All Hands on Deck! A Comprehensive Financing Model for HIV/AIDS in Malawi
Updated: Dec 29, 2019
In commemoration of World AIDS Day 2019.
With approximately 38,000 new HIV infections recorded in 2018 in Malawi, the fight against AIDS in the country is only symptomatic of how its victory is scooching farther away from being reached. It’s true that this reflects a significant drop in all newly recorded annual infections (which were approximately 58,000 in 2003), yet it remains significant enough to amplify the scare the disease that has ravaged our country for decades poses to our foreseeable future. The scourge’s dark side manifests in its ability to particularly affect young people aged between 15 and 17 years, who currently make up 50% of all new adult infections. Those between 15 and 24 years of age make for a third of all new infections. This means the potential impacts of AIDS on Malawi’s affected, as well as the systems put in place to support them, must be inevitably geared for the long haul.
The HIV/AIDS statistics for women, including young women, demonstrate how feminized the present and future of the HIV/AIDS fight is colored.
It is humbling (and humiliating, at times) for Malawians who have somehow or wholesomely been affected in the history with HIV/AIDS to acknowledge the success story that HIV/AIDS financing has been in the past 40+ years our lives have been scarred by the scourge’s torment. The results are clear that progress towards manageable levels has taken place. And although HIV/AIDS-related deaths were staggeringly around 13,000 in 2018, contracting the virus no longer exhibits the same death sentence appeal for the majority of the 1 million people living with HIV/AIDS (almost 1.1 million Malawians will be living with HIV and AIDs in 2020) as it did in the pre-Anti-Retroviral Treatment (ART) days.
For some of those present in the HIV/AIDS arena, the fight has been coupled with life-changing rents. But despite the affluence that HIV/AIDS money has brought on many of those with the leverage to apply these resources into the different interventions, HIV/AIDS indicators of progress have been unrelentingly positive. Add the corruption correlated with handling the public and donor coffers for the fight against AIDS to the mix, and one still sees how resilient the determination for success holds.
Nonetheless, Malawi will continue to face the threat of high HIV – yes, declining – prevalence due to the inappropriacy and inadequacy of funding towards the national fight. This is because AIDS has persistently been a “poverty” syndrome in that the rich will almost always stand at a better vantage point to preventing and managing it (think better nutrition and access to high-quality medications) than the poor. The poor usually must first nourish on others’ generosity and pity, and then face the subjectivity of the politicization of HIV/AIDS initiatives that their own government will endear itself to in order to gain a few points at the ballot box. And in instances where survival of the infected poor can only happen if they must take low-quality ARTs, then they must endure the humiliation of deformity caused by lipodystrophy, an accumulation of fats in certain parts of the body and wasting. See our AIDS Day article of 3 December 2018.
Indeed, funding for AIDS control must stay persistent in spite of its own success. Take the 69% of all people living with HIV who are virally suppressed as a result of the enormous national and international efforts to keep them on anti-retroviral treatment (ART). To keep the virus in that state continues to, unfortunately, call for undisturbed administration of ARTs for life. Many of our poor will have to, then, depend on the guidance of those who must constantly work in projects, programs and policy instruments to not just massage the need for continued treatment, but to also manage the psychological turmoil that a chronic marriage to a life-saving drug brings to one. This means that keeping the virus on the leash will require at least the same, if not more, funding designed to manage the social and behavioral aspects of controlling the spread.
And there are other direct and indirect dimensions of the HIV/AIDS fight that will demand a more integrated approach to financing. An important amount of attention will have to be paid towards the redress of women’s HIV/AIDS burden in the country, which, as a 2016 summary report by the Ministry of Health indicates, the HIV prevalence discrepancy between women and men is an overwhelming 14.1% for women and 4.8% for men. In part, this is driven by gender-based violence, early and child marriages. And where infected women and girls can potentially pass the virus on to men and boys with whom they sexually engage without protection, the risk of mother-to-child infections pose an even greater risk of fabricating a future HIV-laden nation in a country devoted to biblically “go forth and multiply” as we do. According to the 2015 “Malawi AIDS Response Progress Report”, as much as 15% of pregnant women diagnosed with HIV do not opt to start treatment. So, although it is critical that we prevent mother-to-child transmission at the point of birth, the role of modern family planning methods will be an indispensable tool for curbing the spread of HIV before its fangs can dig deep into Malawi’s future. It is, then, undisputable that family planning must receive its fair share of the HIV/AIDS funding.
Another dimension requires the corroboration of efforts between education and the containment and eradication of HIV and AIDS. The first vulnerability is raised by illiteracy. The latest UNESCO data (2015) indicates low adult literacy levels for Malawi at 62.14%. The fine print, though, highlights a critical distinction between men (69.75%) and women (55.2%), which makes it an important explanatory variable for the observable high rates of HIV prevalence among females. Although Malawi has made great efforts to introduce HIV/AIDS education in school curricula, the elevation of education standards and levels will also do much damage to the spread of HIV as people are able to make more informed choices for themselves as well as receive and act on the vast amounts of information available to them.
But this is mainly theoretical. A paradox to the relationship between illiteracy and risk of HIV infection seems to appear in the 2013 work by Alister Munthali et al, in which the authors demonstrate this relationship to sometimes manifest negatively and respondents in their study even claiming a “feeling” of not being at risk.
The dimensions that must be factored in the collective actions to curb the further spread of HIV in Malawi are too numerous to mention, some being as transformative and basic as cultural adjustments. Many, such as culture and education, interact to produce outcomes that may be positive or negative (as in Munthali et al above, where prevention and management of one’s status could simply be a behavioral matter). Using a 2014 study on five East and Southern African countries, the per capita cost of ART in Malawi averages at $208 per patient year in direct interventions. These direct interventions are bound to continue. Donors to the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) just pledged US$14.02 billion for the next 3 years and the world is hopeful to appeal to their generosity in the run up to 2030, the agreed Sustainable Development Goal (SDG) end line.
If this article is to be any useful to anyone, then we must go beyond funding direct interventions. Almost every other aspect of development can potentially play a role in the fight against AIDS. They must all work together.
All data not cited in this article is taken from 2019 UNAIDS Statistics.