HIV programmes in Malawi

National Strategic Framework: 2005–2009

Epidemiological Assessment (UNAIDS):

Major vulnerable and affected groups
Young people 13–24 years old are particularly vulnerable to HIV, especially girls. The HIV prevalence is almost twice as high in urban areas (25%) as in rural areas (13%). High levels of movement among urban, rural, and mining areas facilitate HIV transmission. Mobile groups in Malawi, including truck drivers, sex workers, fishermen and -women and fish traders, migrant and seasonal workers, military personnel, prisoners and refugees, are also vulnerable to the epidemic.

Policy on HIV testing and treatment
The Government of Malawi, through the National AIDS Commission, undertakes to promote and provide high-quality, cost-effective, confidential and accessible voluntary counselling and testing services country-wide, in particular youth-friendly services and services that are adequate and accessible to other vulnerable groups. Voluntary counselling and testing is either confidential or anonymous. The government and the National AIDS Commission further promote and encourage couple counselling and the disclosure of HIV test results to partners, strive to ensure that voluntary counselling and testing services are staffed by adequate numbers of trained counsellors and coordinate and ensure the links between voluntary counselling and testing services and other services related to HIV/AIDS to provide a continuum of prevention, treatment, care, support and impact mitigation. The National AIDS Commission also ensures that HIV testing is routinely offered to all pregnant women attending antenatal clinics unless they specifically choose to decline. The delivery of quality community home-based care is promoted as an essential component of the continuum of care for people living with HIV/AIDS. A National Plan to Scale Up Antiretroviral Therapy has been developed, and antiretroviral therapy has been provided free of charge in the public sector since 2003. The prescription and sale of antiretroviral drugs is regulated to guarantee quality control and to reduce the risk of drug resistance developing through inappropriate use of the drugs. The national Essential Drug List is regularly updated to incorporate essential drugs for HIV/AIDS treatment in accordance with the WHO Model List of Essential Medicines. Infections related to HIV/AIDS are treated according to the national Essential Health Package.

Critical issues and major challenges
As the demand for HIV/AIDS prevention, care and treatment services increases, health sector capacity needs to be built up to scale up provision of services throughout the country. The greatest challenge facing Malawi is a human resource crisis, which has generally created a lack of capacity to deliver health services, especially in rural areas where primary health care is severely compromised. The scaling up of the Essential Health Package has been critically slowed, with only 10% of 617 facilities satisfying the human resource requirements for delivering the Essential Health Package (four professional or technical employees). Staffing is also inadequate to roll out antiretroviral therapy and other services related to HIV/AIDS, including voluntary counselling and testing, treating opportunistic infections and preventing mother-to-child transmission. Drug procurement and supply management systems need to be strengthened, as well as systems for monitoring adherence to treatment and drug resistance. Stigma and discrimination remain present. Nutritional support for people living with HIV/AIDS needs to be assured. Efforts need to be made to ensure greater involvement of people living with HIV/AIDS in the national response. Financial sustainability of the national programme is also a concern.