HIV/AIDS in Malawi

It’s been hard for me to realize that death, especially at a young age, has become commonplace in Malawi. Since the first documented case of AIDS in 1985, the life expectancy has dropped over 10 years, from 52 to slightly over 40. The adult HIV prevalence rate is estimated to be a staggering 12-14%, meaning approximately 900,000 people are living with HIV, the majority of whom don’t even know they are infected. HIV/AIDS accounts for 70% of hospital deaths, with 80,000 people dieing every year of AIDS related illness. Over 400,000 children under 15 have lost one or both parents to AIDS, leaving countless AIDS orphans left in the care of extended family members who are already struggling to survive.
Sometimes, when there is no one to care for them, orphans are left to a worse fates, forced onto the streets or into prostitution to survive.

Girls and young women, in particular, are disproportionately burdened by the disease. This is not just because women are biologically more susceptible to contract HIV; cultural practices, poverty, insufficient education, rape, and a patriarchal society have all increased the risks for young women. Culturally, women are taught to be subversive to men and they must always obey their partners on issues of sex and sexuality, and for the most part the man makes the decisions regarding condom use. Cultural initiation practices and education emphasize to the males their position of dominance and to females their position of powerlessness and servitude. The initiation defines the ultimate goal in life for girls is for them to be good wives and mothers, whereas for boys they are to be participants in society, engaging in sexual conquests with multiple sex partners, even if they have a wife or girlfriend.

Furthermore, men have control of money. Even if the wife has a job, she is expected to give most of her income to her husband. Men also do most of the profitable labour; they engage in business, they sell their cash crops, and they make and sell products on the market. Women, on the other hand, partake in all the “unproductive” but essential labour; they make food, fetch water, tend to the livestock and garden, maintain the house, take care of children and partake in various other necessary household activities. The women are rewarded with very little money of their own and as a result must submit to their man and his every desire in order to ensure that they can acquire everything they need to survive, live healthily, and care for their children. Because of this reliance, Women often don’t have the ability to get out of abusive relationships or escape unfaithful husbands.

When it comes to caring for those who have become sick with an AIDS related illness, the burden usually falls on women. They must forgo any profit making activities or schooling that they may be involved in and are required to stay at home and care for their brothers, sisters, mothers, fathers, children, husbands or other family members. This further exacerbates poverty among women and contributes to their reliance on men, or even worse, their engagement in risky behaviour.
They may perform sexual favours for gifts or engage in prostitution as a quick source of income while caring for their relative, putting themselves at further risk of becoming sero-positive.

For those single women engaged in the labour force, it’s harder for them find jobs, and as a result many resort to promiscuous or risky behaviour for sustenance. It’s common for women, especially young women, to provide sexual favours to older men in exchange for gifts, services and money. Some engage in prostitution or other risky behaviour in order to support themselves or their children. For many women, there is simply no other option then selling their bodies and putting themselves at risk of becoming HIV positive.

This vulnerability of young women is clearly apparent in the statistics; among the young adults aged 15-24 almost four times more women are HIV positive then men. In the older age groups, the gender gap evens out with almost an equal percentage of men and women infected. But overall, HIV disproportionately affects women in Sub-Saharan Africa, strangling their development, human rights, education, involvement in the work force, and even their lives.

It’s hard to understand the severity of the epidemic by observing the average Malawian; for the most part, HIV and AIDS are hidden diseases.
When someone is sick with an AIDS related illness, for the most part they go to the hospital or stay at home with someone (usually a female) to care for them. Out of sight, out of mind. The only direct indications of the devastating impacts of HIV are the occasional HIV related billboard, T-shirt, or newspaper advertisement. And then there are the coffin shops, numerous, profitable, and unavoidable. The diminutive coffins, on display outside, sitting in the dirt or atop supporting units, are perhaps the most chilling reminders of the epidemic’s severity. Varying in size, from caskets which could barely hold an infant to ones which can hold large adults, they painfully denote the fate of so many Malawians, young, old and all ages in between. If infected at birth or at a very young age (usually through breast milk or rape) and left untreated, about 90% of HIV positive children will die before their 10th birthday. Without ARVs, adults will live anywhere from 2-15 years after the initial infection before they succumb to an opportunistic infection.

