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FACTORS GENERALLY PERPETRATING THE SPREAD OF HIV/AIDS IN MALAWI AND OTHER HIGH PREVALENCE COUNTRIES IN SUB-SAHARAN AFRICA.
MARISEN MWALE: PH FELLOW COM/CDC/PEPFAR
ATTACHED- MACRO SECRETARIAT [LILONGWE]
DEPARTMENT OF EDUCATION AND TEACHING STUDIES
HIV/AIDS remains a global health problem of unprecedented dimensions.
Unknown 27 years ago, HIV/AIDS has already caused an estimated 25 million deaths worldwide and has generated profound demographic changes in the most heavily affected countries. According to the Joint United Nations programme on HIV/AIDS, sub-Saharan Africa remains the epicenter of the pandemic and region most heavily affected by HIV/AIDS, accounting for 67% of all people living with HIV globally and for 75% of AIDS deaths in 2007 [UNAIDS, 2008]. Malawi is among the ten sub-Saharan countries with the highest HIV prevalence in the world, estimated at 12% of adults aged 15-49 by the National HIV Prevention Strategy , and pegged at 11.9% by UNAIDS . Other sub-Saharan countries with highest global prevalence rates include; Swaziland- 26.1%, Lesotho- 23.2%, Botswana- 23.1%, South Africa- 18.1%, Zimbabwe- 15.3%, Namibia- 15.3%, Zambia- 15.2%, Mozambique- 12.2% and Kenya- high but not documented; in such descending order.
Several factors account for the high prevalence rate not only in Malawi in particular but sub-Saharan Africa as a whole. Such a constellation of variables range from cultural determinants across the continuum to socio-economic, environmental, psychosocial and other structural determinants. In Malawi culture is one of the most powerful precursors and predisposing factors to contracting HIV and it is interlinked with many other variables in the whole equation. There are several cultural practices across the nation from Nsanje to Chitipa that one can rightly construe as counterproductive relative to the fight against the spread of HIV/AIDS.
Kulowa kufa- a widow cleansing ritual -is practiced in the lower shire. Kusasa/kuchotsa fumbi- sexual cleansing of graduate initiates -is practiced in most parts of the southern region. Chokolo- widow inheritance- is practiced by many ethnic groups across the nation. Chimwanamaye- mutual exchange of wives or girl friends among peers as an expression of good friendship or to strengthen friendship ties- is practiced in certain parts of the southern and central regions. Nhlazi- offering a younger sister to a son in law in appreciation for proper care of the elder sister- is practiced in certain parts of the northern region. Kupimbira- offering in marriage a young girl of unmarriageable age in exchange for material or financial support – is practiced in the northern region. Mitala- polygamy- is practiced by several ethnic groups across the nation and lastly Fisi/chipambanjete- a ritual where some men are tasked with anonymously deflowering virgins- is a practice common in both the southern and central regions of the nation. Above all else cultural initiations of adolescents among the Chewa of central Malawi, the Yao of southern Malawi, the Lomwe of southern Malawi and several other ethnic groupings even in the northern region have a bearing in the spread of the pandemic. It is believed adolescents who have been initiated or even circumcised are more likely to be sexually experienced and active compared to those who are not. This is considered the case because the curriculum in traditional initiation rites condones and encourages sexual exploration. Such cultural dynamics as have been highlighted by no means posit not an optimistic overture in this struggle against HIV/AIDS bearing in mind that old traditions die hard with experience having explicitly taught us that many societies vehemently resist change to their long cherished traditional values, beliefs, attitudes and behaviors.
Multiple and concurrent partnership is another factor that is exponentially perpetrating the spread of HIV/AIDS in Malawi and other sub-Saharan high prevalence nations. Especially so among men of economic standing and even those construed as influential, having several partners is seen as prestigious- a sign of machismo, popularity, potency, virility and manhood. This behaviour is considered normative and is even promoted and condoned by women. Faithfulness to one partner is stereotyped as a sign of weakness which is culturally construed to be a resultant of the man having been given love portions by his wife. Women are thus expected to remain faithful but men to philander irrespective of marital status. These attitudes, beliefs and values militate against contemporary preventive philosophies such as zero-grazing or one-love where persons are expected to be faithful to only one partner of their choosing in marriage or otherwise.
Psychologically research has further indicated that most people do not consider themselves to be at risk of infection by HIV either as a function of cognitive processes such as optimism of personal precautions taken or motivational processes such as are a result of wishful thinking. This has been shown to be heightened even against odds of risky sexual debuts or exposure to HIV. Among the youth for instance lack of intra-personal skills to resist social pressure has been shown to exacerbate such confounded risk perception registering a gap in the need to enhance life-options and social skills training in the age group. Skills training for instance self-efficacy training motivates the youth to uphold the belief and confidence in their ability to withstand social pressure vis-à-vis indulgence in risky sexual behaviours. UNICEF  states that about nine in every ten young people aged 15-19 in sub-Saharan Africa have heard of HIV/AIDS but most are not familiar with the ABCs of prevention- abstinence, being faithful to one partner and use of condoms. This scenario again paints a gloomy and pessimistic picture in the war against AIDS since the youth provide us with a window of hope not only in the area of mitigation but overall curtailing of the pandemic.
A culture of silence also surrounds most reproductive health issues with many parents not comfortable with and considering such sexual issues taboo. Compounding this lack of education is the fact that most young people are left to learn about sex from peers or worse still as already highlighted in the foregoing through initiation rituals where they are exposed to a curricular that perpetrates sexual activity hence fuelling the spread of the pandemic. Many youths are also economically dependent and socially inexperienced and not having been taught or otherwise learnt to protect themselves means being at pernicious risk to the shackles of HIV/AIDS. Psychological egocentrism further fosters and instills a sense of invulnerability among so many teenage youth.
Notwithstanding HIV/AIDS has had several devastating repercussions in Malawi in particular and sub-Saharan Africa in general. First and foremost HIV/AIDS is depleting adult productive capacity with teachers, doctors, lawyers, farmers, engineers and what have you falling prey to the deadly scourge. Secondly, public resources are being drained in no measure comparable to any other plague in history. Especially for the ever dependent economies of Africa and Asia, this has fostered economic underdevelopment and overreliance on western donors further perpetrating the dependency syndrome. Thirdly, relative to life expectancy, gains made previously are drastically being reduced. AIDS is erasing decades of progress made in extending life expectancy which for Malawi is now tagged at around 37 or 40 thereof, whereas it could have been 62 in sub-Saharan Africa in general without AIDS. HIV/AIDS has above all else also put extra pressure on the already limited resources through overtaxing health care facilities, payment of premature death benefits, caring for AIDS orphans and many other liabilities bequeathed. Governments are spending a lot to purchase drugs to curtail opportunistic infections and on ARVs for AIDS patients hence taxing the health sector already overstretched by other tropical diseases as Tuberculosis and Malaria. The question however still remains whether we are fighting a winning battle considering the many variables and factors militating against behavioral change in our cultural, socio-economic as well as psychosocial domains. It might be plausible to bet we still have higher mountains to climb and a long way to go.
NAC (2009) National HIV Prevention Strategy [2009-2013]
UNAIDS (2008) Report on the global AIDS epidemic, Geneva.
UNICEF (2006) How does HIV affect young people? http://www.unicef.org.
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