV Response to the current trends of the
epidemic, the government of Malawi is revising and extending
the National HIV and AIDS Strategic Plan to guide the response
from 2015 to 2020. The UN Joint Team on HIV and AIDS is
supporting the process to ensure the response is evidence-based
to both maximise impact and ensure value for money.
The UN supported a Modes of Transmission study in 2012 that
provides the most comprehensive and concrete evidence on the
interaction of structural, economic, social, biological and cultural
factors that drive the epidemic in Malawi. The findings indicate
that factors facilitating transmission of HIV in the general
population include; multiple concurrent partnerships, low or
inconsistent use of condoms, low comprehensive knowledge on
HIV and AIDS, low coverage of voluntary medical male
circumcision, stigma, discrimination and transactional sex.
Then and Now
In the first 20 years of the HIV epidemic, a positive diagnosis was
devastating with no cure, little or no accessible options for
treatment and high levels of stigma and discrimination. Since HIV
was first diagnosed in Malawi, AIDS has claimed the lives of 1.5
million people and over this time period funerals due to AIDS were
frequent and a normal part of the weekly routine.
The advent of anti-retroviral therapy has been life changing for
people living with HIV. The UN works closely with the Ministry of
Health and all HIV stakeholders including development partners;
non-governmental organisations, faith-based organisations and
civil society to improve quality of HIV services in Malawi for all. An
HIV positive person on ARVs has a life expectancy akin to anHIV
negative person. Malawis ART programme started in 2002 with
three pilot sites.
By 2013, Malawi had established 689 static ART sites and 634
pre-ART sites. In June 2014, Malawi passed an important
milestone: over half a million HIV positivepatients are now alive
on ART! This is equivalent to 50 percent of the total HIV positive
population. This achievement seemed purely an aspiration only
a few years ago. Consequently too, deaths due to AIDS are
declining; in 2013 45,000 Malawians died of AIDS compared to
99,000 in 2004.
The rapid scale up of ART treatment for all in need is facilitated
by funding from the Global Fund, an international fund to fight
AIDS, tuberculosis and malaria. The Government of Malawi is
presently preparing a funding proposal to the Global Fund to
continue support for the HIV Response. The Global Fund currently
provides 100 percent of the funding for Malawis ARVs. This
reliance on a single donor is unsustainable and the Joint Team is
supporting the Government of Malawi to identify ways of
increasing the share of domestic resources for HIV financing.
Getting to Zero the achievements
The UN Joint Team on HIV and AIDS is leading the charge to the
three zeros: zero new HIV infections, zero discrimination and
zero AIDS related deaths in line with the global UNAIDS Strategy
of Getting to Zero. Malawi has been a leader both regionally
and globally in the HIV response. In 2011, Malawi adopted an
innovative way of preventing transmission of HIV from mother to
child called Option B+. Option B+ places all HIV positive
pregnant and lactating women on life-long anti retroviral drugs.
Option B+ has significantly lowered the transmission rate of HIV
from mothers to unborn babies in Malawi and by the end of
2013, 83 percent of women in need of Prevention of Mother to
Child Transmission (PMTCT) services were receiving life-long ART.
There are still 48,000 mothers in need of PMTCT services and the
country needs to increase the coverage of PMTCT to above 95
percent to meet the virtual elimination target by 2015.
Comparing Malawi Demographic Health Surveys shows the
impact of behaviour change interventions. Between 2006 and
2010, the number of men paying for sex and the number of
people with multiple concurrent partners reduced.
The surveys also show an increase in condom use and an
increase in the median age of sexual debut. This has resulted in
a reduction in the incidence rate (proportion of the susceptible
population that contract HIV annually) from 1.21 percent in 2006
to 0.41 percent in 2013.
Voluntary Medical Male Circumcision (VMMC) reduces the risk
of female to male HIV transmission by approximately 60
percent. VMMC coverage in Malawi is estimated at 11.5
percent. The Joint UN Team is supporting partners to create
demand for VMMC for the country to reach the target of 60
percent VMMC coverage by 2020.
Getting to Zero - the challenges
Clear gains have been made to reduce the number of new
HIV infections, reduce stigma and discrimination and improve
the quality of life for people living with HIV. However, with 93
new HIV infections a day in Malawi, the UN continues to work
together with the government of Malawi and partners to
ensure a strong HIV Response.
No Malawian can be left behind in the HIV and AIDS Response.
This is contingent on rights and gender based action on the
social, political and economic determinants of HIV. Key
populationsfor Malawi that is: female sex workers and men
who have sex with menhave a higher HIV prevalence rate
than the general population.
