Factors facilitating the continued spread of HIV and AIDS which AYISE confronts today.

Malawi is one of the sub-Saharan countries with a high prevalence of HIV and AIDS. It is worth noting that a high HIV and AIDS prevalence rate does not mean that the people of Malawi are unaware of HIV and AIDS and its devastating impact. According to a Demographic and Health Survey (DHS) report (2000), public awareness of HIV/AIDS was high. The report stated that 99% of interviewed women and 100% of interviewed men had heard about HIV and AIDS. Knowledge of someone who is living with HIV and AIDS or has died from AIDS has increased significantly. However, knowledge alone has proved insufficient in influencing people’s behaviour, particularly attitudes towards sex. The factors limiting the effectiveness of these earlier behavioural change campaigns need to be considered.

The following are some of the factors:

(i)      The Hidden Nature of HIV

There is a long incubation period of about 8 to 10 years between HIV infection and AIDS-related illnesses and death. Faced with more immediate survival concerns, the long-term threat posed by HIV and AIDS can easily be overlooked. Additionally, despite relatively early awareness of HIV and AIDS in Malawi, its development impact was not well understood by individuals or by the government.
 

(ii)     Cultural Beliefs, Values and Practices

In Malawian culture, sex is considered of great importance. Although most religions advocate abstinence before marriage and remaining faithful in marriage, cultural norms and values define masculinity in terms of sexual prowess and sexual activity. This encourages male promiscuity. At the same time, girls are advised not to say ‘no’ to their husbands when they wants sex, even when they know that their husband has been having sexual encounters outside of marriage. Increasingly, monogamous women are at risk of HIV infection through their promiscuous husbands. Those religions advocating abstinence and faithfulness do not support the use of condoms as this is seen as promoting promiscuity. This perspective hampers interventions aimed at preventing the spread of HIV and AIDS.

There are a number of traditional beliefs and customary practices associated with sex in Malawi that facilitate HIV transmission. These include ‘hyena’ use, initiation rites, circumcision, death rites, healing process and enrichment through charms. All these involve having sex with other people rather than one’s spouse. 

Widow inheritance is also practiced in some parts of Malawi. When a husband dies, one of his surviving brothers is expected to inherit the widow to ensure that she and the children will be taken care of. This can expose the widow and the inheritor to HIV and AIDS.

Polygamy is accepted in Malawi amongst certain tribes and religions, in particular amongst Muslims and traditional believers. Most of the Christians churches discourage polygamy, considering it a sin. Those religions that do not allow polygamy have no institutionalised way of ensuring that both parties are free of HIV infection.

(iii)    Poverty 

In Malawi, poor people are a particularly vulnerable group with regards to HIV and AIDS infection. Although the majority of people living with HIV and AIDS are considered poor, this is not to suggest that all people living with HIV and AIDS are poor. The key difference is that the risky behaviour of some middle class people is largely a matter of power and choice, whereas poverty forces people to behave in a way that puts them at risk of infection. Poverty often leads people to engage in survival strategies that are conducive to the spread of HIV, such as migration and engagement in (commercial and non-commercial) sex work (UNAIDS, 2001). Furthermore, education and health care services that could reduce the risk of HIV infection, like treatment for sexually transmitted diseases and access to condoms, are often not equally available or affordable for poor people.

(iv)     Unemployment and Lack of Recreational Facilities for the Youth
 
The economy of Malawi depends on rain-fed agriculture. This accounts for 33% of the country’s GDP, 93% of its export earnings and employs about 85% of the population. Manufacturing, on the other hand, accounts for only 14% of GDP. Due to the heavy dependency on agricultural output, the country’s economy remains highly vulnerable. Over 80% of the labour force is employed in the informal sector.

Malawi is considered a country with low human development. It currently ranks 151 out of 162 countries listed) in the Human development index. 

Over the past three years, there have been observable trends of high rural-to-urban migration. The premise is that young people who have completed secondary education flock to towns to seek employment and at the same time opportunities to further their education. However, the reality is that employment opportunities are few and many hopeful young people find themselves caught up in a form of unemployment, coupled with a lack of alternative activities to keep them occupied. Many frustrated young people adopt dangerous lifestyles such as drug and substance abuse among boys and commercial sex work among girls which increases their risk of HIV infection. 

