Fighting HIV through oppression

Malawi, the poorest country in the world—or one of them—by measures like the United Nations Development Programme (UNDP) Human Development Index (HDI), is making tremendous strides in dealing with the pandemic that has besieged Africa.

From within, with the traditional caution synonymous with its people, Malawi may not really seem a small giant which with so little has managed to attract global attention regarding fighting HIV and Aids.

But records at the Ministry of Health and empirical evidence by medical researchers from both Africa and elsewhere show a massive leap of hope for a country that, of course, still has the pandemic as one of its biggest threats.

Dzonzi (R) sharing PMCT messages with a family

At the International Workshop on HIV Treatment, Pathogenesis and Research in Resource-Limited Settings which took place in Lilongwe in May this year, then minister of Health Peter Kumpalume, a professor of medicine at Makerere University College of Health Sciences, Elly Katabira, and Deputy Director of Science at the Amsterdam Institute for Global Health and Development, Catherine Hankins, settled on the point that the world has a lot to learn from the southern African country.

“Amid resource constraints, your country has still come top as far as combating the spread of the virus is concerned,” said Katabira, urging that there is, however, no need to sleep easy in the soft arms of the progress.

The medicine expert recalled that in the late 1980s and early 90s, Malawi was one of the heavily affected countries, particularly in terms of HIV cases.

“The population was low, people were dying, but you have changed that because you chose to do it. Donors might have played a role, but it all goes down to your own dedication. HIV is, of course, still there but things are much better now,” Katabira observed.

He also paid special tribute to some researchers like executive director of the Lighthouse Trust, Sam Phiri, who he said have contributed a lot to the reduction of HIV prevalence rates in the country.

Malawi has spearheaded the Prevention of Mother to Child Transmission (PMCT) Option B+ which has since been adopted by the World Health Organisation (WHO), according to Kumpalume.

The Global Network of People Living with HIV (GNP+) says Option B+, a prevention of vertical transmission approach for expectant mothers living with HIV, offers advantages such as protection of a partner, the unborn child as well as benefits to the woman’s health.

Through this approach, women are immediately offered treatment for life regardless of their CD4 count.

But in this ‘era of enlightenment’ where people know their rights more than their wrongs, Malawi had to take a bold step—perhaps a little oppressive—to ensure grinds on the right rail produce something precious.

“The introduction of mandatory testing for every expectant woman has significantly reduced the transmission of HIV from the mother to the child. Of course, at first, women were complaining about their rights being abused.

“Some even shunned the antenatal clinics because they were supposed to get tested before accessing services there. With massive awareness campaigns, things changed. Well, for every good thing, there is a price to pay,” says national coordinator for Grassroots Movement for Health and Development, Alick Makiyi.

The organisation has been particularly keen on ensuring PMCT is wholly achieved in the country.

Makiyi also observes that the policy that makes it mandatory for husbands to accompany their wives to antenatal clinics and get tested has helped in significantly reducing new HIV incidences.

He concedes that it was initially not easy to convince the men for the cause as some felt they were being oppressed by a system “which was just aimed at creating something precious”.

“Abolition of deliveries by traditional birth attendants [TBAs] has also reduced the spread of HIV and Aids especially from mother to child. The TBAs might feel that they are being oppressed but we must look at the greater good,” Makiyi says.

And messages to woo expectant mothers to get tested, husbands to accompany their wives to antenatal clinics and TBAs to abandon their acts are better sent across by those with candid testimonies that achieving zero new HIV infections among children is possible.

Ten years ago, when Malawi was still stuck in the past with stubbornness and tradition; when HIV was still a phenomenon better thrust into the periphery of human thought, Emma Dzonzi of Kalengamadzi Village, Traditional Authority (T/A) Chadza in the outskirts of Lilongwe City decided to defy conventional predictions.

In a community where an HIV-positive status invited nothing but ridicule, Dzonzi spent time thinking about the life of her unborn child.

“When I was three months pregnant, I made a decision to get tested. It was an unpopular decision that time; the message was seen as some kind of oppression; that rights were being abused. But then, there was some life at stake,” Dzonzi says.

In some sheer display of feminine boldness and affection—which she cautiously admits–she convinced her husband to accompany her to the antenatal clinic where they both tested and her worst fears were just confirmed.

“We were immediately put on medication and when my son was born, I had him tested. He was negative. I had him tested again after six months and he was negative again and he still is. I am a proud mother,” Dzonzi boasts.

Her husband passed on some time back.

But her message to expectant mothers out there is that they can significantly contribute to the creation of a generation where every baby is born HIV-free and she pays tribute to the experience as the biggest joy of motherhood.

And for Malawi, Katabira, Makiyi, Hankins and Dzonzi believe there still is more to be done. By any means necessary, expectant mothers—and those expecting to be expectant—and their husbands must endeavour to save their next gifts. n

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