, approximately 1,100,000 people in Malawi are HIV-positive, which represents 10.8% of the country's population. Because the Malawian government was initially slow to respond to the epidemic under the leadership of Hastings Banda (1966–1994), the prevalence of HIV/AIDS increased drastically between 1985, when the disease was first identified in Malawi, and 1993, when HIV prevalence rates were estimated to be as high as 30% among pregnant women. The Malawian food crisis in 2002 resulted, at least in part, from a loss of agricultural productivity due to the prevalence of HIV/AIDS. Various degrees of government involvement under the leadership of Bakili Muluzi (1994–2004) and Bingu wa Mutharika (2004–2012) resulted in a gradual decline in HIV prevalence, and, in 2003, many people living in Malawi gained access to antiretroviral therapy. Condoms have become more widely available to the public through non-governmental organizations, and more Malawians are taking advantage of HIV testing services.
Due to several successful television and radio campaigns by the Malawian government and non-governmental organizations in Malawi, levels of awareness regarding HIV/AIDS are high among the general population. However, many men have adopted fatalistic attitudes in response to the epidemic, convincing themselves that death from AIDS is inevitable; on the other hand, some have implemented preventive techniques such as partner selection to try to reduce their risk of infection. Although many women have developed strategies to protect themselves from HIV, women are more likely to be HIV-positive than men in Malawi. The epidemic has affected sexual relationships between partners, who must cooperate to protect themselves from the disease. In addition, many teachers exclude HIV/AIDS from their curricula because they are uncomfortable discussing the topic or because they do not feel knowledgeable about the issue, and, therefore, many children are not exposed to information about HIV/AIDS at school. Finally, the epidemic has produced significant numbers of orphans in Malawi, leaving children vulnerable to abuse and exploitation.
History
The first case of HIV/AIDS in Malawi was reported at Lilongwe's Kamuzu Central Hospital in 1985. President Hastings Banda, who was in power at the time, responded with several small-scale prevention initiatives and created the National AIDS Control Programme, a division of the Ministry of Health, to manage the growing epidemic. Banda believed that issues relating to sex, including HIV transmission, should not be addressed in the public sphere; during this time, it was illegal for Malawian citizens to discuss the epidemic openly. In 1989, Banda introduced a five-year World Bank Medium Term Plan to combat the epidemic, but HIV prevalence had already increased drastically at this point.
In 1994, when Bakili Muluzi became president, he addressed the nation's need for a coordinated response to the HIV/AIDS epidemic. In 2000, Muluzi introduced another five-year policy known as the National Strategic Framework, but, like Banda's five-year World Bank Medium Term Plan, this plan was largely ineffective. In 2001, in response to problems within the National AIDS Control Programme established by Banda, Muluzi created the National AIDS Commission. Unlike Banda, who prevented the public from accessing information about the epidemic, Muluzi ensured that information about HIV/AIDS was available on the radio and television, in newspapers, and on billboards. However, despite Muluzi's efforts, HIV prevalence was already significantly influencing national agricultural productivity during this period, and Malawi experienced an AIDS-related nationwide famine in 2002.
Malawians gained access to antiretroviral drugs in 2003, and, with a donation from the Global Fund to Fight AIDS, Tuberculosis, and Malaria and the election of new President Bingu wa Mutharika in 2004, government interventions increased substantially. However, soon after his election, Mutharika experienced tensions with Muluzi after implementing an anti-corruption program, which distracted the government from addressing the nation's food and HIV/AIDS-related crises. Despite these obstacles, Mutharika successfully developed a National AIDS Policy and appointed a Principal Secretary for HIV/AIDS during his presidency.
Awareness and risk perception
Despite Malawi's limited health and educational infrastructure, knowledge regarding HIV/AIDS is high among many people living in both urban and rural Malawi. According to a 2004 study by Barden-O'Fallon et al. involving 100 households, women in Malawi are most likely to learn about HIV/AIDS through radio and television, health workers at local clinics, and female members of their social networks. Men are also likely to access information about HIV/AIDS through radio and television; however, unlike women, they are not likely to gain information about HIV/AIDS from their male friends. When 57 Malawian men were interviewed in 2003, 100% of them said they had heard about the HIV/AIDS epidemic on the radio, and 84.2% of them said they had learned about HIV/AIDS during their visits to local health facilities; this supports the fact that many people in Malawi have access to information about the epidemic, both through the radio and other sources. However, this is not a universal sentiment; there are indicators that HIV knowledge is not that high and is comparable to other countries in Sub-Saharan Africa, and that there is a socio-economic knowledge gap.