(v)   Life Skills Building for Adolescents and Youth

AYISE believes that life skills are important in order for young people to maintain healthy lives and prepare for adulthood.

The World Health Organisation (WHO) considers life skills as abilities for adaptive and positive behaviour, which enable individuals to deal effectively with the demands and challenges of everyday life.

The problem in Malawi is that many young people have little or no opportunity to access life skills education. Even though the Ministry of Education has made life skills part of the national curriculum, teachers who are supposed to deliver the subject to the youth have little orientation and understanding of the subject matter and its importance in the development of a whole person. Life skills education is not examined and as a result, many teachers concentrate on the examinable subjects, offering only a casual approach when teaching young learners life skills.

Young people who completed their academic education prior to life skills education making its way into schools, have minimal understanding of the subject. There are few structures in place beyond the schools that offer sensitisation on life skills issues. This therefore means that there is a large group of young people, now out of school, who still require life skills education.

AYISE feels there is a gap in addressing HIV and AIDS issues among young people through life skills education and that many existing formal and informal programmes are not well delivered or implemented.

(vi)     Youth Friendly Health Services and Behavioural Change Interventions

In order to facilitate behavioural change, AYISE recognizes the need for Youth Friendly Voluntary Counselling and Testing (VCT) facilities and centres.

HIV testing has proved a key method in bringing about behavioural change. If an individual discovers they are HIV positive they can informed as to how they can prolong lives by reducing risky sexual activities, improving their dietary intake and beginning antiretroviral (ARV) treatment at the right time. If an individual is HIV negative they can sustain a low-risk lifestyle by practicing abstinence, using condoms correctly and consistently each time they have sex and avoiding intravenous drug abuse.

(vii)    Impact Mitigation

AYISE realises the social and economic impact of HIV and AIDS on a household, community and national level.

One of the social impacts of HIV and AIDS is the question of children orphaned by HIV and AIDS.

However, there are a lack of sustainable programmes to holistically address issues affecting orphans and other vulnerable children particularly children affected or infected by HIV and AIDS.

Focus of AYISE’s HIV and AIDS Programming in a Nutshell:

AYISE’s HIV and AIDS programming focuses on addressing six identifiable and critical areas of:

1. the hidden nature of HIV
2. the gender dimension of HIV and AIDS which is exacerbated by cultural beliefs and practices
3. poverty
4. unemployment and general lack of recreational facilities particularly with regards to the urban poor youth
5. lack or inadequate life skills education for young people
6. inadequate Youth Friendly Health Services enabling young people to act responsibly with the knowledge of their HIV status
7. behavioural change interventions through Voluntary Counselling and Testing (VCT) for HIV as well as promotion of preventative measures
8. reducing the impact of HIV and AIDS on children affected or infected by HIV and AIDS

AYISE’s broad approach to HIV and AIDS is to build community competence in response to the epidemic in Malawi.

The building community competence approach is AYISE’s unique methodology used when addressing issues of HIV and AIDS, its impacts and social concerns.

The approach was designed by AYISE in response to community attitudes towards HIV/AIDS work.

When evaluating a social survey that AYISE conducted in Bangwe Township, it was discovered that community participation in HIV/AIDS work had dropped drastically. This was largely because the communities felt the pandemic was the sole responsibility of Government and participating NGOs, and not that of the communities themselves.

This state of affairs led to potentially dangerous conclusion whereby AYISE felt that if communities continued with the deep-rooted culture of only looking at the Government and NGOs for solutions, then most of the programmes developed by the said two bodies would not be sustainable. In the long term this would lead to major to wastage of investment in programmes through unachievable objectives and minimal impact.

The proposed and agreed solution was to create and work through community structures. AYISE would facilitate the implementation of the structures and training, while the direct implementation would be carried out by the community itself. Some of these community structures are Community AIDS Committees, Women Action Groups Against AIDS (WAGAA), Youth Peer Educators Groups, Youth Entrepreneurial Group and so on. All of the initiatives are sustainable as they are grounded in the community and not in AYISE. When AYISE’s project in that particular district comes to a close, the work of the community structures in place continues.

This concept became the framework for AYISE’s Building Community Competence Intervention