Malawi could be a sick nation where pills fly off the shelves as drugstores fast displace groceries in towns and cities.
The Nation counted two dozen on a 15-kilometre drive from Machinjiri Township to Ginnery Corner in Blantyre.
However, the proprietors are not just worried about uncontrolled drug use fuelling germs’ resistance to prescribed medicine.
We visited about 30 pharmacies in Blantyre and Lilongwe—and the shopkeepers said the same thing: Emergency pills for averting pregnancy after unprotected sex far outsell condoms that prevent both unwanted babies and HIV infection.
Says retired nurse Fidelis Chiku, who owns a pharmacy in Machinjiri: “Emergency pills sell faster than condoms. A box of 20 pills disappears within a week, but I haven’t sold a single condom from a packet purchased two months ago.
“The sales surge when schools close, she states. This points to unprotected sex. However, sexually active young people do not seem to mind HIV infection. They only fear unintended pregnancies. As a concerned nurse, I share tips to motivate them to condomise because the pill doesn’t prevent the virus that causes Aids.”
A girl has to take the pill within 72 hours after sex without a condom.
The rush for it thickens near the campuses of Malawi University of Business and Applied Sciences (Mubas), Malawi College of Accountancy, Malawi College of Health Sciences and Kamuzu University of Health Sciences.
“The demand surges when the colleges open,” said a shopkeeper at a drugstore in Ginnery Corner. “I get at least 10 to 20 customers daily, but the demand more than doubles on Mondays and Tuesdays when most of them return to their senses.”
The seller warns sexually active girls that every every pregnancy results from unprotected sex, which also exposes them to HIV.
“It’s a quirky choice,” said the source. “A pregnancy may disturb their education and parents, but they don’t want to graduate with HIV, do they?”
The ripple effect slows declines in HIV rates, which have been halved from 14 percent since the 1990 when lack of life-prolonging drugs left Malawi to mourning—with funerals and coffin workshop on every street.
National Aids Commission (NAC) spokesperson Grace Khombe says there are no statistics, but several factors shape young people’s attitudes toward pregnancy and HIV risk.
She states: “Evidence shows that adolescents often fear outcomes that feel more immediate, visible and socially consequential. Pregnancy is seen as something that can quickly disrupt schooling, plans and family expectations.
“Improvements in HIV treatment and overall health outcomes mean fewer young people see severe illness in their surroundings, which may contribute to a lower perception of personal risk among some adolescents.”
Khombe says this does not mean the national response is failing, but highlights the need for continued investment in age-appropriate, evidence-based sexual and reproductive health education, accessible youth-friendly services and open family and community conversations about prevention.
Last week, NAC chief executive officer Beatrice Matanje indicated that new HIV infections have dropped by 90 percent from a peak of 115 000 in 1990s to 12 000 in 2024.
“Aids-related deaths have also declined sharply from a peak of 80 000 in 2003 to 14 000 in 2024. It is also pleasing that 92 percent of all HIV positive adults, aged 15 and above, are currently receiving ART. “
What is at stake?
However, she is concerned that a quarter of HIV infections—about 26 percent—occur among adolescent girls and young women, born after the rollout of antiretroviral drugs that help infected people live healthy.
Today, the nation will observe the World Aids Day in the worst-hit districts of Blantyre, Lilongwe, Salima, and Nkhata Bay where rapid urbanisation and widespread poverty fuel risky transactional sex between young girls and older men.
Matanje says the “rapid growth of tertiary institutions with students on self-boarding arrangements and limited supervision” fuels the risky sex web in cities like Blantyre. The colleges are concentrated in the areas with high HIV prevalence and attract students within the worst-infected age group.
This calls for urgent interventions to enhance HIV prevention in tertiary institutions and support the youth living with the virus, Matanje states.
The abolishment of government-sponsored meals and beds in public colleges has pushed girls into risky sex deals amid rising cost of living. Girls desperate for survival dominate the nightlife culture of the cities of Blantyre, Lilongwe, Zomba and Mzuzu.
It could be your daughter.
At Blue Elephant Club in Ginnery Corner, teen girls claimed to be their mothers’ age while old women claimed to be university students.
“Men will shun me if I tell them I am below 18. They are afraid of being arrested for defilement. I’m risking my life to learn, so the after-pill saves my future for now” said a Mubas girl, 17.
‘I weep for them’
Malawi outlawed sex and marriage with girls below 18, but a third still become mothers before their 19th birthday, shows the Malawi Demographic and Health Survey. And men freely buy sex from minors.
This exposes a flashpoint of risky sex web fuelling HIV and drug-resistant gonorrhea beyond Blantyre.
A sex worker, 42, said: “These girls could be your daughters, nieces or your sons’ sexual partners. They hijack our customers, forcing us to pose like university students because old men love them tender.
“But I weep for them. They are playing with fire. After the crazy outings, they return to young sexual partners and infect each other before they graduate or marry.”
