Over 24 months ago, while pregnant she was diagnosed HIV positive ; her CD4 count registered around 200. Since then, she swallows some Antiretroviral drugs (ARVs) daily to prolong her life.

Susan collects her ARV pills from a nearby Limbe Health Centre in Blantyre which treats over 1,000 patients daily and provides the ARVs for free from Malawi Government with funding from the Global Fund for HIV and AIDS fight.

However, Susan’s fear is the viruses in her body might turn drug resistant and lead to her death because she shares her ARVs with another patient.

"I and my husband learnt that we were HIV positive during my pregnancy and my husband died after a long illness. He died about a week just after I gave birth to Cynthia. He died while waiting to have his name added on Malawi Government ARVs beneficiaries list," said Susan.

She therefore, explained that she feels lucky because she was put on ARV treatment right away to protect her life and of her unborn child then.

"But now that I share my treatment with another patient this will compromize my health," she said adding, "I was fully counselled that my health could deteriorate if I skip the recommended dosage for just a day; so I am afraid of what will happen to my life if our health centre in Limbe runs out of the life prolonging drugs."

Susan’s worries come as the tying of red ribbons on World AIDS day this year, there was shadow of frightening prospect – the Global Fund to Fight AIDS, TB and Malaria is financial crisis.

In Malawi’s case, the Global Fund rejected the poor aid dependent nation’s proposal for funding to HIV and AIDS programmes some months ago reportedly due to the country’s failure to meet all required conditions.

Malawi Network of People Living with HIV and AIDS (MANET+) Advocacy Officer George Kampango said he is afraid that patients already on ARVs waiting list may not even get the life prolonging drugs.

“Following the new WHO new regulations the drugs which cost three times as much as the current regime used, it will be too expensive for government to manage providing free treatment to the poor and children,”said Kampango adding that already not everyone requiring ARV treatment is getting it in Malawi.

“Government is even failing to provide free treatment for many poor people and children including orphans who need it most," said Kampango.

Malawi Health Equity Network (MEHN) Executive Director Martha Kwataine, however, said essential drugs including ARVs shortages are as a result of Malawi Government’s arrogance towards donors.

Capital Hill in Lilongwe, dependent for 40 percent of its budget on donors, has fallen out of favor with the donor community including major donor, Britain following concerns about human rights and poor governance, and funding has either been withheld or not been reignited.

London alone provides close to US$122 million annually, of which $49 million goes to Malawi’s staggering public health sector.

However, Britain’s aid disbursing agency,Department for International Development (DfID) pumped its final aid to Malawi in March before deciding not to renew a six-year funding commitment, which expired in June.

Kwataine said it is no secret that Malawi Government has no money to fund HIV services because what the country is living on is hand to mouth.

“Look at ARVs, people are given the ration for two weeks and they walk long distances and the situation could lead to deaths if left unchecked,” she said.

Drug shortages and stock-outs however, have been a problem even before DfID’s aid freeze to Malawi.

In Malawi ARVs are provided by the Global Fund to Fight AIDS, Tuberculosis and Malaria however, their distribution to patients countrywide is the Ministry of Health’s HIV Unit responsibility.

On her part National Coordinator for the National Association of People Living with HIV, Amanda Manjolo, admitted that her organization discovered that some districts were indeed rationing ARVs among patients in Malawi.

However, she said:“But it’s now not a national level crisis. What we have found out is that only one district out of five we visited had ARVs shortages. So it’s just a matter of making sure the supplies are reaching the districts where the drugs are being rationed.”

Nutrition, HIV and AIDS Principal Secretary President Bingu wa Mutharika’s office, Mary Shawa, on the other hand boasted that with donor support including the Global Fund, Malawi has achieved a lot of progress in HIV and AIDS fight, stabilizing the prevalence rate to about 12 per 100 in the 13 million plus population.

She disclosed that the number of people dying from HIV and AIDS related illnesses in Malawi now stands at 5 percent, down from 11 percent in 2004.

“The decrease is due to increases in the number of people living with HIV now on anti- retro viral treatment and over 80 percent of patients on ARV treatment are still alive,” she said.

On the reported ARVs shortage Shawa attributed them not due to donor funding but rather to Malawi’s drug supply chain.

She disclosed that Malawi Government orders the ARVs through UNICEF [the United Nations Children's Fund].

“… and when you [put in] an order today it takes a minimum of three months and a maximum of six months to receive the next supply. So it’s the long process of ordering and supplying the drugs that we are worried about,” said Shawa.

She added that Malawi is looking to alleviate the stock-outs by introducing “buffer stock”.

