Malawi

HIV/AIDS epidemiological summary

HIV prevalence information among antenatal clinic attendees has been available since the mid-1980s from Malawi. In Malawi, Lilongwe, Blantyre and Mzuzu are considered major urban areas. From 1985 to 1993, HIV prevalence among antenatal women increased from 2% to 30%. In 1998, 26% of antenatal clinic attendees tested HIV-positive. In 1997, 17% of the women less than 20 years of age were HIV-positive. Peak HIV prevalence of 32% was seen among women aged 25 - 29 years of age.

Outside of major urban areas, HIV prevalence among antenatal women tested increased from 6% in 1992 to 18% in 1998. The range of HIV prevalence among antenatal women tested in 14 sites¹ in 1998 was from 6% to 25%. In 1998, combined age data were available from all 19 sites, including the major sites and outside of the major urban areas. Fourteen per cent of the women less than 20 years of age were HIV-positive and peak prevalence of 28% was reported among women 25 - 29 years of age.

¹ Two of the reporting sites had sample sizes of less than 100.

In 1986, 56% of sex workers tested in Blantyre were HIV-positive. In 1994, 70% of sex workers tested in Lilongwe were HIV-positive. Over 50% of STD clinic patients tested in the major urban areas between 1989 and 1996 were HIV-positive. In 1995, 46% of STI clinic patients tested at seven sites outside of the major urban areas were HIV-positive.

Estimated number of people living with HIV/AIDS, end 1999	Adults and children	Adults (15-49)	Adult rate (%)	Women (15-49)	Children (0-14)
Source: UNAIDS/WHO, June 2000	800 000	760 000	15.96	420 000	40,000
Demographic impact of HIV/AIDS		Year	Estimate	Source
Children who lost their mother or both parents due to HIV/AIDS at age 14 or younger since the beginning of the epidemic		1999	390 000	UNAIDS/WHO, June 2000
Estimated AIDS deaths		1999	70 000	UNAIDS/WHO, June 2000
Behavioural indicators		Year	Age group	Male	Female
Reported condom use during most recent intercourse with a non-regular partner (%)		-	-	-	-
Reported non-regular sexual partnership over a 12-month period (%)		-	-	-	-
Measured HIV prevalence		Year	Median	Min.	Max.
Women in antenatal care clinics - major urban areas (%)		1998	26.0	18.5	30.4

Figure

Economic Impact of HIV/AIDS

Summary of the economic impact of HIV/AIDS

Data on the economic impact of AIDS in Malawi are extensive when compared with other countries of sub-Saharan Africa. Studies available include the macroeconomic impact, assessment and planning work carried out by the World Bank and the Government of Malawi, and a study on a commercial tea estate. Much of this work uses regional data to model potential impact on the economy or economic sectors. Preliminary results of a recently developed model on the macroeconomic impact of AIDS show that the impact is average for sub-Saharan Africa. Of the sectors explored, no data are available on the impact of AIDS at the household level. The studies in business show a reduction in profits due to AIDS-related morbidity and mortality. In education, increasing mortality rates due to AIDS have led to discontinuity in teaching, with many pupils losing or having a change in their teachers. The health sector studies demonstrate that there is a large gap in funding to meet the full needs of a scaled-up care and prevention programme, equivalent to US$ 3-4 per capita and 1.9% of GDP.

Macroeconomic impact

Preliminary results of a model developed in 2000 estimate the annual loss in GDP growth per capita as a result of AIDS to be 0.7% by 2010 (1).

Economic impact of HIV/AIDS on households

Not available

Economic impact of HIV/AIDS on agriculture

On a Makandi tea and coffee estate, production loss as a result of AIDS was shown to be 3.4% of gross profit in 1995/96 (2).

Economic impact of HIV/AIDS on firms

Supply: AIDS-related costs were found to be 1.1% of total costs and 3.4% of gross profits in Lonrho companies in 1992 (3).

