Inter Press Service - October 11, 1999
Hazwell Kanjaye

The strategy, called Malawi HIV/AIDS Strategy 2000-2004, is the country's first "comprehensive plan" on mitigating the impact of the epidemic. It has been developed following 18 months of a national consultative process, and hopes to break the silence surrounding HIV/AIDS.

"This is a strategy that provides a common vision on the fight against HIV/AIDS; it provides a common platform for resource mobilisation and allocation," says Owen Kaluwa, head of the Strategic Planning Unit at the country's National AIDS Control Programme (NACP).

The strategy, whose consultative process was funded by the UN Development Programme (UNDP), the European Union (EU), the UN Children's Fund (UNICEF), and the US Agency for International Development (USAID) as well as the UN Joint Programme on HIV/AIDS (UNAIDS), will end the ad hoc nature in which HIV/AIDS issues have been handled before.

"The consultative process helped build national ownership. Representatives of every sector of our community, from civil society including chiefs, the private sector to policy makers in government were contacted," says Kaluwa.

Malawi, with a population of 10 million people, reported its first AIDS case in 1985. By the end of 1997, nearly one million people had tested HIV positive, a figure which will double by the year 2010, according to the NACP.

Today, with at least 14 percent of the population infected, and 25 percent of the urban workforce likely to die from HIV/AIDS in the next ten years, the epidemic is the most critical challenge to the small southern Africa country's development.

According to a new AIDS assessment study conducted by the Malawi Government and the World Bank, the most hit sectors include education and health where the annual personnel death is now three percent, six times higher than the expected 0.5 percent.

The study says Malawi's life expectancy, which was predicted to rise to 57 years by 2010 will now drop to 44 years. Life expectancy in Malawi is currently estimated 43 years.

"The epidemic has now reached crisis proportions," former Health Minister Harry Thomson told a recent meeting with donors. "Productivity and growth of the labour force will fall while health expenditure will increase," he warned.

The estimated financial costs of caring for an AIDS patient until he or she dies is between 200 - 900 US Dollars, almost four times the country's per capita income, and much higher than the per capita health budget.

In the next ten years, the NACP says, 70,000 children will be orphaned annually by the epidemic, while the number of people with fully blown AIDS will reach 100,000.

UNDP Programme Officer Fred Mathengere says the challenge of HIV/AIDS prevention in Malawi is to move beyond awareness to behaviour change.

He notes that although the government has since 1985 undertaken civic education, blood screening, supported community-based organisations, providing care to people living with HIV/AIDS and orphans, and establishing the NACP to coordinate HIV/AIDS activities, infection rates have not yet scaled down.

"Behaviour change is limited," he says. "The culture of silence is still a major factor inhibiting behaviour change compounded by weak institutional capacity to provide policy and technical leadership in such areas as surveillance, counseling, home-based care, civic education, and control of sexually transmitted diseases.

"Fortunately, these are some of the critical issues addressed by the strategy," says Mathengere whose organisation, together with UNAIDS, is the lead agency providing institutional support to the NACP.

Apart from strengthening counseling and testing services, HIV prevention programmes, establishing a comprehensive advocacy programme and increasing support to orphans, the strategy promotes the enactment of legislation that will protect people living with HIV/AIDS from discrimination and stigmatisation.

A Cabinet Committee on HIV/AIDS Prevention and Care, chaired by Vice-President Justin Malewezi, has already been set up to guide policy formulation and implementation, speed up enactment of legislation on HIV/AIDS issues and ensure HIV/AIDS attains priority in all arms of government.

"People living with HIV/AIDS have the right to protection against discrimination and stigmatisation, and should have equal access to education, health, employment and other services while at the same time playing their rightful role in HIV/AIDS prevention and care work," says Kaluwa.

The strategy also calls for more investment in programmes for young people. Today, over half of those newly infected globally are younger than 25 years old. In Malawi, 1997 estimates by NACP indicate that 13 percent of the youth aged 15-24 are HIV positive, with infection rates of females in this age group being four to six times that of males.

According to Kaluwa, the strategy advocates a culture of "frank and open communication" within the family in the socialisation of girls and boys, adapting traditional educational institutions and curricula to become effective vehicles for HIV/AIDS instruction, and participation of the youth in public issues.

"We are very hopeful that this strategy will catalyse the engagement of all society and all government sectors working to control the disease to reverse the trends of the epidemic and mitigate its devastating impact," says Kaluwa.

Once launched, Malawi will join several other sub-Saharan African countries that have already developed such strategies in recent years. They include Tanzania, Namibia, Zimbabwe, and Uganda where significant successes in reducing the spread of the epidemic have been recorded.(END/IPS/hk/mn/99)
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