The stigma associated with being HIV positive has also proven a large barrier in the fight against HIV. People lose jobs. Husbands, wives, friends, boyfriends, and girlfriends run away. Families disown daughters, brothers, sons and sisters. To some people, HIV is god’s punishment for indulging in Sinful behaviour. Some just don’t understand the virus, and think it will be passed on to them if they live with or associate with a sero-positive person. Others just don’t want to associate with people who are infected, fearing others will think that they are as well. It’s no wonder that so many people do not want to know their sero-status. There is also another myth preventing people from getting tested in the first place: there is no way to treat the disease, and as such, there is no point in knowing ones sero-status, as testing positive is akin to an early death sentence.
For many, hiding from reality appears to be the best option.

Only a handful of countries have been worse hit by the epidemic.
Fortunately, some, such as Botswana, have at least some of the necessary financial resources to invest in adequate prevention and mitigation strategies. Yet others, like Malawi, are forced to rely on international assistance while stretching their own national budgets just to prevent the epidemic from getting worse.

Don’t let anyone tell you that HIV and AIDS have been conquered; there is far too much work that needs to be done throughout sub-Saharan Africa. Not only is the sickness resulting in the death and illness of countless numbers of people, the epidemic is further manifesting itself in the form of slowed or even backwards social and economic development. How can these countries invest in infrastructure when they must spend so much caring for the sick, the dieing, the orphans and the poor? How can countries with very limited national budgets afford to pay multinational corporations a large sum of their revenues for the purchase of anti-retroviral (ARV) drugs and other medicines? How can countries invest in human capital (education) when many of those who they educate will die at a young age, and therefore result in no return for their investments? These are some of the serious constraints that have retarded the advancement of sub-Saharan Africa over the last two decades.

Fortunately, there is light, however fait, at the end of the tunnel.
Some estimate that the spread of HIV has actually levelled off to the point that the number of new infections is almost the same as the death rate. That still means 80,000 are becoming infected and another 80,000 die each year, but this is a step in the right direction. Awareness campaigns have successfully made HIV and AIDS household subjects, and people are becoming less afraid to talk about them. Furthermore, some of the stigma associated with being HIV positive has been reduced, although people who are openly HIV positive still face extreme social and economic hardship. VCT (Voluntary Counselling and Testing) centres are located across the country, which provide condoms and HIV testing free of charge. Expectant mothers are also being screened for HIV and those who test positive are given the medical assistance needed to avoid passing the virus to their children. Almost everyone being admitted to hospital is now being tested (although you can refuse to hear the results). A national campaign has been launched through women’s salons which is training hairdressers to talk to their clients about HIV/AIDS, other STIs, and family planning, all while introducing female condoms to their patrons (which they have available at the heavily subsidized rate of about 25 cents for 2).

For those who are HIV positive, there have been a few encouraging developments. Anti-Retroviral (ARV) treatment has been made available free of charge for those who are positive and their CD4 blood cell (immune cells that the HIV virus attacks) count is below 200. For those who still have a CD4 count above 200, they are encouraged to regularly visit the clinic for counselling on living healthily with the virus in addition to checking on their immune system’s health. The unfortunate part is that for many of the rural masses (I believe about 80% of the population still lives in rural areas) who live far from clinics, they must take an expensive bus ride into town, if they even have that option. For some of the poor or those who are farmers, especially during important planting and harvesting times, this puts the drugs out of reach. Some men are refusing to go to the clinics if they are HIV positive, fearing that others will find out, instead insisting that their wives go and share the drugs with them (which makes the drugs ineffective for both of them and in fact increases the risk that a strain of HIV will develop that is resistant to ARV treatment).

In a future post, I’ll go more in depth on the cultural practices that have contributed to the spread of HIV in Malawi. For now, thank you for reading. Zikomo Kwambili. Tionana.

From Blantyre, Malawi,

Lucas

MALAWI: Charcoal is a burning issue

Faisoni Kandoje, 38, has sold charcoal for nearly two decades. Each day he sets up his stall along one of the major highways in Blantyre, Malawi's commercial hub, to provide for himself and his four children.

Charcoal production has been illegal since independence from Britain in 1966, and although the authorities turned a blind eye to the industry after Malawi's autocratic leader, Hastings Kamuzu Banda, was voted out of office in the 1994 elections, the government is once again clamping down on the practice.

"This is where my bread and butter come from; this is where I get money to pay school fees for my children," Kandoje told IRIN. "They should find better ways of controlling the unnecessary cutting down of trees in our forests, rather than looking at us as criminals."

