HIV/AIDS in Malawi

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

HIV & AIDS in Malawi. (2011). Retrieved August 10, 2012 from

Rosenthal, Anat. (September 26, 2005). MDICP-3 Ethnographic Project: Assessing Community Reaction to a Large Scale Survey. Social Network Project Working Papers, 1-18.

Malaria in Africa, and in particular, Tanzania

Malaria, a disease that has been mentioned several times throughout this course, can be effectively cured by medication, but it still remains prevalent in Sub-Saharan Africa, where it kills 3,000 African children a day.  This parasitic disease is transmitted by mosquitoes. Once inside the body, the parasite destroys red blood cells and can clog cerebral arteries.  Without treatment, the initial flu-like symptoms from infection can progress to life-threatening illness.

Malaria is a major public health issue in the poor countries of Africa, where it is tied to poverty in a grim cycle: the disease is a consequence of poverty, and at the same time further impoverishes the communities it affects.  By preventing infected people from working, causing immeasurable human suffering from the loss of loved ones, leaving children with lasting neurological damage, requiring costly medication, and negatively impacting the economic decisions of households and entire nations, malaria has a devastating effect wherever it strikes.  The governments of the countries where malaria has a high incidence are generally poor to begin with, and this lack of funding for treatment and prevention is a major barrier to controlling the disease.  People with HIV or AIDS, which are also a major health concern in Africa, are particularly vulnerable to malaria.  As malaria is such a large-scale global health problem, multiple health organizations like WHO and the World Bank, as well as the UN, donor governments, and various charitable organizations are focused on addressing it.

One medical anthropologist studying malaria in Africa is Dr. Vinay Kamat, a professor at the University of British Columbia who has focused his research on how recent changes in malaria medication and control strategies are affecting those afflicted with the disease.  In a 2009 study, he researched how the Tanzanian government implemented new treatment guidelines that included the large-scale deployment of an artemether/lumefantrine-based combination therapy (ACT) medication commonly known as ALu.  This medication is regarded as an effective treatment and a “key weapon” against malaria, but its high cost is unsustainable in the long-term for Tanzania without a significant donor.  Dr. Kamat studied the public’s perspective on ALu as public health facilities began distributing it within the new policy.  He found that the majority of mothers of children with malaria do not rush to the hospital within the initial onset of the disease; rather they rely on store-bought fever medications.  Despite this, once at a health care facility, the mothers were satisfied with the efficacy of ALu, as well as its affordability due to the government subsidy.  This study prompted further questioning of how to encourage early treatment of malaria, to avoid the delay between the onset of symptoms and proper treatment.


Bio of Vinay Kamat:

Kamat’s study in Tanzania:

Basic facts on malaria:



Public Health and Medical Anthropology

This course has opened my eyes to just how important and functional the field of medical anthropology is. I previously was most intrigued by the field of archaeology but have slowly switched my focus over to this subject. There are currently an abundance of medical jobs in the United States which definitely has an influence on its attractiveness. Also the advancement in technology is soaring right now, making western medicine even more dependable and efficient. On the other hand, our country has admitted that the healthcare system we currently have is not so good at all. Even countries rated below us in terms of wealth, technology, etc., have longer average life spans. The reason for this may be the existence of universal healthcare systems, in which no citizen has to worry about not having access to sufficient health services.

After watching a video on the subject of healthcare systems earlier in the semester, I have drawn up a little dream scenario in my head. I wish I could come up with a solution to our country’s problem. It isn’t fair that a portion of our population is denied healthcare due to poverty, lack of insurance, and other hardships. And it isn’t just poor families suffering. I have friends who don’t have insurance because their parents’ plans have dropped them and they are unable to work a job that provides benefits or can’t afford to pay for another type of insurance and don’t qualify for governmental assistance.

In order to come up with a new medical situation for this country, I think that well-educated and passionate anthropologists are a vital part of the research team. They bring a culture-analyzing view. As professionals, they are able to take on an objective perspective, pointing out the important qualities of our culture that would affect a proposed system. Coming up with a new healthcare system isn’t just about developing one that seems good but shaping it so that it fits into our lives easily and naturally, ensuring its success. We may need economists, politicians, doctors, and other professionals to create a system but the anthropologists would be able to predict its success rate before it is even put into action.