Economic impact of HIV/AIDS on education

Supply: a model developed by UNAIDS and UNICEF in 2000 shows that, of around 2.8 million primary school students, 52 000 would have lost a teacher to AIDS in 1999 (4). By 1997, over 10% of education personnel in urban areas are estimated to have died from AIDS and, by 2005, this figure is projected to increase to 40% (5). In one district, 10% of teachers died in the first term of the 1998/9 academic year (6). Malawi Schools Support Systems Programme Review Report projects cumulative AIDS deaths among primary school teachers and secondary school teachers to be 2369 and 284, respectively, by 2001, and 6158 and 739 by 2006, cited in (7).

Demand: Not available

Economic impact on the health sector

Supply: It is estimated that, by 1997, over 10% of health, education and military personnel in urban areas would have died from AIDS; by 2005, this figure is projected to increase to about 40% (5).

Demand: AIDS patient numbers were estimated to have at least equalled the total number of all other causes of outpatient visits in 1996 (5). Approximately 20% of MOH curative budget is spent on HIV/AIDS-related expenditure (5).

Resource gap: The annual cost of scaling-up HIV/AIDS activities is estimated to be between US$ 31million and US$ 48 million (8).

Management and implementation of the national response to HIV/AIDS

Policy formulation

Existence of National HIV/AIDS policy (either a written document or part of one)

Yes	No
	X

Comments/Key elements: Will include: MTCT, multisectoral issues, gender, VCT, human resource management, other legal and ethical issues. Currently being developed. Estimated completion by October 2000.

Source: UNAIDS Malawi

Date: June 2000

Existence of HIV/AIDS policy in the following sectors:

Sector	Yes	No
Agriculture		X
Education		X
Health	X
Military	X in draft
Workplace		X
Sports		X
Others (prisons & immigration)	X In draft

Comments/Key elements: Processes are under way in agriculture, education, sports and other sectors to incorporate HIV/AIDS into their sectoral policies.

Source: UNAIDS Malawi

Date: June 2000

Existence of HIV/AIDS-specific legislation against discrimination on the grounds of HIV

Yes	No
	X

Comments/Key elements:
Source: UNAIDS Malawi
Date: June 2000

Organizational structure

Existence of high-level structure in support of the national response

(e.g. National AIDS Committee/Commission, Inter-Ministerial Committee, Presidential-level bodies)

Yes	No
X

Comments/Key elements: A cabinet committee on HIV/AIDS prevention and care, chaired by the Vice President, was established in 1998 to oversee the activities of the National AIDS Control Programme and to provide support to issues requiring urgent attention. Within the context of the National Strategic Planning Framework, the placement, legal status, and staffing of the National AIDS Secretariat is being reviewed to identify the changes required to enable the Secretariat to effectively manage and coordinate an expanded multisectoral response. An inter-ministerial committee is being established to coordinate public sector interventions and to monitor the extent and quality of mainstreaming of HIV/AIDS into the different sectors.

Source: UNAIDS Malawi

Date: June 2000

Planning and programming

Existence of national strategic plan on HIV/AIDS

Yes	No
X

Comments/Key elements: The National HIV/AIDS Strategic Framework (2000-2004) and the Agenda for Action, which were launched on 29 October 1999, are the culmination of a national process that started in February 1998. The framework sets out goals, guiding principles, broad objectives and strategies for the country for the period 2000 - 2004. The activities of the framework have been costed and the financial resource gap has been estimated in broad terms. The National AIDS Secretariat has done prioritization in terms of the interventions requiring urgent attention to stem the epidemic and to provide for a strengthened NACP, necessary to manage and coordinate the national response. A Round Table to mobilize resources for the implementation of the Framework was conducted in March 2000.

Following the launch of the National HIV/AIDS Strategic Framework, a process was initiated to develop district-specific plans. While the district plans will be based on the national framework, the contents of each plan will vary, depending on the circumstances and priorities in that district. District Assemblies will be responsible for implementation, monitoring and evaluation of their activities. Six district plans were in place by the end of March and the remaining 20 districts are expected to have plans in place by the last quarter of 2000.

Source: NACP/Malawi

Date: June 2000

National strategic plan on HIV/AIDS includes clearly identified priorities

Yes	No
X

Comments/Key elements:

The priorities are as follows:

1) Dissemination of the National Strategic Framework for HIV/AIDS through the development of district-specific implementation plans.

