Malawi should own the war on HIV or...

As part of World Aids Day coming up on 1st December, here is an issue Malawi should sit and listen to.

Emily Banda [not real name] is about 55. A grandmother of six, she had three children who are now dead, leaving her with the burden of looking after the grandchildren.

 Her skin is close to her bones and her eyes beam from deep inside her skull. It is a familiar story—Banda is HIV positive.

Gogo Banda flanked by her two friends - Whats their future?  

“I loved my deceased daughter so much that I cared less about her ailment and in the process of taking care of her during her sickness, I contracted the virus,” said Banda.

She discovered her condition after illness would not leave her a few months after burying her daughter. She is now three months on anti-retro-viral therapy (ART). She is not fully used to the drugs and she is feeling the effects of the powerful medicines.

Banda sits in a hut in Lilongwe’s Area 21 flanked by three other women who also carry the HIV virus. The reason their faces brighten up is that the life-prolonging medicines give them hope that they will see another day at least.

That could all change after 2014.

A crucial donor who buys most of the anti-retroviral drugs (ARVs) for Malawi will no longer do so after 2014 and unless Malawi identifies another donor or buys the ARVs herself, HIV and Aids will ravage people such as Banda and take an enormous toll on the impoverished nation.

The revelation has been discussed in a resource mapping document prepared by the Ministry of Health and Clinton Health Access Initiative titled HIV Funding in Malawi: Key Findings from Resource Mapping, published on 18 September this year.

“55 percent of HIV funding in Malawi is at risk with the Global Fund grant ending in 2014,” warns the document.

The report says although the current grant will end in 2014, Malawi will have access to two years of funding that will maintain drug purchases for all existing patients which will allow for continued treatment, but with limited chances of being increased.

Banda and the other women that I assembled in Area 21 are worried by the spectre of a potential scaledown in the distribution of ARVs.

“ARVs gave us hope; we are now able to do manual labour to take care of our families because ARVs give us strength. Cessation of HIV funding would be killing the Malawi nation because we are not alone, there are many of us,” said one woman who does laundry in people’s houses for a living.

Another woman pointed to her pregnancy, saying despite having HIV, she can afford to bear a child because of the drugs.

“Recall the deaths that used to be there in the late 90s. ARVs give us a reprieve. If they stop giving people ARVs, the number of orphans will rise sharply. Imagine, we are already unhealthy with ARVs; how will life be without them?” she said.

The woman added that without drugs, stigma will come back as it will be easy to identify those with HIV.

Martha Kwataine, executive director of the Malawi Health Equity Network, says it is time Malawi put ARV purchases in the budget.

Kwataine - lets act with speed

“The government must start with the forthcoming 2013/14 national budget to allocate resources for ART. That will be a way of weaning ourselves from donors. If we can start by allocating say K5 billion in the 2013/14 budget, that would go a long way than leaving the whole game to donors who sometimes impose unrealistic conditionalities to their aid.

“It’s high time Malawi began to show its commitment to allocating resources for ART,” said Kwataine.

Board chairperson of the National Aids Commission (NAC) Mara Kumbweza-Banda played down the gravity of the situation, saying Global Fund is not the only partner supporting Malawi in HIV interventions.

“Even if Global Fund withdrew today, we will be able to manage. We have other strong partners such as the United States Government, CDC and others,” said Kumbweza-Banda.

Kumbweza-Banda - Not worried

However, she acknowledged the need for Malawi to avoid relying too much on donors. Kumbweza-Banda said a resource mobilisation strategy is being drafted to that effect, but could not divulge details, saying the information will only be available when the strategy is ready.

She said independence cannot come overnight, arguing that Malawi is making strides in the fight against HIV and Aids.

Out of the $354 million (about K114 billion) that was channelled to fight all diseases in the 2012/13 financial year, 60 percent went to HIV. That is a staggering $212 million (about K70 billion).

The $212 million, which comprises money from the Global Fund, Health Resources and Services Administration, and UNAIDS, among others, will shrink to $117 million next year, $84 million in 2014-15 and remain the same $84 million in 2015-16 following the decreases in funding from Global Fund and others.

According to CHAI (clintonfund.org), the average cost of treating an HIV patient for one year in Malawi is $200 (K64 000).