FGM in the Sudan

As I was doing research on what FGM was, I found some stories of girls that have gone through this “procedure.” It was not by personal choice in their cases. Female Genital Mutilation or FGM is “the partial or total removal of the female genitalia,” as described by It is also known as female circumcision. Despite being condemned by the United Nations, health professional, and human rights organizations, FGM is practiced all over the world especially in Africa, more specifically the Sudan. It was actually declared illegal in the Sudan in 1941, but has since been legalized.  An article in the Sudanese Tribune claims, almost 90 percent of northern Sudanese women have suffered through this. According to another source, that is about 14 million women and girls. Usually this ordeal is done to girls from age’s six to ten but it has been done to girls younger than that. One of the girls from the story who was forced to undergo this procedure was asked who made her get it done, her answer was her grandmother; “She said that this is something belonging to the traditions and customs and we can’t get away from it. And at that time everyone in the Sudanese society used to have this circumcision,” Aside from just the traditions of the culture, FGM also occurs in the Sudan because some believe it promotes hygiene and Sudanese men prefer women who have been circumcised. Not only does Female Genital Mutilation cause girls excruciating pain but there are also serious side effects that could occur. According to, “The highest maternal infant mortality rates are in FGM- practicing regions.” Though the numbers are not exact, they believe about a third of girls who have been circumcised die due to treatment unavailability. One Non-Governmental Organization (NGO) that has had a big effect on stopping FGM from happening is the Babikar Scientific Studies Association on Women Studies. They were the first NGO to try to help the fight against FGM in Sudan. While there are many who think this practice should be stopped, one Sierra Leonean anthropologist named Fuambi Ahmadu thinks that is not right. Ahmadu does not see circumcision as a barbaric act or a mutilation nor does she believe that it affects a woman’s health. He is working to try and spread his opinion and educate people on what he believes to be true about Female Genital Mutilation.,12647

Clinical Medical Anthropology

According to lecture video on “Applied Medical Anthropology” clinical anthropologists work with medical professionals and patients in clinical settings on ways to improve healthcare and management. Just like in global health arena these anthropologists apply the same theoretical and methodological training to address barriers to health. One of the primary goals of clinical anthropologists is to emphasize the cultural context of an illness experience. This especially important when clinicians are treating patients from other cultures who understand health through different ethnomedical systems and explanatory models.Anthropologists are important because according to the lecture video “Applied Medical Anthropology, they “recognize that neither of the clinician nor the patient is a blank slate and that the only way to come up with a workable treatment program is to consider the complete cultural, biological, psychological and social circumstances.” In essence I  would say that this a more affective approach because the treatment program considers a persons biological, cultural, psychological and social factors in creating a workable treatmentl. All these factors are important in creating a treatment for a person because they act as a cultural mediator to develop the best possible strategies to achieve health for individual patients

I picked this intersection because I believe clinical medical anthropology is essential and important in treating patients more affectively by providing a recovery plan that reflects their cultural and social needs. Medical clinicians are essential because they provide a link and communication between the patient and the medical world. According to the article Anthropology in the Clinic: The Problem of Cultural Competency and How to Fix It, “clinicians are grounded in the world of the patient, in their own personal network, and in the professional world of biomedicine and institutions. Clinicians serve as social and cultural links that connect the patients to the social world of the medical field. If I was working with a provider in the area of clinical medical anthropology who is not an anthropologists I would explain to the provider that taking an anthropological approach is useful in this particular area because “culture factors are crucial to diagnosis, treatment, and care”(Kleinman & Benson 1673). These factors help shape beliefs, values, and behaviors that reflects a patients culture. This is invaluable because it allows the clinicians to understand and formulate a treatment that will help their patient recover base on their cultural needs. Clinical medical anthropologist are for the patients and the serve as communicators for their patients to the medical world.





