For Margaret Madeya—a 46-year-old mother of five from Group Village Head (GHV) Madeya in Traditional Authority (T/A) Chikumbu in Mulanje—testing HIV-positive was an opportunity to reclaim her sound health.
Nevertheless, that remains a pipedream having been impeded from enrolling on antiretroviral therapy (ART) courtesy of the country’s ART management system which currently does not allow for a universal ART rollout.
“Since February 2015 when I was tested HIV-positive, I have had nagging back pains and terrible stomach problems. As a result, I cannot do farming as I have left all that responsibility to my son. Our food reserves have dwindled. Probably if I were on treatment, the situation could have been different,” says Madeya, flanked by her daughter.
As she sits in her almost empty two-bedroomed house, the ambience of deprivation is well written across the homestead.
As it stands, only those HIV infected persons that have a CD4 count of less than 500 and their health not impressive are eligible to be enrolled on the drug regime as compared to other countries such as Zambia and Swaziland that have adopted a universal ART rollout for all those found HIV-positive.
According to Madeya, her CD4 count currently stands at 703 down from 913 when she got tested in February 2015-and apparently she is not alone in this.
The 2015 Global Aids Response Progress Report states that by December 2014, Malawi had 533 027 people on ART.
This figure is drawn from an estimated population of 14 million where it is said that the prevalence rate of HIV had decreased to 10.6 percent in 2014 from 16.4 percent in 1999—implying that over 500 000 other HIV-infected persons are currently not on treatment in the country as director of HIV and Aids Department at the Ministry of Health Dr Frank Chimbwandira admits.
“Indeed, Malawi current estimates indicate that there are 1.1 million people living with the virus. Close to 600 000 are already on ART. This means we need to strive to identify more than 600 000 by 2020 according to 90/90/90 targets. Note that we will still have new infections,” he says.
UNAids has set up the goal which is an ambitious treatment target to help end the Aids epidemic across the globe. The goal sets that by the year 2020, 90 percent of all people living with HIV (PLWHs) will know their HIV status, 90 percent of those diagnosed with HIV infection will receive sustained ART while 90 percent of all people receiving ART will have viral suppression.
President Peter Mutharika has just endorsed the new ‘Test and Treat’ strategy which is scheduled for implementation in April 2016.
The international humanitarian organisation Medecins Sans Frontières (MSF) has been adding its weight for the new approach in their recent statement.
‘By adopting the “Test and Treat” strategy, Malawi has the opportunity to significantly impact on improving the health of people living with HIV as well as introducing a powerful new tool to reduce the spread of the virus. ARV treatment acts as prevention, because people on effective treatment have close to zero risk of transmitting the virus to others,’ reads their statement.
MSF’s medical coordinator Dr Reinaldo Ortuno adds that the new strategy will help uncover many people who have not been able to get tested at all, but warns that government should be ready to dig deeper into its pocket.
In the chase for treatment for all HIV infected people which also acts as a preventive measure against the further spread of the virus, Chimbwandira says treatment acts as a defence shield on two fronts.
“Treatment as prevention essentially means that any successful HIV treatment should register reduction in the amount of virus (viral load) in the person taking standard combination of ARVs. In turn, this reduction in viral load means there less is chance of transmitting the virus to another person and at the same time there is very low level of the virus to damage the immune system,” he says.
Adds Chimbwandira: “In that case, prevention with successful treatment has two fronts; preventing transmission and also to prevent damage to immune system, thereby preventing the body from being easily attacked by other opportunistic infections which come when the immune is too low to contain them.”
In his assessment, he rates the success of the treatment to as high as 96 percent reduction in transmitting the virus saying it has been recorded that people with successful treatment have less chance of transmitting the virus to others and may have their health boosted.
“Test and Treat’ will need many factors to be in place. These will include trained personnel, adequate commodities, space or infrastructure,” he says.
A recent tour by National Aids Commission (NAC) officials to various districts across the country where they were courting Community-based organisations (CBOs) that man the frontline response to the HIV problem exposed various challenges that government must look at between now and April 2016.
Among others, long distance to access ART clinics, lack of trained professionals to man testing and treatment centres and the unavailability of ARVs and complementary drugs.
With such situations for people like Madeya, the future does not look bright at least if what she says is anything to go by.
“My health is failing, my household crumbling. I cannot work in my garden and cannot do any business activity. Why should we not be given a chance now other than wait for us to die either with diseases or starvation?” she queries.
As issues of readiness for a universal rollout are being debated upon, and with six months to go, executive director for Health and Rights Education Programme Maziko Matemba says lives would be lost in between.
“Obviously, there would be loss of lives between now and April which would have been saved if all infected people were put on treatment,” he observes. n