Country situtational analysis

According to the 2010 UNAIDS global report on the AIDS epidemic, HIV prevalence in Malawi was 11% at the end of 2009. There were 920,00 adults and children living with HIV in the same time period.

According to the 2007 HIV and Syphilis sentinel survey, HIV prevalence is higher in the urban (17.1%) as compared to the rural areas (10.8%). However in both the rural and urban settings, HIV prevalence is higher in women than in men. This is mainly due to the younger average age at infection in females, coupled with the age structure of Malawi’s population (there are many more young people than older people).

The survey results also showed that HIV prevalence rate was higher in the urban areas at 15.6% compared to 11.2% in the rural areas. HIV prevalence in urban and semi-urban areas has declined considerably from less than 20% reported in 1990s to 15-17.6% in 2007 whereas in rural areas, the prevalence has stabilised at around 12%. However, although the prevalence is higher in urban and semi-urban areas, the majority of HIV positive people are in rural areas since over 80% of the population resides in rural areas.

The same survey showed that HIV prevalence in the 15-24 and 15-49 age groups is higher in females than in males.

According to UNAIDS, there were 198,846 people on antiretorviral treatment at the end of 2009. The estimated percentage of pregnant women on antiretroviral treatment to prevent mother-to-child transmission of HIV was 58% in the same time period.

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
• National HIV Prevention Strategy (2009-2013) developed to respond to prevailing gaps in HIV prevention

Key challenges

Human resources

• The scale up of health services is largely impinged by a thin human resource base that is struggling to cope with an enormous workload. Although support has been solicited from the Global Fund and other development partners to train, recruit and retain more health workers (doctors, nurses and clinical officers), the impact of this support had not yet started being felt as training of the first cohorts was still in progress;
• Rural areas are greatly disadvantaged as most districts do not have qualified doctors and clinicians;
• There is not enough nursing personnel to work with doctors and clinical officers.

Financing

• Global Financial crisis: Since 2008 many western countries and bilateralagencies through which they channel funds have experienced reduction in budget and exercised austerity due to the effects of the global financial crisis. Although this does not yet appear to have been reflected in the funding for theyears under review, it was a constant threat to pool and overall funding;
• Delayed disbursement Due to the delayed signing of MoU between Malawi and Global Fund and also between Malawi and the World Bank, there were delays in funds disbursal which affected the efficacy of the Care and Treatment program;
• Tracking funds going to the National Response is still problematic. A lot more resources are used by the private sector but not tracked by NAC, within its own monitoring and evaluation system or under the just concluded NASA, because most players believe their obligation to NAC only applies when they receive funding from NAC.

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
• 2010 UNGASS Report

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 living with HIV and organisation working on HIV and 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