Kleinman and Benson – Anthropology and the Clinic

Lecture: 6.1- “Applied Medical Anthropology”

Female Genital Mutilation(FGM) in Sudan

Female genital mutilation “comprises all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons.” (Female genital mutilation, Februrary) FGM leads to infertility, bleeding during, pain sexual intercourse, and sometimes causes death. I found different possible origins for Female genital mutilation but it can be date as far back as the 5th century B.C in Egypt.  Nearly 90 percent of Sudanese woman go through this procedure every year. They say encourages hygiene for Sudanese woman, men think highly of women who are circumcised, and it makes the bride price higher.  With the bride price being high it will help poor families with the additional income. Some Sudanese say it also has to do with their religion who Muslims and say the Koran says woman should be circumcised. In 2008 WHO passed a resolution to put end to FGM.UNICEF and the National Organization for Women (NOW) are trying to stop FGM. These are organizations are to make people know the consequences of FGM through support, research, and guidance.

Professor Ellen Gruenbaum did research in Sudan where FGM is way more common. Her research showed that the more western civilization got involve there was more the Sudanese resist to change. “Gruenbaum shows that the practices of female circumcision are deeply embedded in Sudanese cultural traditions – in religious, moral and aesthetic values, and in ideas about class, ethnicity and gender” (PANEL: Medical Anthropologist Speaks on Abolishing Female Circumcision, 2012). Professor Gruenbaum research shows how to take a different approach to stop FGM in Sudan.  She wants to bring to light both the reception and the confrontation to change. Gruenbaum says it happens because of social and financial changes, religion influences, and woman not being educated about FGM. “ Gruenbaum seeks to provide an insightful analysis of the process of changing this complex, highly debated practice”. (PANEL: Medical Anthropologist Speaks on Abolishing Female Circumcision, 2012)

Works Cited

PANEL: Medical Anthropologist Speaks on Abolishing Female Circumcision. (2012, September 29). Retrieved from

Female genital mutilation. (Februrary, 2012). Retrieved from Who Health Organization:,12647


Epidemiology and Medical Anthropology

According to the World Health Organization (WHO), Epidemiology is the study of the distribution and determinants of health-related states or events (including disease), and the application of this study to the control of diseases and other health problems. I picked the intersection of these two fields because Epidemiology is something that I have been interested in for a long time. I am currently in the undergraduate program here at Michigan State and this summer I had my first experience with Epidemiological research that I shall continue in the fall. I think that Epidemiology is an interesting field because it in itself is an interdisciplinary field and then combining the viewpoint of an medical anthropologist add an additional layer of understanding the group one is studying. Taking into account medical anthropology will cause you to think more about the culture of the area. Because often Epidemiologist find themselves asking why do we see the distribution that we have. It will be difficult to understand why people are still be infected with cholera in a small village. That is until you realize that the people of the village believe that the fluorine and chlorine compounds you provided to clean the water are seen as toxins and therefore they do not add them to the water source. It is the job of the anthropologist to learn more about the culture so that the team can come up with other methods of providing safe sustainable drinking water for the village without offending them. Another great example would be from the youtube video in this week’s lesson. It is a recording made by a medical anthropologist who mentions some of the possible ways of applying medical anthropology. The one I found very interesting was the women who of the village who during their period where been essential kicked out during those few days. This might they did not have access to things that others in the village had like water, food, and other resources. So when they starting giving women the IUD devices to decrease the rate of pregnancy they we causing the women to be isolated from the village for a longer period of time which is not going to be helpful when you think about the fact that many of the women have quite a few children to care for. This is a great example of where the anthropologist taking the time not only to learn the language but the culture and why they do the things they do can come in handy. It will allow for a level of care that may not be high but may end up being a program that individuals will follow because it goes along with their beliefs.

