Stopping HIV/AIDS in Malawi: Stigmatize the Failure

Updated: Jan 21


In commemoration of the 2018 World AIDS Day.

A fast-growing population in Malawi is the major feature that’s making the HIV/AIDS situation appear to be improving. However, according to 2017 UNAIDS statistics, the number of people living with HIV and AIDS (PLHAs) continues to soar, albeit flattening out as the rate of new infections slows down. Between 2016 and 2017 alone, UNAIDS reports that new annual infections fell from 36,000 to 34,000. However, the total number of PLHAs remains staggeringly high, exceeding one million men, women and children since 2015 and growing. In the decade starting 2007, this represented a growth of at least 170,000 new infections in the country.

So, although the proportion of PLHAs seems to be waning under a rapidly growing population, such mathematical allure is no match for the continuing negative impact of HIV/AIDS on the prospects for the country. This means, in spite of the support in the millions of foreign monies, expertise and medications that have been poured into the country to fight the disease, Malawi’s capacity to churn new HIV infections every year into its charts should remain a disturbing prospect.

It is agreeable that, like with almost all major epidemics, the rate of spread must eventually fizzle out. And, for HIV infection rates, they have, to a great extent. The curve of the total number of PLHAs is flattening out. At times, one is persuaded to think that the battle is being won. Yet there remains that one thing in Malawi that continues to hamper the gains that efforts to combat the virus’ spread are making: stigmatization of PLHAs.

“Ameneajatu ali pa mankhwala,” meaning “that one is on medication,” usually pronouncing “that one” with a sarcastic intonation of belittling respect for the individual being discussed. To a bona fide Malawian, this is a dreaded phrase to experience if you are the one being referred to, yet all so common in Malawi even after 40 years of programmes and projects targeted at culling stigmatization against PLHAs.

We’ve come a long way in our evolution of managing the spread and impacts of a scourge that has not just ravaged the prospects of every single Malawian, infected or not, but one that has also managed to steal away the dignity of a nation whose character has been coated with the disease on its identity. In the eighties and nineties, stigmatization mainly took the character of equating PLHAs with walking corpses that were unworthy of befriending or human touch. So many societal myths surrounded the lives of the infected, and sometimes the affected, to the extent that isolation became a major player in the deterioration of their conditions as well as their prospects of a productive life.

Yet the solutions to curtailing the spread of new infections in Malawi, let alone the world over, have not required a magic wand. Although it took time since the first anti-retroviral treatment (ART) developed in 1987 would reach countries like Malawi, they eventually came en masse to countries in the Global South that suffered. This, fueled mainly by the expiry of drug patents which led to the exponential proliferation of generics, became an important factor in managing the spread and longevity of the lives of those living positively. Unfortunately, it was an opportunity that we have failed to take advantage of, as Malawians and as development workers, mainly because we have not successfully stopped ourselves from continuing to stigmatize.

It’s hard to resist acknowledging the culpability of medications in exposing PLHAs receiving ARTs to heightened discrimination. Lipodystrophy, the accumulation of fats in certain parts of the body, and wasting can be very hard to hide to the public. Nonetheless, if one must fulfill obligations that require interaction with public spaces, this has come at the enormous social cost of embarrassment and the psychological belief that one does not fit in the normal, regular world because of ART-induced changed looks. Insinuations of identifying PLHAs based on “new looks” have not helped quell stigmatization of PLHAs either. So, living in a world where one’s conspicuous looks and the mockery faced at the consciousness to others easily telling one is swallowing ART pills quickly became one of the major killers for PLHAs in Malawi as patients opted to quit the shame by abandoning treatment altogether.

It is sad that the first decade of the 2,000s would be marked by such regression in the effort against HIV/AIDS in Malawi as it has been driven by a new wave of stigmatization. The more patients preferred to opt out of treatment, the more easily their vulnerability would heighten to opportunistic infections that can worsen disease and bring forth an early death.

The irony is that ARTs also came with the attribute that, with consistent use, would see the reduction of the viral load in one’s blood stream. The viral load could get to untraceable levels, making it virtually possible for unprotected sex between a PLHA and a non-PLHA to be safe! A study done in 2011 – called HTPN 052 – showed that, for HIV-serodiscordant couples that received ARTs early enough, roughly 96% of the cases showed success in preventing transmission to their partners. ARTs would not spread the virus while extending the life of a PLHA indefinitely. In a country setting where HIV and AIDS have been a real burden, this needed to be a rare opportunity to hang on to with every last breath it takes. This website believes that our HIV/AIDS statistics would have been much lower than they are today.

Of course, the complexity of social beings means that a zero-new-infections scenario remains utopian. However, it does not replace the fact that the job of advocates, government and international organizations should be directed more at understanding the changing patterns of stigma, and the new challenges it poses to the anti-AIDS fight. The general public, sensitized appropriately, has a big job to do too. The major public concern must be geared towards the realization that any future spread of the virus is potentially a burden on livelihoods, the health of a future generation (Young Hong, UNFPA Representative in Malawi, reckons that a third of all new HIV infections occur among young people aged 15-24) and a perpetuation of social vices that will continue holding back sustainable development in Malawi.

This website, then, appreciates that HIV and AIDS have been a burden so painful for the larger part of our independence, almost forty years of our fifty-four years of self-rule. This makes it a major failure of a nation to fulfill its responsibilities to its citizens. We have failed to tackle the challenges of fast spread, staggering openness to testing, and maintaining treatment for those with access using more radical approaches that would also prove cost-effective in the projected future. Yet, the solutions to the spread of HIV are perhaps among the simplest, if only we could figure the right messaging in development work.

It will take a more dynamic approach, one that is responsive to the behavioral patterns of societies in the wake of improving and accessible ARTs, to rectifying the further HIV spread.

We can arrest the growth of HIV spread.

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