Personal traits such as age, gender, location, and education correlate, either positively or negatively, with HIV/AIDS awareness levels. For example, older women have demonstrated higher levels of knowledge regarding HIV/AIDS than younger women in Malawi. Because men typically have greater access to education and other social resources, they are often more knowledgeable about HIV prevention and transmission than women. While men are, on average, able to list 2.2 ways to prevent HIV transmission, women are only able to list 1.5 ways. Only 38% of women surveyed in 2003-2004 understood that their husbands would be less likely to contract HIV if they used condoms during intercourse with prostitutes and other women from high-risk groups. In addition, men who are raised in urban environments are, on average, more informed about HIV/AIDS than men who are raised in rural environments, presumably because urban children typically have greater access to educational resources than rural children. Among both men and women, higher levels of education correspond to increased knowledge about HIV/AIDS: men and women who have received secondary school educations are significantly more likely to understand complex aspects of the disease, such as the fact that people who appear healthy can still be HIV-positive, than those who have not. Finally, people who have lost friends or family members to the disease are likely to have greater knowledge about HIV/AIDS due to their personal, firsthand exposure to the problem.
The aforementioned study by Barden-O'Fallon et al., which surveyed 940 women and 661 men, indicated that, despite their knowledge and awareness, many people in Malawi do not feel personally susceptible to HIV infection. On average, only 23% of the adults who were surveyed during this study, both male and female, believed that they were likely to contract HIV and die of AIDS. Greater HIV/AIDS awareness among men does not seem to correspond with increased perceived risk; on the other hand, increased levels of knowledge about HIV/AIDS do correlate positively to perceived risk among women. Another study conducted in rural Malawi between 1998 and 2001 by Kirsten P. Smith et al. indicated that concerns about personal vulnerability to HIV/AIDS declined during this four-year time frame, probably because the increased use of preventive strategies gave people a sense of control. In fact, many participants in this study claimed that they were "not at all worried" about HIV/AIDS; unless they had simply adopted a fatalistic standpoint towards the epidemic, these respondents probably felt that they had successfully reduced their risk of exposure through personal behavioral changes.
Education
Students in Malawi have expressed high levels of dissatisfaction regarding the HIV/AIDS-related education and support they receive at school. According to a survey of students in Malawi, most secondary students do not believe that the HIV/AIDS curricula at their schools provide them with an adequate understanding of the disease. Although the Malawian government and non-governmental organizations have conducted many campaigns to improve awareness about HIV/AIDS in schools, there is still a significant shortage of age-appropriate audio and visual educational materials relating to HIV/AIDS available to instructors, particularly in rural areas. In addition, most teachers cannot identify the students in their classes who have been personally affected by the epidemic, either through friends or relatives, which suggests that school-based support for HIV/AIDS is minimal. However, despite this lack of support, surveys indicate that children who have been affected by the epidemic do not usually experience HIV/AIDS-based discrimination at school.
Most teachers are required to address HIV/AIDS in their curricula; although instructors are, for the most part, committed to helping their students understand and avoid the disease, they face many obstacles that prevent them from informing their students about HIV/AIDS in productive ways. For example, some teachers cannot advise their students to remain faithful to their sexual partners without seeming hypocritical because they engage in extramarital sexual relations themselves. Others feel uncomfortable discussing sexual matters with their students, and some believe that, due to their limited training, they are not knowledgeable enough about HIV/AIDS to direct classroom discussions about the disease. In addition, many teachers feel unsupported by community members, who often either deny the extent of the epidemic or believe that HIV/AIDS should not be addressed in the classroom.
Affected groups Although the HIV/AIDS epidemic has affected men, women, and children in Malawi, certain factors such as sexual orientation, gender, and age influence infection patterns. In Malawi, HIV/AIDS is usually transmitted through heterosexual sex, but the epidemic has also significantly impacted the homosexual male population in Malawi. In addition, women in Malawi are more likely to be HIV-positive than men, suggesting that women are particularly vulnerable to HIV/AIDS. Finally, the disease has affected children and young adults both directly and indirectly; 170,000 Malawian children were HIV-positive in 2011, and the number of orphans in Malawi has increased dramatically since the epidemic began in 1985.
Men Due to the vast scope of the HIV/AIDS epidemic, many Malawian men believe that HIV contraction and death from AIDS are inevitable. Older men in particular often claim that the HIV/AIDS epidemic is a punishment issued by God or other supernatural forces. Other men refer to their own irresponsible sexual behaviors when explaining why they believe that death from AIDS is inevitable. These men sometimes claim that unprotected sex is natural (and therefore necessary and good) when justifying their lack of condom use during sex with extramarital partners. Finally, some men identify as HIV-positive without having undergone testing for HIV, preferring to believe that they have already been infected so they can avoid adopting undesirable preventive measures such as condom use or strict fidelity. Because of these fatalistic beliefs, many men continue engaging in extramarital sexual relations despite the prevalence of HIV/AIDS in Malawi.