2. Tribal Jazzman Medical Anthropologist

Tuberculosis in Sub-Sahara Africa

Tuberculosis is only the second leading cause of death in the
world with AIDS/HIV being the first according to the World Health
Organization (WHO). What makes this infection so harmful to
sub-Saharan countries is that AIDS/HIV and Tuberculosis is found to
have a positive correlation with each other. (Cantwell, 1996)
Tuberculosis is a bacteria that can be easily passed through the air
from an infected individual. Because most of its symptoms are mild,
many people who are infected are unaware for months. Treatment
programs in these countries are in their teenage years with some
major kinks to work out, the larges being how drug interactions with
HIV/AID treatments cause one to be inefficient. The WHO and Global
health organizations such as The International Union against TB have
been in the forefront fighting this battle. Many individual countries
do not participate because many of these countries are poverty
stricken and have nothing that they would want, such as oil. As we
saw in the video clip from this weeks lecture material, a group of
four men had to bring TB treatments to countries because no one else
would due to the belief that they would die and it would not make a
difference. Major organizations have been working at enforcing laws
that cause people to be tested for TB before working in places such
as the coal mines. Sadly they found this to be inefficient as the
percentage of workers who had TB increased from 1% to 30% in a matter
of twenty years. (Corbett, et. Al, 2006) While the reasons as to how
the amount of infected persons increased so greatly with such high
standards are long and unknown, many organizations feel that
establishing preventative actions and some treatments cause more harm
that good.

In the article, “Barriers
and outcomes: TB patients co-infected with HIV accessing
antiretroviral therapy in rural Zambia”,
Chileshe followed a series of patients with TB and HIV and how easy
or hard it may be to get treatment. It was discovered that living in
the rural areas of Zambia made treating TB and HIV more difficult.
With having to foot the bill for transportation to the facilities and
then upon arrival learning that blood work was lost, the electricity
was off or lack of staffing prolonging treatment caused the
financially incapable to suffer even more. When the person was sick
or not feeling well some normal family roles were changed such as the
woman becoming the bread winner. In many cases the families were
ashamed to be acknowledged with having such a disease so they moved
further away from their communities. Having the illness caused the
same financial strain on the families as the funeral for the family
member. At the end of her year long studies of the seven individuals,
only three were taking the treatment and two were to start treatment,
the other two had already passes. Several months after leaving the
three that were on treatment when she left were the only survivors.
The lack efficient treatment options and accessibility for the
patients caused the mortality rates to decrease significantly
alongside with the inability to eat the proper foods. In conclusion,
treatments are only helpful if they can be given in a reasonable
amount of time and other factors do not exist such as lack of
transportation to hospitals and lack of nourishing food. It is only
when theses factors are eradicated that treatment can be effective in
these countries.



1. Cantwell, M. F., and N. J. Binkin. “Result Filters.” National Center for Biotechnology Information.U.S. National Library of Medicine, June 1996. Web. 10 Aug. 2012.

2.Corbett E., Martson B., Churchyard G.J., De Cock K.M., “Tuberculosis
in sub-Saharan Africa: opportunities, challenges, and change in the
era of antiretroviral treatment” Lancet 2006; 367: 926–37

3.Muatale Chileshe, Virginia Anne Bond,
Barriers and outcomes: TB patients co-infected with HIV accessing antiretroviral therapy in rural ZambiaAIDS Care Vol.22, Iss. sup1,2010

4.Dye C, Harries AD, Maher D, et al. Tuberculosis. In: Jamison DT, Feachem
RG, Makgoba MW, et al., editors. Disease and Mortality in Sub-Saharan
Africa. 2nd edition. Washington (DC): World Bank; 2006. Chapter
13.Available from:

5.”Tuberculosis.” WHO.
N.p., n.d. Web. 10 Aug. 2012.





HIV in Malawi

The global health problem I chose to discuss is HIV in Malawi. I just wrote a paper about AIDS for another class so I’m well caught up on the subject so that’s why I chose this topic. The first case of AIDS in Malawi was in 1985. Because of the poverty and famine in Malawi it continues to still be a problem today, and is actually the leading cause of death in adults. The government has formed many policies to help fend in the fight against HIV but the number of cases continue to grow despite the efforts. Not having a financially stable government means that money for ads and prevention programs fall short and are sacrificed for things that are more important in their eyes. There are programs to educate people on HIV/AIDS and to teach them to be cautious but with limited resources it is sometimes not possible to avoid a situation in which they could be infected because the need to survive is greater.

An anthropologist working in Malawi is Dr. Anat Rosenthal. She started out by hearing about the HIV/AIDS epidemic in Malawi from women who lived in Tel Aviv who were HIV+ and decided that she wanted to do something about it. She now aids in the effort to prevent the spread of HIV/AIDS. She researches the impact that HIV/AIDS has on communities and focuses most of her attention to the children. She looks at the health status of children who have been orphaned by HIV/AIDS and who will raise them after this has happened. She has done twelve months of field work, used participant observation, and has several interviews to help aid her in her work. She recently spoke at SMU (Southern Methodist University) in Texas to get word out about her efforts and to hopefully encourage people to follow in her steps and to realize the problems these people face.

