Analytical summary - HIV/AIDS
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HIV/AIDS is a leading cause of mortality in Malawi. The prevalence among people aged 15–49 years is 10.6%. Over the years, HIV prevalence has decreased by 25%, mainly due to the natural evolution of the epidemic and prevention interventions being implemented.
HIV testing and counselling is a key strategic intervention as well as a significant preventive measure. It is an entry point for other interventions such as prevention of mother-to-child transmission and antiretroviral therapy. In 2004, there were 167 000 individuals counselled and tested and by 2010 this number had increased to 1 700 000, surpassing targets for universal access. The proportion of health facilities with at least a minimum package of prevention of mother-to-child transmission was 7% and this proportion was 100% in 2010, thus achieving the target as set in 2004.
Challenges remain in the fight against HIV, including:
- male involvement remains low
- there is low uptake of antiretroviral therapy among children
- there are inadequate human resources and other resources
- the continued prevalence of cultural practices that enhance HIV transmission
- gender and power imbalances.
These challenges need to be addressed in the Health Sector Strategic Plan.
Malawi developed its National HIV/AIDS Policy in 2003 in a major effort to consolidate its various efforts, to expand interventions that have had great impact and to direct the response to new areas that call for action. The goals of the National HIV/AIDS Policy are to prevent the further spread of HIV infection and mitigate the impact of HIV/AIDS on the socioeconomic status of individuals, families, communities and the nation. The National Action Framework forms the basis for implementing the National HIV/AIDS Policy.
The Malawi Blood Transfusion Service (MBTS) screens blood for HIV. However, not all blood comes through the MBTS and quite a large proportion is collected and screened at the individual facility level. Although the MBTS has the mandate to provide screening for all units transfused in the country, the Northern Region is not yet covered by MBTS and shortages in supply have led to hospitals carrying out replacement donor top-ups.
Availability of blood and blood products is one of the key objectives of the national response. While the MBTS collects, tests and supplies safe blood, its operations have been crippled by financial and infrastructural constraints. There are also not enough volunteers coming forward at present to supply enough blood to meet the national demand.
The Prevention of Mother to Child Transmission Programme in Malawi began in 2001. Prevention of mother-to-child transmission services are provided through antenatal care clinics and maternity and labour wards, using a four-pronged approach that includes:
- primary prevention
- prevention of unintended pregnancies among HIV-infected women
- use of antiretroviral prophylaxis for prevention of mother-to-child transmission
- care and support treatment.
In 2007 about 50% (16 551 out of 32 725) HIV-positive pregnant women received antiretroviral prophylaxis.
The Prevention of Mother to Child Transmission of HIV. A Five-year Scale-up Plan 2008–2013 promotes the provision of integration of maternal and child health services and prevention of mother-to-child transmission services. Sustained decentralization of service delivery to districts and strong coordination of the programme at all levels are expected to ensure that pregnant women have access to care and treatment as early as possible. As of June 2011, prevention of mother-to-child transmission services are offered in 544 sites nationwide.
Malawi is implementing HIV prevention, treatment and care activities in the workplace. One such activity in the prevention of HIV in health care setting is the provision of postexposure prophylaxis in situations where health workers may have been exposed to the HIV virus in the course of discharging their duties. One of the challenges is that the service is not offered in all health facilities in the country. Postexposure prophylaxis services are available in most districts but may not be accessed by those in need due to lack of knowledge of their availability and inadequate infrastructure.
The National Policy on Orphans and Other Vulnerable Children was launched in 2004. This was followed by the development of the National Plan of Action on Orphans and Vulnerable Children (2005–2008) for stipulating non-discriminating treatment, care and support for orphans and other vulnerable children. An estimated 50% of orphans and other vulnerable children are reached with existing interventions of different types through Government, civil society organizations, faith-based organizations, nongovernmental organizational and private organizations. These interventions include nutritional, educational, economic, material and psychosocial support.
The first round of the Behavioural surveillance survey (BSS) Malawi, 2004 was conducted to provide baseline information that would assist in, among other things:
- developing a system for tracking behavioural pattern data for high-risk and vulnerable target groups
- providing information on behavioural patterns among target groups
- providing information that can guide programme planning.
The Behavioural surveillance survey (BSS) Malawi, 2004 selected 13 target groups for data collection. Results show that knowledge of HIV/AIDS is very high among all the groups. Despite high levels of knowledge, this has not been translated into behaviour change.
In 1994, HIV sentinel surveillance was conducted in 19 sites in Malawi. By 2007, the number of sites had increased to 54, covering all districts in the country. HIV surveillance trends show that there has been a downward trend in HIV prevalence from antenatal clinics since 1999. Sentinel surveillance surveys carried out since 1980s have shown that the median HIV prevalence among sexually active persons aged 15–49 years is 12%, a decrease from 16.2% in 1998. It is 10.6% according to the Demographic and health survey 2010. In 2007, the prevalence of HIV among pregnant women aged 15–24 years was 12.3%.
- ↑ Prevention of mother to child transmission of HIV. A five-year scale-up plan 2008–2013 (pdf 369.34kb). Lilongwe, Government of Malawi, Ministry of Health, 2008
- ↑ National Policy on Orphans and Other Vulnerable Children. Lilongwe, Government of Malawi, 2003
- ↑ National Plan of Action on Orphans and Vulnerable Children (2005–2008). Lilongwe, Government of Malawi, 2005
- ↑ 4.0 4.1 Behavioural surveillance survey (BSS) report, Malawi 2004 (pdf 1.19Mb). Lilongwe, Government of Malawi, 2004
- ↑ Malawi demographic and health survey 2010 (pdf 823.48). Zomba, National Statistical Office and Calverton, MD, MEASURE DHS, ICF Macro, 2011