Quick HIV stats-Malawi (source UNAIDS)
 as of 2011

 
Percentage of adults infected with HIV
 11%

 
Number people living with HIV/AIDS
920,000
Number of adults living with HIV/AIDS
800,000
Number of children living with HIV/AIDS
120,000
Number of deaths annually from AIDS
  51,000
Number of orphans due to HIV/AIDS
650,000


Early AIDS Epidemic

Malawi's first AIDS case was reported in 1985. In response, the government implemented a short-term AIDS strategy (including blood screening and HIV education programs), and in 1988, created the National AIDS Control Programme (NACP) to coordinate the country’s AIDS education and HIV prevention efforts. Some have argued that these measures did little toward controlling AIDS in Malawi, and that it was not until 1989, when a five-year AIDS plan was announced, that the government began to show any real commitment toward tackling the problem.

Malawi was under the rule of President Hastings Banda for thirty years starting in 1964, during which time little attention was paid to the escalating AIDS crisis. His puritanical beliefs made it very difficult for AIDS education and prevention schemes to be carried out, as public discussion of sexual matters was generally banned or censored, and HIV and AIDS were considered taboo subjects. Between 1985 and 1993, HIV prevalence amongst women tested at urban antenatal clinics increased from 2% to 30%.4

In 1994, following protests and international condemnation, Banda agreed to relinquish power and Malawi became a multi-party democracy. President Bakili Muluzi took office and made a speech in which he publicly acknowledged that the country was undergoing a severe AIDS epidemic and emphasized the need for a unified response to the crisis. Freedom of speech was re-established and political prisoners were released, creating a more liberal climate in which AIDS education could be carried out without fear of persecution.

However, by this point AIDS had already damaged Malawi’s social and economic infrastructure. Farmers could not provide food, children could not attend school and workers could not support their families, either because they were infected with HIV or because they were caring for someone who was. In 2002, Malawi suffered its worst food crisis in over fifty years, with HIV recognized as one of the factors that contributed most significantly to the famine. A report suggested that 70 percent of hospital deaths at that time were AIDS related (source avert.org)

Malawi's ART Program

In October of 2000, the Malawi government had its first meeting to evaluate whether or not it would be feasible to offer the life-saving anti-retroviral therapy (ARVs) that had so significantly improved the life-expectancy of HIV/AIDS patients in the west.  At the time, the financial and human resource barriers seemed insurmountable but the Ministry of Health (MOH) and the National AIDS Commission (NAC) initiated an effort to develop a strategy for HIV/AIDS treatment and Malawi was one of the first, and largest recipients of funding from the Global Fund for HIV/AIDS, Tb and Malaria (the Global Fund). 

In 2005, Malawi launched its ambitious ART scale-up plan to deliver free ARVs throughout the country.  Using what has been termed a "public health approach", the initial scale-up plan utilized lower level health providers and essentially no laboratory testing.  The initial scale-up focused on treatment of adults and utilized primarily larger hospitals and health centers in the urban settings where HIV prevalence was highest.  This program is considered to be one of the most successful in resource constrained countries and has proven to have the lowest cost per patient.  Partners in Hope was one of the earliest and largest ART scale-up sites supported by the MOH and NAC.

In 2011, the National ART program began a bold endeavor to maximize access to HIV testing and treatment through an integrated ART/PMTCT (prevention of mother-to-child transmission) program which more than doubled the number of ART sites and reached into previously unreached rural communities.  Partners in Hope was a significant partner coordinating all of the training in Malawi's northern region, training nearly 500 health providers in the new integrated protocol.  This program has significantly improved HIV testing and treatment for pregnant women and children. 

Malawi faces significant financial and human resource challenges as it continues to expand toward universal access to HIV testing and treatment.  The US PEPFAR (President's Emergency Plan for AIDS Relief) has increased its support for HIV/AIDS through USAID (US Agency for International Development) and CDC (Center for Disease Control).