Famine/Malnutrition in Somalia

I wanted to talk about the famine of two thousand eleven in Somalia and the malnutrition in their country at all times. In Somalia tens of thousands of people dies from the famine caused by a serious drought. It was their worst drought in over sixty years. The largest group of people who died was children under five years old. The CBN article that was posted for our class said that during this drought parts of Somalia had the highest malnutrition levels in the world. The article went on to stats shocking facts about the devastation of this famine. The drought has affected eleven million Somalians and many people are fleeing to the surrounding countries of Kenya and Ethiopia (Gartenstein-Ross).

The people are trouble surviving this because they have reserves for food, but they were quickly used up and years of poor rain do not allow them to stock large reserves. Governments can try to help, but when your country has tough climate issues only so much can be done without receiving foreign food aid. Somalia had been receiving foreign aid but the Muslim group al-Shabaad (linked to the terrorism group Al-Qaeda) has been preventing the people of Somalia from receiving aid. They recently stopped during this horrible famine (Gartenstein-Ross). This terror group involvement is another problem that the government and political leaders need to address because these groups take advantage of poor and hungry people. They will join these groups in order to receive food and water. The United States assisted during Somalia’s civil war and the power of warlords is a problem throughout the region.

When people constantly struggle to have clean water and access to adequate food, overall health is severely affected. Africa in general is constantly in trouble with their ability for food and clean water. The climate is so extreme in the region and there is a constant battle for the people to survive. I read an article that referred to and said, “Professor David Himmelgreen has worked in the Department of Anthropology at the University of South Florida for more than a decade. He’s done extensive research in Africa dealing with food, nutrition, chronic disease, and security” (Fields). He and other anthropologist try and find solutions to Somalia’s problems and other African Nations. Vice-President Joe Biden’s wife has led the United States aid effort to help with the drought and famine. There are other programs that constantly help this region and the main one is UNICEF. They say, “640,000 children are acutely malnourished in southern Somalia alone. Their programs support 16 stabilization centers, 201 outpatient therapeutic programs, and 325 supplementary feeding programs” (Fields).

Referring back to the problem with terrorist and militant groups disrupting aid, “When a United Nations food shipment arrived on Friday in Mogadishu, a gunfight broke out and seven people were killed.  Himmelgreen says, “I think it will get better, but it won’t be before a lot more children die or get very sick”(Fields). Not only do these militants take aid away from the Somalians, but also they disrupt refugees from fleeing to surrounding countries. The article says that Somalia has seven million people and over three million people needed food, water, and health care due to malnutrition.

Anthropologists like Himmelgreen knew the situation in Somalia was getting worse. He says, “They have these early warning famine systems in place. The U.S. government has one so there are sets of indicators that they look at and they can tell months in advance if there’s an impending famine. But because of all the politics there was relative inaction”(Fields). It is unfortunate that politics can get in the way of what needs to happen. I think when a serious problem like this occurs people should act and let politics take place later on. The worst part is that children suffer the most. They have the least amount of representation.

Hopefully in the future there can be improvements in famine prevention, but as bad as it sounds Africa seems to never truly benefit from aid. Everything that seems to be done there is just a small band-aid on a very large wound. There are many political and government issues that need to be worked out. The countries have governments, but warlords control many countries. The saddest part is that the people suffer and without the basic human necessities of clean water, quality food, and shelter the health of the country will not improve. The amount of people dying in Somalia also takes a toll on those who survive. The mental and physical health of these people is constantly in shambles. I think anthropologist, health care providers, and political leaders are all needed to fix this lingering problem.


Fields, Tammie. “29,000 Children Dead from Famine in Somalia.” N.p., 6 Aug. 2011. Web. 10 Aug. 2012. <>.


Gartenstein-Ross, Daveed. “Thousands Dying from Malnutrition in Somalia.” Thousands Dying from Malnutrition in Somalia. Christian Broadcast News, 20 July 2011. Web. 10 Aug. 2012. <>.