However, they face high levels of stigma and discrimination
related to HIV as well as laws and law enforcement that drive
them away from HIV services. This situation is undermining the
HIV response in Malawi. The UN takes its leadership role in
advocating for the rights of key populations seriously and is
making major investments in programmes to reduce such
stigma and increase access to justice for those affected by
HIV.
The UN is promoting innovative strategies and campaigns to
engage all stakeholders in getting Malawi to Zero. One
example, is the Protect the Goal Campaign which uses
football as a platform to disseminate HIV prevention messages
amongst the youth.
There is no specific law that deals with HIV issues but the
Government is committed to addressing human rights, as
reflected in: the Malawi Growth and Development Strategy
(MDGSII), the National HIV and Aids Strategic Plan 20152020,
the HIV Prevention Strategy 2015 - 2020 and the National HIV
and AIDS Policy which are all aligned to other legislations
prohibiting the practice of discrimination.
The Joint UN Team on HIV and AIDS also provided technical
support in the drafting of the HIV and AIDS Bill; providing
information on best practices to address the criminalisation of HIV
transmission, and mandatory and compulsory HIV testing.
The findings from UN supported studies including the Legal
Environment Assessment and the Stigma Index Report fed into the
development of the draft HIV and AIDS Bill. The Joint Team
continues to work with relevant stakeholders to advocate for the
HIV and AIDS Bill and to ensure its passing by Parliament.
Post 2015
Malawi is on course to achieve Millennium Development Goal 6
combating HIV and AIDS, Malaria and other diseases - by the
December 2015 deadline. However, achieving MDG 6 does not
imply the UNs work on HIV is complete and attention is turning to
post-2015.
Never before, in the history of the epidemic has there been such
bold confidence that ending the AIDS epidemic as a public
health threat is possible by 2030. Ending the AIDS epidemic will be
achieved when new HIV infections, discrimination and AIDS
related deaths are reduced to 10% of 2010 levels.
The Joint UN Team on HIV and AIDS is working towards targets to
achieve the end of AIDS which will get Malawi to the three
zeros. Post 2015, the world will work towards Sustainable
Development Goals. Recognising the cross cutting nature of HIV
and AIDS, its envisaged rather than HIV and AIDS featuring as a
standalone goal, the fight against the HIV epidemic will have
specific targets under each goal.
The UN, HIV and AIDS and the Future
One million Malawians are living with HIV. HIV and AIDS remains
unfinished business of the Millennium Development Goals and so
relevant for the UN Malawi. Looking forward, post 2015, the UN
family will continue to Deliver as One explicitly prioritising human
rights, promotion of universal health, education and rights for
women, men, girls and boys. The UN is committed to reaching
Zero and will continue to support the Government of Malawi in
its HIV and AIDS response, ensuring no Malawian is left behind in
the response.
"The UN is much more than a partner in
our fight against HIV and AIDS in
Malawi. It is a critical social institution
that continues to motivate the
government and all implementing
partners to rethink strategies, policies
and programmes to ensure that we get
the best returns from the minimum
investments" - Mara Kumbweza Banda,
Chairperson of the National AIDS
Commission (NAC)
The UN family has been instrumental in
the HIV and AIDS sub-sector particularly
looking at their tireless support on the
stirring CSOs involvement, key
populations (mainly MSM, the Youth
and Sex Workers) participation and
gender transformative programming in
Malawi within the sexual and
reproductive health and rights
frameworks - Mr. Robert Mangwazu
Phiri, Country Director, Southern African
AIDS Trust
"Malawi has managed to put close to
half a million HIV positive people on
treatment in a very constrained
resource environment. The UN Family
has supported the country to achieve
this in a number of ways including
advocacy efforts for the free HIV
treatment policy and technical support
on the proposal to Global Fund" - Safari
Mbewe, Executive Director, The Malawi
Network of People Living with HIV and
AIDS (MANET+) Secretariat
The UN Joint Team on HIV and AIDS has
been a strategic partner in the
HIV&AIDS response in Malawi. The
technical assistance received from the
Joint Team is invaluable. Substantial
achievements made so far in the
response can be attributed to the
support received from the UN Joint
Team on HIV and AIDS. Let us step up
our commitment now more than ever
to end AIDS - Edith Mkawa, Principal
Secretary, the Department of Nutrition,
HIV and AIDS
Ghana National Team Captain Asamoah Gyan (L) and UNAIDS Country Director Amakobe Sande hold the Global
Ball after His Excellency President Peter Mutharika signed it to endorse the HIV Prevention Protect the Goal
campaign in Malawi.
People march carrying messages combating stigma and descrimination.