Don’t forget HIV, Aids

Dan Namarika graduated from the University of Malawi’s College of Medicine in 1999 as one of the first students to follow their entire medical training in the country.

The doctor has risen to become the principal secretary for the Ministry of Health.

His long career as a medical doctor, which included four years as personal physician to the late president Bingu wa Mutharika, was prompted by a desire to act against HIV and Aids.

“The reason I chose medicine was because of Aids. I couldn’t believe there was an illness like this with no cure. I remember the first case in my neighbourhood. It was a lady who succumbed to Aids after a chronic illness. I have had family members that have died. My long history has been impacted on by Aids,” he says.

During the peak of the HIV epidemic to which Namarika refers, there were 110 000 new infections annually between 1993 and 1994. Every year, nearly 65 000 deaths from Aids-related illnesses occurred from 2004 and 2005.

Ever since, Malawi has made good strides in its HIV response.

This progress can be attributed to the introduction of innovations such as Option B+ in 2011. The prevention of mother-to-child transmission of HIV strategy ensures that all pregnant women living with HIV have lifelong access to HIV treatment.

In 2016, the Ministry of Health rolled out the test-and-start strategy, which offers immediate HIV treatment for all people living with HIV.

As a result, new HIV infections in the country have dropped by 40 percent from 64 000 in 2010 to 39 000 in 2017.

This approach has also halved Aids-related deaths by 34 000 in 2010, increasing life expectancy from a mere 46 years in 2004 to 64 in 2018. Interestingly, projections show that life expectancy will rise to 74 by 2030.

In 2017, about 92 percent of pregnant women living with HIV in the country accessed services to prevent mother-to-child transmission of HIV. This lowered the number of new infections among children below 14 years old to an all-time low of 4 900 in 2017.

Namarika attributes these successes in large part to the multisectoral HIV response and high-level political commitment and leadership.

“Besides policies being made at the highest levels of government, we also have ministries other than health involved, such as the treasury, gender, education and local government. We have civil society, the faith-based sector, cultural leaders and technical assistance from development partners, such as Unaids,” he says.

He also praises programme-related innovations, such as task shifting from doctors to nurses and community healthcare workers, which has helped to reach more people with HIV testing and treatment services.

The 2015–2020 National Strategic Plan for HIV and Aids has the 90–90–90 targets at its heart, with ending Aids by 2030 in Malawi as the end goal.

This calls for efforts to ensure 90 percent of people living with HIV know their status by 2020 as well as ensuring 90 percent of those diagnosed with the virus know their status and 90 percent of those on treatment take drugs consistently until the viral load is undetectable.

The country has made good progress in the number of people living with HIV who know their status. Almost 90 percent know their status and 71 percent of people living with HIV are on treatment.

However, more work is needed to increase the number of people who have suppressed viral loads from 61, which puts the country at risk of not meeting the targets next year.

The major obstacle to Malawi’s progress in meeting the targets, according to Namarika, is people being left behind because of socioeconomic and structural disparities driven by poverty, unemployment and gender inequality.

He also believes that a location–population approach is needed to address vulnerabilities exacerbated by migration and natural disasters, such as frequent drought and floods experienced by people in the south-eastern region.

Another challenge in the national Aids response is high new HIV infections among adolescent girls and young women aged 15 to 24. They accounted for 9500 new infections in 2017,  more than double that of their male counterparts (estimated at 4 000).

“Most young people cannot make ends meet. This puts girls most at risk. Their rights can be easily trampled on by older men. Also, health-seeking behaviour among young men needs to be improved,” he says.

However, the secretary for health believes that the biggest obstacle to progress in the Aids response is complacency.

“When I was a young medical doctor, on some days, we would have 19 deaths in the paediatric ward alone. Not in the whole hospital, just in that one ward. Now, the young doctors don’t see that anymore, so they don’t believe that HIV is real,” he says.

Namarika calls for continued financing for the Aids response and greater emphasis on HIV prevention.

“This will require a growing domestic investment as well as convincing development partners to put more external sources of funding into HIV prevention, he says.

He believes that it is critical to continue to engage with communities on Aids with the same urgency that there was in the early 2000s, so that the significant gains that the country has made are not lost.

 “If the cost of Aids is not regarded as one of the biggest historical disasters we have experienced in the 54 years of our independence, then we have lost our history,” he states.—Unaids