An AIDSFree Case Study from Malawi

On Wednesday, July 27, UNAIDS launched the In Danger—UNAIDS Global AIDS Update 2022 at Montreal as part of many events marking the AIDS 2022 Conference. The report revealed that progress in prevention and treatment is faltering worldwide, putting millions of people in grave danger. Eastern Europe and central Asia, Latin America, the Middle East and North Africa have all seen increases in annual HIV infections over several years. In Asia and the Pacific, UNAIDS data now shows new HIV infections are rising where they had been falling. Action to tackle the inequalities driving AIDS is urgently required to prevent millions of new HIV infections this decade and to end the AIDS pandemic. 

AIDS response in Malawi: Gains made but there is room for improvement

New data from UNAIDS on the global HIV response reveals that during the last two years of COVID-19 and other global crises, progress against the HIV pandemic has faltered. Resources have shrunk, and millions of lives are at risk as a result.

There is some positive news for Malawi regarding the country’s AIDS response. In 2021, new HIV infections decreased by 61%. The new In Danger—UNAIDS Global AIDS Update 2022 highlights the positive decline in HIV infections attributed to Malawi’s expansion of HIV treatment.

“The country expanded HIV treatment with a focus on reaching both women and their partners through antenatal care,” the report says.

Malawi also saw a considerable decline in tuberculosis-related deaths. Among 30 tuberculosis–HIV high-burden countries, the most significant declines in tuberculosis-related deaths among people living with HIV occurred in Ethiopia (84% decline), India (81% decline), Malawi (77% decline), South Africa (77% decline), the United Republic of Tanzania (75% decline), Thailand (74% decline), Eswatini (72% decline) and Kenya (72% decline).

A global challenge in HIV treatment is the urban-rural divide where people access HIV services unequally, depending on where they live. For Africa, the UNAIDS Global AIDS update shows that HIV treatment disparity is pronounced in countries such as the Central African Republic, Gabon, Guinea, Ethiopia, Haiti, Nigeria and Sierra Leone.

“[However] Some countries that have minimized coverage gaps between districts—such as Lesotho, Malawi and Rwanda—have also achieved some of the largest reductions in new HIV infections and AIDS-related deaths,” the report says.

By 2020, Malawi had achieved 90–90–90 targets for HIV testing and treatment, alongside Botswana, Eswatini, Rwanda, Zambia and Zimbabwe for eastern and southern Africa.

In spite of Malawi’s progress in ending AIDS, the country also shares in the region’s faltering progress in fighting the pandemic. In eastern and southern Africa, young women, children, and key populations are disproportionately affected by HIV.

In sub-Saharan Africa, sex workers (15%), clients of sex workers and sex partners of key populations (26%), gay men and men who have sex with men (6%), people who inject drugs (3%) and transgender women (1%) accounted for 51% of the distribution of new infections in 2021. In sub-Saharan Africa, adolescent girls and young women are 3 times as likely to acquire HIV as adolescent boys and young men.   

In eastern and southern Africa, the UNAIDS Global AIDS Update 2022 highlights that women and girls continue to be disproportionately affected by HIV. They accounted for 63% of the region’s new HIV infections in 2021 where new HIV infections are three times higher among adolescent girls and young women (aged 15 to 24 years) than among males of the same age.

UNAIDS Malawi Country Director Nuha Ceesay said ending AIDS requires concerted efforts.

“Ending AIDS as a public health concern in Malawi by 2030 is not a moving target but a realistic commitment that requires predictable partnership and sustainable funding, including the increased use of domestic resources,” Ceesay said.

Giving a global perspective, UNAIDS Executive Director Winnie Byanyima said the AIDS response is in severe danger.

“If we are not making rapid progress then we are losing ground, as the pandemic thrives amidst COVID-19, mass displacement, and other crises. Let us remember the millions of preventable deaths we are trying to stop,” Byanyima said.

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