The government recently signed an edict empowering soldiers to arrest people found producing charcoal, but usually those involved in the multimillion-dollar industry only have their charcoal and tools confiscated.

Thomas Ngozo, 45, said he would stop producing and selling charcoal when the government and money-lending institutions provided him with access to loans.
"Banks only offer loans to people who are already rich. What then do they expect us to do? We have families to feed and it is this very illegal business that keeps us going," he told IRIN.

Calls for regulation

A report released in December 2007: Charcoal - the reality: A study of charcoal consumption, trade and production in Malawi, concluded that regulation of the charcoal industry, as opposed to criminalisation, would provide substantial tax revenues and make the sector sustainable.

The document was produced by the Malawi Forest Governance Learning Group (FGLG), the Institute for Environment and Development (IIED), Community Partnerships for Sustainable Resource Management in Malawi (COMPASS II) and the Improved Forest Management for Sustainable Livelihoods Programme (FMSLP).

Between 1990 and 2005 Malawi lost nearly 13 percent of its total forest cover due to fuel-wood collection and subsistence commercial agriculture. The scale of charcoal production, if regulated, could make it one of the country's top earners after tobacco and tea, and would also encourage the sustainable use of wooded areas.

"Charcoal is potentially a renewable forest product, but the current production and distribution methods in Malawi prevent reinvestment in the next cycle of harvest. Reversing the lack of incentives for reinvestment is a critical political and economic issue," the report said.

"If the charcoal trade was regulated and taxed, government could raise substantial revenues, using the estimated industry worth of K5.78 billion (US$41.3 million) per year. Value Added Tax (VAT) alone could generate more than K1 billion (US$7 million) annually in revenue," the authors noted.

According to recent estimates, 90 percent of urban residents rely on biomass energy, mainly charcoal, for cooking, and spend more than three times as much on the fuel as they spend on electricity.

The report's convenor, economist Patrick Kambewa, told IRIN: "There is huge potential in the charcoal trade, and government - through its agents and ministries, such the Malawi Revenue Authority and the Ministry of Finance - can devise ways of collecting tax from those involved in the trade.

"Money can be collected at village or community level from producers, transporters and vendors, but the only challenge would be in accountability," Kambewa said.

He said criminalising the industry meant arresting thousands of people involved in what is perhaps Malawi's most substantial, pro-poor forest industry, which the report estimated employs about 93,000 people as producers, bicycle transporters and roadside or urban vendors.

"Criminalising ... [it] has not helped matters, and all government ought to do is look into issues of taxation and rehabilitation of forests," said Kambewa. "People should be trained on how to manage forests at community level. They should be told about the importance of reforestation and the need to manage such resources."

Malawi needs 160 million trees to reverse environmental degradation.

Malawi needs to plant 160 million trees annually to reverse the current environmental degradation the country is going through due to poverty which is forcing citizens to carelessly cut trees nationwide for sale as fuel-wood, Secretary for Energy, Mines and Environmental Affairs, Charles Msosa, said here on Wednesday.

Speaking in Lilongwe on Wednesday during a two-day National Conference on Land Sustainable Management, he said Malawi will slowly become a desert if issues of tree cutting and land are not looked into carefully.

“Most trees that are cut down are used in charcoal production and this has affected power generation. We, therefore, need to look at other sources of energy for us to preserve and manage our land resources effectively,” he added.

Currently, Malawi has a 7.5% access to electricity, which is far below the 20% SADC provision.

He bemoaned the tendency of cultivating on mountains and along the riverbanks, which he said, was illegal and must stop at all costs if Malawi is to conserve its land.

\"Enhancement of land is a priority to government, hence the need to work together towards the sustainability of the land,\" he explained.

The conference will, among other things, discuss Malawi’s vision on land management and how to upscale it and practical activities of up-scaling land management.

Malawi president pledges to ease transport on lake islands

Malawi President Bingu Wa Mutharika said he was in the process of procuring a boat from South Africa to ferry passengers travelling between the mainland district of Nkhata Bay and the twin islands of Likoma and Chizumulu located in Lake Malawi.

Speaking Tuesday afternoon during his developmental tour of the islands, the president said the ferry will reduce transport problems which the people of the islands are currently facing.

"Government is purchasing the ferry to be used for the island. This, we hope, will ease the transportation problems and the ferry will be in use very soon," he said.

The high speed boat will be an additional transport apart from the privately-run but ever busy Ilala and Mtendere ships which travel once a week from the mainland to the islands.

