My Africa by Adamson S. Muula [email protected] > Croat Med J. 2008;49:853-5 > doi:10.3325/cmj.2008.49.853 Language as Vehicle for Spread and Prevention of HIV in Malawi Malawi, formerly Nyasaland, is AIDS-related illness was recog- regard to the diplomatic recog- a southeastern African country nized in February 1986. nition of Taiwan independence bordering with Tanzania to the The KCH is the second larg- from the mainland China. north and northeast, Zambia to est referral health facility of the It is important to remember the west, and Mozambique to the country, the main referral center that this was the period when southeast, south, and southwest. for Lilongwe City, and the main the country was under one-party The country became a British referral center for the central re- system of the Malawi Congress colony after the voyages of Scot- gion of the country. Until recent- Party and the constitutional Life tish Medical Missionary and anti- ly, the Kamuzu Central Hospital President Dr Hastings Kamu- slave trade campaigner, Dr David was also the main referral center zu Banda, a medical doctor with Livingstone. Later, it was trans- for the sparsely populated north- qualifications from the United formed to a British Protectorate ern region of Malawi. Mzuzu States and Scotland. The Kamu- colony until it gained political in- Central Hospital in the north- zu Central Hospital was just one dependence in 1964 and became ern district of Mzimba and now of the institutions which were a republic in 1966. the main referral center for the named after the first Malawi Pres- The first case of the human northern region, was opened in ident (the list Kamuzu Interna- immune-deficiency virus (HIV) 2000. The hospital was built and tional Airport, Kamuzu Proces- and the acquired immunodefi- largely equipped with the funding sion Road, Kamuzu Highway, ciency syndrome (AIDS) in Ma- from the Republic of China (Tai- Kamuzu College of Nursing Ka- lawi was diagnosed at Kamu- wan). Taiwan had also provided muzu Academy, Kamuzu Bar- zu Central Hospital (KCH) in about half a dozen physicians un- racks, Kamuzu View and a dozen 1985. By the end of 1985, a total til 2007, when the Malawi gov- or so Kamuzu bridges). Kamuzu of 12 adult HIV cases were iden- ernment sided with the Peoples’ was Prime Minister of Malawi tified. The first case of childhood Republic of China (Beijing) in between 1964 and 1966 and the www.cmj.hr 853 Croat Med J 2008;49:853-855 president until 1994. In 1993, such as prostitutes was a con- full-blown AIDS. In Malawi, it there was a national referendum venient strategy in a sense that has been called kaliwondewonde in which the citizens voted in fa- it supported the perception (wasting or slim disease). This vor of a multi-parti system. that “good” people needed not was due to the marked weight The period between 1964 to pay attention to the HIV loss that many AIDS patients and 1994 in Malawi was char- problem, as long as they were experienced. However, people acterized by monopolization good. “Bad” people, on the oth- started to stigmatize every adult of power and information. The er hand, deserved to be infect- that was losing weight although Ministry of Health was, there- ed. For the rest of the commu- weight loss is an indication of fore, the only party which could nity, the advice was that people many diseases other than AIDS. issue reports about any health- needed to avoid malezala (razor On the other hand, if people related occurrence in the coun- blades) and zotsukira mmano were plump or did not exhibit try. Anyone else who would try (tooth brushes). Any admission weight loss, it meant that they to warn about epidemic or com- that HIV was becoming a pub- did not have HIV. Such beliefs munity health threat faced the lic health threat was met with continue to still abound in clini- danger of ending up in prison. the usual response of the time cal practice –it is rather difficult Such an “offense” was character- that such warnings were com- to persuade someone to have an ized as intending to raise pub- ing from government enemies HIV test “when they are not los- lic alarm and disrupting public ( ) aimed to “tarnish akapilikoni ing weight.” peace or security. This did not the good image of Malawi.” AIDS has also been called mean that rumor mongering mtengano (dying in twos) since was absent; only that people in- Naming the infection the death of one partner is soon volved in spreading information followed by the death of anoth- needed to be careful as to whom When it became impossible er. As the government was in- they were discussing any aspect to deny the fact that HIV was strumental in hiding relevant of public life. among us, the infection was fur- The political and social envi- ther conveniently described as information about HIV in the early stages of the epidemic, the ronment prevailing in the 1985 matenda aazimayi (the disease Malawi colored the discourse you catch from women). Little disease was for a time called ma- and the response toward HIV did anyone think that within a tenda a boma (government’s dis- in the country. Like in many decade the disease will no longer ease). The name also referred to other countries, the first cases of be matenda aazimayi but rather the government’s measures for HIV infection emerged in tra- be so widespread that it would AIDS prevention – promotion ditionally marginalized groups. be considered as ili muufa (it is of sexual abstinence among un- While in the United States, the in the maize flour), since with- married persons and use of con- first cases appeared among the out sex there is no life, as there doms in relationships – which members 4 Hs (Haitians, he- is no without maize, one of the were the same measures that mophiliacs, homosexuals, and most basic foodstuffs. were advocated in family plan- heroine addicts), the situation In Western medicine, HIV ning programs. The disease was, in Malawi the virus appeared infection and the syndrome it therefore, perceived as a hoax among “innocent men” who causes have had many differ- created by the government to got infected from prostitutes. ent names: AIDS-related dis- prevent people from having sex Blaming a marginalized group eases, AIDS-related complex, or and children. 854 My Africa Culture and initiations Also, the Malawian man the country, where 12% of the thinks that whenever a female adult population is infected. When pubescent girls go is being friendly or makes sexual Many people continue to have through initiation, they are advances, then papsa tonola (eat fatalistic beliefs, such as that taught important survival/life if it is ripe) or kayitana kavula imfa sithawika (you cannot run skills but also sex (bedroom (what is calling is already naked). away from death), that manners). The girl is also told Adult men are not supposed to pofera that mwana mkazi sachepa (a be friends to other adult females salambula (death is sudden), female is never too young). Not unless pali kena kake (there is and uthawa edzi nkugundidwa only that the girl cannot be too something more – sexual ar- ndi galimoto (there is no benefit young for sex but also osaopa rangements). Therefore, there from running away from AIDS mwamuna (she should not fear are expectations of sex from any when you may be run down by a man). A woman who is soon kind of association between men a car). Also, there exists the fol- getting married is told that mka- and women for both of them. lowing saying: khwangwala wa- zi asangalatse mwamuna wake mantha anafa ndi ukalamba (a woman must make her hus- Conclusion band happy), even if it means (the cautious or careful raven to have unsafe sex when she sus- The language of HIV and died from old age). Old age in pects that the husband has been AIDS in Malawi sheds light on Malawi is considered to start at unfaithful. the current HIV situation in 50 years of age. 855.