“As I am talking today there is still $300 million from the Global Fund, most of it is meant for buying ARVs,” said Shawa.

She even claimed that the money Malawi has is enough to purchase ARVs for the next four years.

“So, people should not get worried. No government wants its people to die,” said Shawa.

She further assured Malawians that the situation would normalize as drug supplies had already begun to reach most public hospitals.

But Shawa quickly said she is praying that Malawi succeed in getting the $60 million aid package held by Global Fund to help the country continue in HIV and AIDS fight.

“Yes, we have made a lot of progress in HIV and AIDS fight. But we still need resources because the pandemic is still with us,” said Shawa.


She further explained that the funds would enable over 400,000 HIV positive Malawians currently on ARV treatment to access drug replacement against the medication they are presently taking as is causing them experience some side effects.

If the Global Fund’s aid taps to poor developing countries like Malawi remain dry, not only will they have significant repercussions for prevention efforts and treatment for people living with HIV (PLWHA), but also for care workers, most of whom are women.

After all, less money for prevention and treatment - who is likely to pick up the slack in providing home based care? Women and girls of course.

To grasp women’s experience in the course of caring HIV and AIDS patients with inadequate resources on the ground just talk to 59-year-old Neriah Mankhwala.

She provides care to her community in Malawi and to her the global funding cuts could mean more work pressure and even less support to the sick.

Mankhwala was inspired to care for others after nine months of taking care of her own son, 22-year-old Grant. He was both on ARVs and treatment for tuberculosis (TB), but he did not respond well.

“To take care of him I was fully counseled,” said Mankhwala adding, “But his condition continued deteriorating and he died in September 2007.”

She suspected some factors contributed to her son’s condition to deteriorate.

“He was reluctant to live positively with HIV and AIDS. Following the diagnosis that he had TB and was HIV positive, his employer fired him,” recalled Mankhwala.

“Just a few days later, his fiancé also terminated their relationship. He used to worry about these two issues to the extent that he would refuse to swallow his drugs and even eat.”

After her son’s burial Mankhwala was heartbroken with sorrow. Joining the bandwagon of women Community Home Based Care (CHBC) nurses who voluntarily care for over 2,000 HIV and AIDS patients within Area 23 Township in Lilongwe, she felt better.

“Grant was not my only child. Apart from him, I have six other children, four girls and two boys, all of them married. However, after his death I felt an overwhelming painful emptiness that I have never experienced in my life. But since joining CHBC volunteers I am relieved.”

Mankhwala and other CHBC nurses work with support from Lighthouse, a centre for comprehensive HIV and AIDS treatment and care within Malawi’s major referral hospital in Lilongwe and central region.

“Apart from counselling patients we also encourage them to take the life prolonging drugs [ARVs] they receive from Lighthouse,” she said.

However, care does not end there. Volunteers also deliver Water Guard for treating drinking water to protect the patients from waterborne diseases such as cholera, mosquito nets, nutrition packages and complementary drugs from Lighthouse to HIV and AIDS patients in the community. Even as the Global Funds are drying up, Mankhwala’s call is for more resources.

“As care givers we still need more resources to support HIV and AIDS patients in the community because most of them are critically ill, and they can’t do any work to generate income for their upkeep, so they are very poor.”

She explained that for example, some patients’ lives are in danger despite the care given, simply because when the weather is cold they lack warm bedding.

While Mankhwala’s main motivation to become a volunteer was her son, in poor countries like Malawi there is even an obvious need for some kinds of incentives to keep volunteers motivated and continuing with work that can be both backbreaking and heartbreaking.

A study by Lighthouse Director Sam Phiri, Ralf Weigel, Mina Housseinipour, Matt Boxshall, and Florian Neuhann revealed that since CHBC volunteer workers comprise the majority of, mostly unpaid, carers of PLWHA, they need motivation to do their work.

The researchers say that one of the Lighthouse’s most valuable assets is to have a strong link with the community, especially in some of the poorer areas of Lilongwe, in order to provide care and support to HIV and AIDS patients. Even if not all volunteers are continually active, they are a powerful force that can be mobilized.

The study mentions that to motivate the CHBCs, the workers are, among other things, invited to attend annual get-togethers, exchange visits to other programmes, given token gifts like T-shirts, and participate in World AIDS Day commemoration activities.

“They are also invited for refresher training courses in CHBC all to help to create some kind of corporate identity while increasing or sustaining their motivation,” the researchers say.

