Chimwemwe (not real name), a sex worker from Zingwangwa Township in Blantyre, says the suspension of oral and injectable pre-exposure prophylaxis (PrEP) “is a death sentence”.
She said this on Wednesday night in reaction to the suspension of PrEP by the Directorate of HIV, Sexually Transmitted Infections (STI) and Viral Hepatitis under the Ministry of Health.
Oral PrEP is a daily pill used to reduce chances of contracting HIV while injectable PrEP, which Malawi rolled out in 2024, is an antiretroviral (ARV) medication injected every two months to prevent HIV.
These are given to people at high risk of HIV such as sex workers, men who have sex with men, survivors of rape and people who inject drugs, among others.
Chimwemwe said she is now worried and fears for her future.
“I have been taking PrEP for two years, giving me peace of mind because even if a customer insists on not using a condom, I know I am protected,” she said.
She said men who discard condoms offer irresistible hefty sums of money to sleep with them, further exacerbating her fears.
National Aids Commission’s (NAC) recent data shows HIV prevalence is highest among the sex workers, drug users and transgenders.
But Chimwemwe is not alone as many sex workers, including men who have sex with men, rely on PrEP to reduce their risk of HIV transmission.
In a separate interview on Tuesday, Elizabeth (not real name) from Chilobwe Township said the suspension will likely result in her contracting HIV.
She said: “We are already stigmatised, marginalised and now we are being deprived of the one thing that can protect us from HIV.”
Several other sex workers we spoke to from Lilongwe with the assistance of organisations they work with also expressed similar fears, saying in the absence of PrEP, the majority will be at risk of contracting HIV.
A circular signed by Directorate of HIV, STI and Viral Hepatitis director Linley Chewere says PrEP suspension is part of contingency measures following the temporary suspension of the President’s Emergency Plan for Aids Relief (Pepfar) by its implementing partners.
Pepfar halted its operations following United States (US) President Donald Trump’s Executive order on January 20 2025, immediately suspending all foreign assistance.
Apart from PrEP, the directorate has also suspended dispensing of ARV emergency refills, sample transportation for HIV viral load and routine viral load HIV testing.
Reads part of the circular: “The following services are considered as of moderate/low priority and, therefore, may need to be reduced or discontinued if staffing/logistics dictate.”
NAC figures show that as of December 2022, HIV prevalence among an estimated population of 39 000 sex workers was 49.9 percent while among a population of 35 400 men who have sex with men, it was 12.8 percent.
The statistics further show that among a population of 8 400 who inject themselves with drugs, the prevalence stood at 27.0 percent and 13.8 percent among Health rights activist Maziko Matemba on Tuesday said the situation must be a wake-up call for Malawi and other low-income countries to do soul-searching when introducing programmes and products that are too donor-dependent so that rights of people accessing such services are respected.
“But also, donor countries should allow countries to introduce only sustainable health services in respecting the rights of people accessing them.
“It is also important for Malawi to consider adopting health financing reforms to fill gaps of the suspended services at short, medium and long-term,” he said.
Data from NAC shows new HIV infections have been reduced by 88 percent since the peak of the pandemic in 1993 as 15 630 people were newly-infected in 2022 compared to 130 880 people in 1993.
The data further shows that since 2010, new HIV infections have declined by 72 percent from 56 054 to 15 720 in 2022.
New HIV infections among children also declined by 82 percent since 2010, from 15 561 to 2 792 in 2022.
According to the data, women and girls accounted for 61 percent of all new infections in 2022 with 33 percent being women while 21 percent were among adolescent girls and young women.
Aids-related deaths also reduced by 85 percent since the peak in 2003.
In 2022, about 11 931 people died from Aids-related illnesses, compared to 77 319 people in 2003.
It is estimated that 1 006 000 people out of Malawi’s estimated 21 million population are living with HIV with the country targeting to reduce new HIV infections from 17 700 in 2022 to about 11 000 cases in 2025.
In April 2024, NAC attributed high HIV infection rate to tertiary institutions.
