COUNTRY SITUATION ANALYSIS

Situation of HIV epidemic in the country

The first case of AIDS was diagnosed in Malawi in 1985 at Kamuzu Central Hospital in Lilongwe after which HIV prevalence grew quite rapidly. Malawi started monitoring HIV prevalence among pregnant women attending antenatal clinics in the late 1980s. At the start of this surveillance, the HIV prevalence among women attending antenatal clinics was approximately 2% but then rose to 26 percent by 1998. According to UNAIDS/WHO estimates for 2007 adult HIV prevalence in Malawi is 11.9%. 930,000 people were living with HIV at the end of 2007.

HIV prevalence among 15-49 years old has remained stable over the last 9 years: in 2003 it was 14.4% dropping to 12% in 2007.

There were 101,000 people on antiretroviral treatment at the end of 2007 which is equivalent to 35% coverage.

Key elements of the national response

Initially Malawi's response to HIV was slow as public discussion of sex and sexuality issues was not promoted during the pre-1994 period. However a number of mechanisms were soon put in place to tackle the epidemic. For instance, the National AIDS Committee was established at the end of the 1980s with the purpose of coordinating the national response to HIV. Blood screening centres were established in all the major cities across the country, while the government started a very comprehensive HIV and AIDS awareness campaign.

The National AIDS Control Programme was established in 1988 to coordinate the national response to HIV. The first Medium Term Plan covering the period 1989-1994 was launched in 1988. This plan consolidated earlier initiatives and put a lot of emphasis on blood screening, public awareness and setting up infrastructure for epidemiological HIV surveillance.

The second medium term plan (MTP II) was implemented over the period 1995-1999 and focused on addressing the shortage of human resources, mobilizing financial resources and setting up programmes for the care and treatment of people living with HIV.

After the expiry of MTP II, the National HIV and AIDS Strategic Framework (NSF) was developed and the framework guided the national response to the HIV epidemic from 2000 to 2004. The overall goal of the NSF was to reduce incidence of HIV and STIs and improve the quality of life of those infected and affected by HIV. The NSF was multi-sectoral and promoted the participation of people living with HIV, a community-based approach and had an emphasis on young people.

In July 2001 the National AIDS Commission was established and replaced the National AIDS Control Programme. The National HIV and AIDS Policy was launched in 2003. This was developed through a wide consultative process which included civil society organizations, the public and private sectors, the media and people living with HIV. The National HIV and AIDS Policy provides the guiding principles for all programmes and interventions.

Other policies such as the Orphans and other Vulnerable Children Policy and the Antiretrovirals Equity Policy were also developed during this period.

In October 2004, Malawi developed the National HIV and AIDS Action Framework (NAF) which is guides the national response for the period 2005-2009. The NAF is a tool for mobilizing an expanded and multisectoral national response to the HIV epidemic. The overall goal of the NAF is to prevent the spread of HIV, provide access to treatment for people living with HIV and mitigate the health, socio-economic and psychosocial impact of HIV on individuals, families, communities and the nation. In order to achieve this goal, eight priority areas have been defined. These areas are prevention and behaviour change; treatment, care and support; impact mitigation; mainstreaming, partnerships and capacity building; research and development; monitoring and evaluation; resource mobilization and utilisation; policy coordination and programme planning.

A number of strategies have been included in the NAF such as the Behavioural Change Interventions Strategy; the HIV and AIDS Mainstreaming Framework; the ART Equity Policy Paper; Impact Mitigation Framework; the HIV and AIDS Research Strategy; the Monitoring and Evaluation Plan; among others.

Key achievements

• Creation of National AIDS Control Programme (NACP) in 1988
• Launch of first Medium Term Plan (MTP I) in 1988
• Launch of Second Medium Term Plain (MPTII) in 1995
• Launch of the National Health Policy for 1999-2004
• Launch of Vision 2020 in 2000
• Creation of the National AIDS Commission in 2001
• Launch of the Malawi Poverty Reduction Strategy Paper (MPRSP) and HIV/AIDS in April 2002
• Launch of the National HIV/AIDS Policy in 2003
• Launch of the National Policy on Orphans and Other Vulnerable Children in 2003
• Launch of National AIDS Framework for 2005-2009 in 2004

Key challenges

• Enhance coordination, implementation and monitoring of the response to HIV at all levels
• Foster collective accountability by strengthening governance mechanisms and their substructures
• Improve the utilization of resources, including through the early identification and addressing of bottlenecks
• Systematically address the long term capacity needs through the development of appropriate technical support plan
• Improve the tracking of resources in order to identify potential gaps
• Address potential gaps by ensuring sustainability through the development of a national resource mobilization strategy.
• Better define the drivers of the epidemic Malawi in order to develop an effective and focused national prevention strategy.
• Intensify the implementation of the National Plans of Action to address HIV prevention amongst young people and women
• Support civil society to better engage in national policy discussions

USEFUL LINKS

National Strategic Plan
HIV Prevention Strategy
HIV and AIDS Extended National Action Framework (NAF) - 2010-2012
Male Cicumcision: situation analysis
Malawi National AIDS Commission website
PMTCT and Paediatric Care and Treatment Fact Sheet

CONTACTS

UNAIDS Country Office
P.O. Box 30135, Lilongwe, Malawi
Tel: +2651773329
Fax: + 2651773992

National AIDS Commission
Biswick Mwale
Executive Director
P.O. Box 30622
Lilongwe, Malawi
Tel: +265 1 770022
Fax: +265 1 776249
Email: bmwale@aidsmalawi.org.mw

Networks of People/Organizations Working on HIV/AIDS

Malawi Network of AIDS Service Organizations
Executive Director
P.O. Box 40435
Lilongwe 4, Malawi
Tel: +265 1 724 886

National Association of People Living with HIV/AIDS (NAPHAM)
Thandi Loga
Director
P/Bag 355
Lilongwe, Malawi
Tel: +265 1 770 803
Fax: +265 1 770 628
Email: naphamed@malawi.net

Networks of people living with HIV/AIDS (MANET+)
The Director
P/Bag B 377
Lilongwe 3, Malawi
Tel: +265 1 773 727
Fax: +265 1 770194
Email: manetplus@manetplus.com

GLOBAL REPORT 2008 DATA