The study further explains that while Malawi has been receiving funds from the Global Fund, community involvement is a critical component in identifying patients for ARV treatment. Of course, supporting community workers also requires resources to train, motivate and equip them.

Malawi is one of the countries in the world with highest rates of HIV and AIDS, as 10.6 percent of people between 15 and 49 is affected by the virus.
HIV and AIDS is the main cause of death in what should be the country’s most productive age group.

The epidemic is the leading cause of death amongst adults, reducing life expectancy to just 43 years. The majority of HIV infection occurs amongst young people, and the rate of HIV prevalence is higher amongst women than men.

The Global Fund AIDS aid cuts to poor developing countries such as Malawi therefore, are more like baiting lives with AIDS aid. Such plans deny patients from treatment or provide them with a compromised one like what Susan is getting hence endanger their lives.

Providing AIDS patients with required,adequate essential resources including drugs for treatment early, on the other hand prolongs their lives and removes them from sick beds to return to productivity.

“New scientific evidence shows that treating people with HIV not only fights their own illness but also stops the HIV virus spreading – in fact, the evidence is that people on antiretroviral treatment are 90 percent less infectious than those not on treatment,” explained Dr. Isabelle Andrieux-Meyer, Doctors Without Borders/Médecins Sans Frontières (MSF) HIV Advisor, MSF Access Campaign.

She added: “This opens up a whole new world where we not only treat the individual with ARVs but we can reduce new infections at the community level too.”

In 1997, (MSF) started its HIV and AIDS treatment programme in the rural district of Chiradzulu, southern Malawi. The district is home to more than 290,000 people, and where today 14.5 percent of the population between 15 and 49 is infected with the HIV virus (17.5 percent of women and 11 percent of men).

At that time, as no antiretroviral (ARV) drugs were available in Malawi until 10 years ago, MSF focused on the treatment of opportunistic illnesses and palliative care at the district hospital and on prevention of infections. The organization began providing ARV treatment and follow-up at the district hospital, giving priority to the sickest patients.

The first patients were placed on ARV drugs in August 2001 and the programme was designed to demonstrate that ARV drugs could be provided in low-resource rural contexts, where they would prolong life and allow people to regain their autonomy. The aim was also to show that those patients are able to follow a lifelong treatment.

Although no one believed this could be achieved, MSF took up the challenge. Since MSF’s ARV treatment programme began in 2001, more than 52,000 patients were followed by MSF teams. Today, more than 55 per every 100 of the patients who started treatment in 2001 are still alive and healthy.

As of September this year, MSF was still following 30,000 HIV positive patients in the project. Not all patients are eligible for treatment; only those with a severe reduction of their immunity need to start treatment.

Today 22,000 patients are receiving ARV treatment in Chiradzulu, 12.5 percent of whom are children. Over the last three years, approximately 3,000 new patients were integrated in the project annually.

The Chiradzulu programme is one of MSF’s largest HIV programmes, with an average of 175,000 medical visits and 50,000 counselling sessions held annually.
MSF was a pioneer in this field, and MSF’s patient cohort is the most longstanding in the country.

The project has already shown that when treatment is adapted to local conditions and supported by human and financial resources, rural health systems can effectively provide comprehensive HIV and AIDS care. It has even allowed many more people who were bedridden to get back on their feet and resume productive lives.

“Before 2001, we had no testing material and no ARV drugs. We could only treat opportunistic infections. We didn’t have any alternative. Most of the patients were dying. Then MSF came. They introduced the ARV drugs. We started with a very small number of patients, then we scaled up. From then on, the death rate of HIV patients started to reduce,” said Innocent Nyangulu, Clinical Officer from Malawi’s Health Ministry.

53-year-old Fred Minandi testified that he is a beneficiary of early AIDS treatment. He has been MSF patient since 2001 and now works as MSF peer counsellor.
Without the MSF project in Malawi he would have probably died long time ago.

“I was one of the first patients to start taking ARVs in August 2001. Since then, my health has improved greatly,” he explained adding, “In 2000, I could not go to work anymore because I was sick. But since I started ARVs, the disease has retreated. I have started working again. My life has gone back to normal.”

UNAIDS Executive Director Michel Sidibe’ said since HIV discovery 30 years ago a lot of successes have been registered globally in the fight against the pandemic.

However he said:“It’s imperative for us to re-energise the response today for success in the years ahead. Gains in HIV prevention and antiretroviral treatment are significant, but we need to do more to stop people from becoming infected–an HIV prevention revolution is needed now more than ever.”

Sidibe’ warned that if the global community will not invest more resources in AIDS fight the 2015 goals for the pandemic’s response will not be met.