According to AVERT, a humanitarian foundation based in the United Kingdom, AIDS is the leading cause of adult mortality in Malawi, where one in fifteen people have HIV. Social variables that represent greater risk include urban residency, being female, and age between 13 and 24 (AVERT, 2011). Gender stratification has magnified the epidemic since the subjugation of women translates into sexual abuse, sexual coercion, and inability of women to advocate for condom use. Although the government has discouraged wife inheritance, this cultural practice also manifests as AIDS transmission in some cases. Certain occupations, such as those in the sex industry, policewomen, and male primary school teachers represent disproportionately afflicted populations.
Historically, the reign of Malawi President Banda from 1964 to 1994 resulted in escalating HIV incidence, due to his moral objection to sexual discourse. Hence, social conduct dictated that HIV/AIDS discussion was taboo, derailing preventative measures. Public dissent and international pressure resulted in Banda’s surrendering of power, the inauguration of democratic President Muluzi, and the introduction of a more liberal political climate that enabled AIDS education without political persecution. However, the intolerance fostered by the Banda era had already reaped devastation to Malawi’s socioeconomic infrastructure, culminating in a severe impoverishment and a 2002 famine.
The National AIDS Commission (NAC) was established in 2001 to implement AIDS prevention, testing, and treatment. These efforts were amplified and supplemented with support services by a multi-sectoral National AIDS Policy put into operation by President Mutharika, elected in 2004. Moreover, the NGO Malawi AIDS Counseling Resource Organization (MACRO) began providing voluntary counseling and testing (VCT) in 1995. Also, NGOs such as PSI and Banja La Tsogolo and a 2008 UN project have facilitated modest success in promotion of condom use. In particular, they have used beauty salons to distribute female condoms to circumvent cultural norms whereby it is seen as a traditional male domain. Collaboration of the Malawi government with the Global Fund and civil society organizations such as the World Health Organization, UNAIDS, and The President’s Emergency Plan for AIDS Relief (PEPFAR) has also resulted a dramatic increase in dissemination of antiretroviral drugs.
But, efficacy of campaigns has been limited due to financial shortcoming, in particular due to withdrawal of support by the UK Department for International Development (DFID) and other donors due to suspected political corruption and mismanagement. Additional impediments include deficient human resources, training, and equipment, drug stock-outs, and failure to target health messages to culture or language. Especially problematic is lack of human resources resulting from migration, unsatisfactory education, and loss of health care workers due to AIDS. Although access to rapid screening has increased, only 1% of adults employed this service up until 2003, due to lack of transportation and the cultural stigma of accessing VCT clinics or being diagnosed as HIV-positive, especially for married women (AVERT, 2011). Furthermore, because homosexuality is illegal, prevalence rates among gay men have not been collected, impeding intervention efforts. Community leaders have made some progress in changing attitudes toward AIDS, however, as evidenced by Chief Mudwa’s claim: “We have made it policy that whoever discriminates against people living with HIV and AIDS shall be heavily fined or expelled from our kraals (villages)” (AVERT, 2011). In addition, prevention of mother-to-child transmission of HIV (PMTCT) efforts have been hindered by excess demand for tests and inadequate staff, which compromises test quality.
Although deaths due to AIDs have declined in Malawi, numbers of new infection have increased. This necessitates a strategy where AIDS is combated on multiple fronts in concert with promotion of HIV nutrition, treatment of opportunistic pathogens, and confronting socioeconomic barriers. An anthropologist working in this area is Dr. Anat Rosenthal, who has examined the means by which local and global health organizations affect AIDS in Malawi communities, the sociocultural effects of AIDS-related health policy, and the more general objectives of evaluating and preventing HIV/AIDS outbreaks (Boh, 2011). For example, she conducted participant observation to discern community perception of the Malawi Diffusion and Ideational Change Project (MDICP), whose mission was to elucidate how social networks act in shaping attitudes to family planning and HIV/AIDS (Rosenthal, 2005). Through ethnographic research, Rosenthal studied the role this survey enacted in day-to-day Malawi lives. In essence, her intention was to uncover the impact of this project and provide recommendations for improving its design, ethics, and the community cooperation (Rosenthal, 2005).
Boh, Patricia. (January 27, 2011). Medical anthropologist promotes AIDS awareness in Malawi. The Daily Campus. Retrieved from http://www.smudailycampus.com/news/medical-anthropologist-promotes-aids-awareness-in-malawi-1.1922507#.UCXM2qNSQ-0
HIV & AIDS in Malawi. (2011). Retrieved August 10, 2012 from http://www.avert.org/aids-malawi.htm
Rosenthal, Anat. (September 26, 2005). MDICP-3 Ethnographic Project: Assessing Community Reaction to a Large Scale Survey. Social Network Project Working Papers, 1-18.