Malawi athletes off to India for Commonwealth Games

Malawi has sent ten athletes to represent the country at the Commonwealth Youth Games slated for 11-23 October in India, APA learnt here Wednesday.

Malawi Olympic Committee (MOC) president Floriano Massa said the athletes will represent the country in athletics (3), lawn tennis (3) and table tennis (4).

"The young athletes have been trained for quite some time and we hope that they will bring back medals to the nation," he said.

Malawi reopens agriculture schools to foster food security

As part of his war against hunger in the country, Malawi President Bingu was Mutharika on Monday announced that he would reopen several educational institutions that once taught modern agriculture methods but were shut down by his predecessor Bakili Muluzi due to financial constraints between 1994 and 2004.

Mutharika, who has won praise from both local and international observers for his achievement of food security since he took power in 2004, said he would reopen the farm schools to consolidate a strong base for sustainable agriculture as a basis for the country’s development.

Malawi has been producing a bumper harvest of its staple food crop maize in the past three years, mainly by Mutharika’s subsidising smallholder farmers with fertilisers and seeds.

As a result, some 400,000 metric tonnes of surplus maize was exported to Zimbabwe in 2007, while 10,000 metric tonnes was equally divided as a donation to Lesotho and Swaziland as Malawi’s humanitarian gesture to the two drought-hit states of the Southern African Development Community (SADC), formed in 1980 to economically empower the region.

Malawi: AIDS organisations face funding interruptions

Grassroots AIDS organisations in Malawi are facing uncertainty as the National AIDS Commission (NAC) ends its dependence on international non-governmental organisations (NGOs) for dispersing grants.

The responsibility for channelling funds to more than 3,000 AIDS organisations working to alleviate the impacts of HIV and AIDS in Malawi has now shifted to local government authorities known as district assemblies.

Dr Bizwick Mwale, the NAC's executive director, explained to IRIN/PlusNews that the NGOs, called umbrella bodies, were contracted in 2003 to disperse AIDS funding from donors and government until the district assemblies had built sufficient capacity to take over.

"We did an assessment after 18 months and found there was still a gap [in capacity], so we extended the contract to umbrellas for another two years, with the view that by that time [the district assemblies] would be ready," he said. Some responsibilities of the umbrella organisations have already been transferred to the assemblies.

A number of AIDS organisations have expressed concern about both the readiness and the trustworthiness of some district assemblies to distribute funds.

"Our membership is worried because the processes involved will be lengthy, and there are some reports that when a CBO (community-based organisation) comes up with a proposal, [the district assemblies] demand a certain percentage from this amount," said Ishmael Nkosi, a policy and advocacy officer at the Malawi Network of AIDS Service Organisations (MANASO). "There are also concerns that there will be a lot of nepotism in the approving of funds."

Nkosi said the previous arrangement had not been without its problems as it had been difficult to coordinate efforts without the local authorities. "In the new set-up, the district assemblies will manage programmes and be much more involved in the national response," he said.

The funding maze

The flow of funding from international donors to local organisations working on the ground is a long process, fraught with the potential for bottlenecks and delays.

McBride Nkhalamba, an HIV/AIDS coordinator at the international NGO, ActionAid, which served as one of the NAC's umbrella bodies until 18 months ago, noted that disbursements from the NAC were often late or inconsistent.

CBOs also experienced delays or the cancellation of grants because they lacked the skills or training to adequately account for funds received in the previous quarter. "An organisation has to account through a very rigorous system, and some of the demands are discriminatory, because if you're dealing with a local organisation there's only so much you can expect," said Nkhalamba.

He noted that so much time often elapsed between an organisation writing a proposal and receiving the funds to implement it that the reality on the ground had sometimes changed by the time the money arrived.

ActionAid decided to terminate its contract with the NAC when the administrative burden became too cumbersome. "We thought the primary reason for engaging NGOs as umbrellas was to allow for innovation and greater efficiency, but there was less space for that in the implementation," commented Nkhalamba.

According to Mwale of the NAC, organisations should brace themselves for some disruption in the disbursement of grants while district assemblies take over from the umbrella bodies.

Mathias Milanzi, who works for a CBO that assists orphans and vulnerable children in Blantyre, Malawi's commercial hub, said his organisation was still waiting to receive funding for the 2008 October to December quarter. "We have a big problem with lack of food," he told IRIN/PlusNews. "We need some more money."