By Her Excellency Gertrude Hendrina Mutharika
The UNAIDS vision of the three zeros – zero new HIV infections, zero stigma and discrimination and zero AIDS-related deaths – has captured global attention and imagination around setting bold targets in the global HIV response and now, there is growing consensus that the end of AIDS is possible by 2030.
In recent years, programmes have been scaled up to avert new HIV infections and prevent AIDS-related deaths and we are clearly able to quantify successes in these areas. However, the third zero on stigma and discrimination presents real challenges which require our collective and consorted effort. Commemorated on 1 March, International Zero Discrimination Day, allows us to come together to raise awareness and stand firm against any form of HIV-related stigma and discrimination.
Malawi can be extremely proud of its successes in expanding its HIV treatment, saving lives and preventing new HIV infections. The national treatment programme, and in particular successful rollout of the ‘option B+’, where all pregnant women living with HIV and breastfeeding mothers are provided life-long antiretroviral therapy (ART), is respected internationally. This programme not only prevents mother-to-child transmission of HIV but it also keeps mothers living with HIV alive and healthy.
As a result of these programmes, Malawi is now one of few countries in the eastern and southern Africa region that has witnessed a more than 50% decline in new infections over the past two decades. Progress has been particularly significant in preventing mother-to-child transmission of HIV – among the 22 highest-burden countries for pediatric AIDS, Malawi has achieved a 67% decline (in new infections among children, the largest decline of any of the countries. With the introduction of ‘Option B+’, eight in ten women living with HIV accessed treatment in 2013. These results are laudable achievements and Malawi must stay the course and guard these successes jealously.
Despite this progress, children in Malawi are left behind in the HIV response, right across the age spectrum from infancy to adolescence. In 2013, only one in four children and adolescents living with HIV were receiving life-saving treatment and care services. Collectively, we can all do more to change this situation, and to give these children an opportunity to grow up healthy, reach their potential and contribute to this great country.
To achieve this, we will need to tackle the harmful barriers of stigma and discrimination. We are all too familiar with heart-rending stories of women – who tend to be the first to know their HIV status, not disclosing their status to their partners and taking extra-ordinary measures to hide their medication, for fear of the repercussions of disclosure. How then do we expect a woman who is adamantly concealing her own HIV status to confidently support treatment for her child? Self-stigma coupled with stigma and discrimination in the home, community, schools and health facilities conspire together to limit a woman’s ability to take the right decisions and actions for her new born child and her other older children.
The impact of stigma on children can have devastating consequences. An open, loving and supportive family relationship provides an enabling environment for children to thrive and lead happy, healthy and peaceful lives but where HIV is concerned, it is not that simple. Will parents do everything it takes to ensure all their children get tested for HIV, access treatment and adhere to their medications? There should never be a world where parents must struggle with this fear of stigma when the health of their child is at stake.
Three decades into the HIV epidemic, we have the tools and the science to help us manage HIV like we do diabetes, high blood pressure or any other chronic condition; but stigma and discrimination distinguishes HIV from all these other ailments. For adults, it is stigma and discrimination that stop them from taking a test to know their HIV status and as a result, Malawi registers 43,000 needless AIDS-related deaths a year. For children, the situation is worse because they are dependent for their health on parents or guardians who may be too fearful to provide them with the care they need.
On International Zero Discrimination Day, let us commit to do more for Malawi’s children and create relationships, homes, communities, churches, schools and health facilities that are free from the debilitating shame and fear of HIV disclosure. Let us commit today to closing the gap for children and to fast tracking access to testing, treatment and adherence programmes for children. Let us not let stigma and discrimination come in the way of our making progress and casting the shadow over our successful HIV programmes.
It is time to open up and reach out to save children living with HIV in Malawi.
The Author: Her Excellency, Mrs. Gertrude Hendrina Mutharika the First Lady of the Republic of Malawi and Member of the Organisation of African First Ladies against AIDS in Africa (OAFLA)