2) Institutional capacity building: NACP - staffing, equipment/materials funding and monitoring and evaluation; NGOs/CBOs - strengthening coordination mechanisms in place.

3) Prevention: Interventions for youth (behavioural change, youth-friendly reproductive health services, life skills programmes), STI management, condom promotion, prevention of MTCT, blood safety, exploration of modalities for increasing access to antiretroviral drugs and treatment of opportunistic infections.

Source: NACP/Malawi

Date: June 2000

Existence of budget for implementation of the national strategic plan

Yes	No
X

Comments/Key elements: The total cost estimated for implementing the framework (activities and institutional support) over the period 2000-2004 is US$ 121 million. Government contribution is US$ 445 000. It should be noted that the estimated government contribution does not include financial resources consumed by HIV/AIDS patients in health care facilities. About 70% of inpatients in public health care facilities are suffering from HIV/AIDS-related illnesses, which implies that most of the recurrent expenditure in the public health care facilities is spent on HIV/AIDS-related illnesses. All of the foregoing, of course, means that the government contribution noted above is grossly inadequate. The resource mobilization round table, organized in March 2000 to mobilize funds for the implementation of the framework, raised in excess of US$ 100 million.

Source: UNAIDS Malawi

Date: June 2000

General demographic and socioeconomic indicators

Demographic indicators	Year	Estimate	Source
Total population (thousands)	1999	10 640	UNPOP
Population aged 15-49 (thousands)	1999	4694	UNPOP
Annual population growth (%)	1990-1998	1.3	UNPOP
% of population urbanized	1998	14	UNPOP
Average annual growth rate of urban population (%)	1990-1998	2.9	UNPOP
Economic indicators	Year	Estimate	Source
GNP per capita (US$)	1997	210	World Bank
GNP per capita average annual growth rate (%)	1996-1997	2.5	World Bank
Human Development Index rank (HDI)	2000	163	UNDP
% population economically active	-	-	-
Unemployment rate	-	-	-
Education indicators	Year	Estimate	Source
Total adult literacy rate	1995	56	UNESCO
Adult male literacy rate	1995	72	UNESCO
Adult female literacy rate	1995	42	UNESCO
Male secondary school enrolment ratio	1996	22.0	UNESCO
Female secondary school enrolment ratio	1996	12.2	UNESCO
Health indicators	Year	Estimate	Source
Crude birth rate (births per 1000 pop.)	1999	47	UNPOP
Crude death rate (deaths per 1000 pop.)	1999	23	UNPOP
Maternal mortality rate (per 100 000 live births)	1990	560	WHO
Life expectancy at birth	1998	39	UNPOP
Total fertility rate	1998	6.7	UNPOP
Infant mortality rate (per 1000 live births)	1999	135	UNICEF/UNPOP
Contraceptive prevalence rate (%)	1990-1999	19	UNICEF/UNPOP
% of births attended by trained health personnel	1990-1999	47	UNICEF
% of one-year-old children fully immunized-DPT	1995-1998	68	UNICEF

References

(1) Bonnel, R. What Makes an Economy HIV-Resistant? Draft report presented during the International AIDS Economic Network Symposium, Durban, South Africa, 7-8 July 2000.

(2) Jones C. What HIV costs a tea estate in Malawi. AIDS Analysis Africa 1997; 7(3):5-7.

(3) Ntirunda and Zimba. The Impact of HIV/AIDS on production: the experience with Lonrho companies, Malawi. Paper represented at the International Conference on AIDS, Geneva, 1998.

(4) UNICEF. The Progress of Nations 2000. Background paper. New York, UNICEF, 2000.

(5) The World Bank. Malawi AIDS Assessment Study. 10. Washington D.C., World Bank, 1998.

(6) Government of Malawi and UNICEF. Youth and Education Sectoral Review. Malawi, Government of Malawi/UNICEF, 1999.

(7) Tayari, M. Assessment of the Impact of HIV/AIDS on the supply and demand of primary education in Malawi. Draft. Department for International Development (UK) - Education Sector, 2000.

(8) World Bank and UNAIDS. Costs of Scaling HIV Programmes to a National Level for Sub-Saharan Africa. Draft report, April 2000.