Malawi HIV and AIDS Monitoring and Evaluation Report: 2008-2009 UNGASS Country Progress Report Reporting Period: January 2008-December 2009 Submission Date: 31 March 2010 Malawi HIV and AIDS Monitoring and Evaluation Report: 2008-2009 UNGASS TABLE OF CONTENTS ACKNOWLEDGEMENTS........................................................................................................... 5 FORWARD .................................................................................................................................... 6 PREFACE ...................................................................................................................................... 7 ACRONYMS ................................................................................................................................. 8 1. STATUS AT A GLANCE .................................................................................................. 10 1.1 Purpose of the Report ....................................................................................................... 10 1.1.1 Introduction and Purpose ............................................................................................................. 10 1.1.2 Highlights of the Report ................................................................................................................ 12 1.2 Report Preparation Process ............................................................................................. 12 1.2.1 Methodology .................................................................................................................................. 12 1.2.2 Data Limitations ........................................................................................................................... 14 1.3 Status of the Epidemic ...................................................................................................... 15 1.3.1 Prevalence ..................................................................................................................................... 15 1.3.2 Modelling New Infections ............................................................................................................. 16 1.3.3 Sub-populations ............................................................................................................................ 17 1.4 Policy and Programmatic Response ................................................................................ 17 1.5 Overview Table of the UNGASS Indicator Data ............................................................ 19 1.6 Operationalising the Recommendations ......................................................................... 22 1.6.1 Way Forward: Approaches for Specific Groups .......................................................................... 23 1.6.2 Way Forward: Summary of Action Plan ...................................................................................... 27 2. OVERVIEW OF THE AIDS EPIDEMIC ........................................................................ 28 2.1 Context ............................................................................................................................... 28 2.2 HIV Prevalence in the General Population .................................................................... 28 2.2.1 Sentinel Surveillance Data ........................................................................................................... 28 2.2.2 Variations by Location .................................................................................................................. 29 2.2.3 Variations by Region .................................................................................................................... 30 2.2.4 Variations by Gender .................................................................................................................... 30 2.2.5 Sexually Transmitted Infections (STIs) ......................................................................................... 31 2.3 HIV Prevalence in Most-at-Risk Populations and Vulnerable Groups ....................... 32 2.3.1 Men who have Sex with Men ........................................................................................................ 33 2.3.2 Sex Workers ................................................................................................................................... 33 2.3.3 Youth .............................................................................................................................................. 33 2.3.4 Truck Drivers ................................................................................................................................ 33 2.3.5 Teachers ........................................................................................................................................ 33 2.4 Orphans and Vulnerable Children .................................................................................. 34 2.5 HIV Incidence .................................................................................................................... 35 2.5.1Modelling of Incidence .................................................................................................................. 35 2.5.2 Estimated Annual Number of New Infections .............................................................................. 35 2.6 Key Drivers of the Epidemic in Malawi .......................................................................... 36 2.6.1 Factors Facilitating the Transmission of HIV ............................................................................. 36 2.6.2 Diagram of Key Drivers of the Epidemic ..................................................................................... 37 2.6.3 Harmful Cultural Beliefs, Attitudes and Practices ...................................................................... 38 3. NATIONAL RESPONSE TO THE AIDS EPIDEMIC ....................................................... 40 3.1 National Commitment ...................................................................................................... 40 3.1.1 Institutional Context ..................................................................................................................... 40 3.1.2 HIV and AIDS Financing and Expenditure (Indicator 1) ............................................................ 45 3.1.3 Policy/Strategy Development and Implementation (Indicator 2) ................................................ 54 3.2 Prevention .......................................................................................................................... 55 3.2.1 Fair Distribution of Wealth, Good Governance, and Infrastructure ........................................... 55 3.2.2 Ending Stigma and Discrimination and Reducing Vulnerability to HIV .................................... 55 3.2.3 Reaching Most-at-Risk Populations (Indicator 9) ....................................................................... 57 3.2.4 Life Skills-Based Education in Schools (Indicator 11) ................................................................ 59 3.2.5 Blood Safety (Indicator 3) ............................................................................................................ 59 3.2.6 PMTCT (Indicator 5) .................................................................................................................... 60 30/3/2010 Page 2 Malawi HIV and AIDS Monitoring and Evaluation Report: 2008-2009 UNGASS 3.2.7 Combination Prevention Programmes ......................................................................................... 64 3.2.8 HIV Testing and Counselling (Indicators 7 and 8) ...................................................................... 65 3.2.9 Management of Sexually Transmitted Infections ......................................................................... 67 3.3 Treatment .......................................................................................................................... 69 3.3.1 ART (Indicator 4) ......................................................................................................................... 69 3.3.2 Co-Management of TB and HIV Treatment (Indicator 6) ........................................................... 73 3.4 Care and Support .............................................................................................................. 75 3.4.1 Nutrition ........................................................................................................................................ 75 3.4.2 OVC Households Receiving Support (Indicator 10) .................................................................... 75 3.4.3 Home-Based Care ......................................................................................................................... 77 3.5 Knowledge and Behaviour Change ................................................................................. 77 3.5.1 School Attendance (Indicator 12) ................................................................................................. 77 3.5.2 Knowledge (Indicators 13 and 14) ............................................................................................... 77 3.5.3 Sex before the Age of 15 (Indicator 15) ....................................................................................... 81 3.5.4 Reducing the Number of Sexual Partners (Indicator 16) ...........................................................