HIV AIDS

Almost a million people [940 000 with a range of 480 000–1.4 million] were living with HIV in Malawi in 2005. Adult national HIV prevalence was estimated at 14.1% [6.9%–21.4%] in 2005 (UNAIDS, 2006), close to the 12.7% adult prevalence reported in the 2004 Demographic and Health Survey (National Statistical Office and ORC Macro, 2005). HIV infection levels in Malawi overall appear to have stabilized since the turn of the century, with median HIV prevalence measured at sentinel surveillance sites fluctuating between 15% and 17% in 2001–2005 (National AIDS Commission Malawi, 2005). However, infection levels decreased at semi-urban and urban HIV surveillance sites from 26%–27% in 1999 to 17%–20% in 2005 (National AIDS Commission Malawi, 2005). In the capital, Lilongwe, HIV prevalence among women using antenatal services peaked at 27% in 1996 before receding to 17% in 2003. That decline, however, was not sustained in 2005, when prevalence among pregnant women increased slightly to 19% (Bello, Chipeta, Aberle-Grasse, 2006; National AIDS Commission Malawi, 2005).

Some behavioural changes appear to be associated with the observed declines in HIV prevalence. When surveyed in 2000, smaller percentages of women and men reported having sex with multiple partners, compared with 1996. The proportion of young men (aged 15–24 years) with two or more casual partners, diminished by more than half (from 28% to 12%), while among young women it declined from 3% to less than 1%. More young women reported using condoms with casual partners in 2000, compared with 1996 (31% versus 22%), although condom use rates for young men stayed the same at 38%. The percentage of women and men abstaining from sex in the previous 12 months altered slightly between 1996 and 2000 (for women it rose from 21% to 22%, and for men it increased from 17% to 20%) (National Statistical Office and ORC Macro 2001 and 1997). In addition, it is likely that rising mortality rates (which doubled between 1992 and 2000) could be responsible for large parts of the observed declines in HIV prevalence.

Although Malawi is a small country, its epidemic varies considerably from place to place. At 17.6% in 2004, adult HIV prevalence in the southern region was roughly three times higher than in the central region and twice as high as in the northern region (National Statistical Office and ORC Macro, 2005). The epidemic in the north has been growing, with HIV prevalence tripling from around 5% in 1998 to above 15% in 2003 in rural areas (Bello, Chipeta, Aberle-Grasse, 2006; Ministry of Health and Population Malawi, 2005). This trend in the north may be related to socioeconomic growth in and around Mzuzu city and along major transportation routes (Bello, Chipeta, Aberle-Grasse, 2006; Ministry of Health and Population Malawi, 2005).

As in other countries in the region, HIV prevalence among young women (15–24 years) in Malawi is much higher than among men of similar age: 9% compared with 2% overall, and 13% compared with less than 1% in urban areas (National Statistical Office and ORC Macro, 2005). Only one in four young women demonstrated comprehensive knowledge of HIV when surveyed in 2004, compared with more than one in three men (National Statistical Office and ORC Macro, 2005).

Source UNAIDS. DEC 06 EPIDEMIC UPDATE