The Public Economics of HIV/AIDS in Malawi
Updated: Jan 21, 2020
Gift was a security guard in Lilongwe in the latter years of the 2000s. Despite hard work and sharp alertness in attending to duty, a rare occurrence among workers in the industry he served, revealing his HIV status to his employers was not the quickest thing he could do. But soon a regular malaria or bout of flu could no longer be handled with the calm demeanor that a few pills of Fansida or the traditional water and rest remedy could previously resolve. So much was at stake. The announcement to the employer came in at a time his health had deteriorated significantly enough that his repeated and extended absences had to be explained. Although this website cannot certainly confirm, Gift may not have afforded to live another year since his frail health led to his voluntary resignation in 2009.
The face of HIV/AIDS in Malawi depicts the picture of vulnerability of the country’s productive population, and it is workers like Gift who continue to be the statistics that development experts are using to preach the devastation of the scourge in a country so poor. As a matter of fact, the delayed diagnosis of HIV meant only a commencement of taking anti-retroviral (ARV) treatment at an advanced stage of Gift’s illness. As a young man, he was only joining the meagre 58% of men who knew their HIV status that were taking ARV treatment, in contrast to women who do better at 75%. His lack of access to health insurance meant the reliance on government health clinics for ARVs was his only choice to prolong a life already on the margins of full-blown AIDS. Gift’s circumstances demonstrated the need to stick to a strict routine for collection of ARV treatment, which several times meant skipping a month’s supply of medications when the lines at the Kamuzu Central Hospital were too long for his turn to yield any success.
It is about a decade since Gift disappeared, either from public life or from life itself. Yet, despite the efforts – and the money – to cull the spread of HIV in Malawi, including through improved versions of ARVs, dietary advice and any fathom of programmable influence on behavior change, HIV/AIDS statistics show that numbers of infections continue to rise. According to UNAIDS, about 1 million (6.25%) of Malawi’s men, women and children lived with HIV/AIDS in 2016, up from about 950,000 in 2007. 70% of these people know they carry the HIV in their blood (in large part, thanks to Option B+, which requires pregnant mothers automatically receive treatment) and about two-thirds take ARVs.
The hypothetical situation in which no new infections will ever be recorded in Malawi is one that currently remains an aspiration, particularly when three hundred thousand Malawians roam the streets with an active virus that is acquiescent to finding new bodies. And, our growing population is a sign of fertility as much as it is a signal of our shyness at using protection. For these factors, we can only hope that the actual spread of HIV/AIDS in Malawi is not several times more than what the statistics tell us.
It is no doubt that awareness has been raised for every adult and child. HIV/AIDS awareness has managed to break traditional and cultural boundaries that those who do not know may well face the ridicule of society. However, it is seldom sensitivity that will intervene in the spread of HIV. Similarly, we have attacked every harmful cultural practice known to mankind, and many have responded positively to the extent that we could have reversed the trends more than a decade ago. We have looked at the rights of people suffering and those most at risk; we have provided treatment that weakens the virus and allows those living with HIV/AIDS (PLHAs) to live a normal life again and moderate their ability to spread it to others; and some compatriots have even learned family planning through HIV prevention methods such as abstinence and condom use.
And the failure to halt the spread of HIV for 32 years, today, since the first diagnosis was made in the country, could only mean that we are getting many things wrong. Perhaps the most affective has been the impact that high HIV prevalence has had on careers and graft. In Malawi, HIV/AIDS money has been the quintessential parallel to blood diamonds when one considers the amount of corruption that has seen resources, especially foreign resources, diverted to unintended use. Many of us vividly recall the decision of the National AIDS Commission to allocate several million dollars to Beautify Malawi, an initiative of the country’s First Lady, that brought the Global Fund to reevaluating its pending support worth US$574 million to Malawi in 2015. Many have also dared to question the return-to-the-dollar of resources spent to fight HIV/AIDS in the country, which by 2016 summed to about US$936 million of Global Fund resources since 2003, and have observed how salary and benefits structures for employees doing HIV/AIDS work are not comparable with the results on the ground.
Perhaps a baffling disposition is where we have flopped at elaborating the AIDS problem within the paradigm of poverty. And while the Kamuzu Banda regime was slow to respond to the scientific advice on the likelihood of the virus in Malawi in the early 1980s, an appropriate model of development would have aided the management of HIV spread when we found out. We could have contained the impacts of AIDS on development. Take infrastructure development in the road sector, for example. A timely construction of roads would have not only facilitated reaching PLHAs but would have also brought information and competencies to mitigate the spread much earlier in time. Immediate solutions like prophylaxis would have reached the poor more efficiently. Strategic infrastructure investments in health centers and hospitals would have meant the adequate handling of cases in the most remote areas where the risk of contracting the HIV is higher due to limited familiarity of the Syndrome.
The acceleration of formal education would have also assisted in several important ways. Schooling would facilitate access to and use of useful knowledge; it would prepare medical personnel that would be within reach of the government’s AIDS budget; it would also shorten the idle time for people to engage in risky sexual behavior, either through consensual interactions or forced acts that have hidden in cultural codes leading to early/child marriages or child initiation ceremonies. The latter could also be very well achieved with fiscal and monetary policies that give the economy a demand boost so that men and women can work instead of fantasizing their next fleshly conquest.
On the contrary, the country has nourished on its position of disadvantage, a vulnerability to undisputable suffrage in the absence of foreign assistance. In turn, we have allowed the problem to grow beyond levels our culture, wit and resources could manage, letting the burden to continue registering positive growth year after year. The result has been the flourishing of organizations working at national, local and grassroots levels in an attempt to mitigate the virus’ spread and care for the sick, when what we have done is normalize a disease that is actually abating in other countries (check Brazil and Ethiopia, for example).
Our attempts to resolve challenges that have an implication on our already small, static, economy must always be accompanied by a candid poverty analysis. The case of HIV/AIDS prevalence in Malawi, touted one of the highest in the world, should barely be considered one of promiscuity as this is a natural human competence everywhere across the planet. Neither is it just a consequence of bad luck. HIV and AIDS are very much a subject of poverty.
If Gift were a high-earning white-collar officer working at a vibrant Non-Governmental Organization (NGO), he would have accessed treatment in time, and would have maintained a diet that was supportive of his condition, and would have probably had a variety of sources of critical information to keep him and others around him safe. Perhaps, if we dealt with Gift’s poverty, we would still have him around with us.