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Dan Namarika, Principal Secretary for Health in Malawi, graduated from the Faculty of Medicine in 1999 and was one of the first students to complete all of her medical training in Malawi. His long career as a physician, including four years as a personal physician to the late President Bingu wa Mutharika, was motivated by the desire to take action against AIDS.
"The reason I chose a drug was AIDS. I could not believe there was an illness like that without treatment. I remember the first case in my neighborhood. It was a woman who succumbed to AIDS after a chronic illness. My family members have died. AIDS has an impact on my long history, "he said.
Since the peak of the HIV epidemic reported by Mr. Namarike, 110,000 new cases of infection (in 1993 and 1994) and 65,000 deaths are due to AIDS-related illnesses (in 2004 and 2004). 2005), Malawi has made good progress in its response to HIV.
These advances can be attributed to the introduction of innovations such as the test and start-up strategy in 2016, which offers immediate HIV treatment to all people living with HIV and the option B + in 2011, a strategy to prevent mother-to-child transmission of HIV that: ensures that all pregnant women living with HIV have permanent access to HIV treatment.
As a result, new HIV infections in Malawi have decreased by 40%, from 64,000 in 2010 to 39,000 in 2017, and AIDS-related deaths by half, from 34,000 in 2010 to 17,000 in 2017. Life expectancy continues to increase from 46 years in 2004 to 64 years in 2018, it should rise to 74 years by 2030.
In 2017, 92% of pregnant women living with HIV in Malawi used services to prevent HIV transmission from mother to child. This has reduced the number of new HIV infections among children (aged 0 to 14) to a historic low of 4900 in 2017.
Namarika attributes these successes largely to the multisectoral response to HIV and to political commitment and high-level leadership. "In addition to the policies put in place at the highest levels of government, ministries other than health are also involved, such as the Treasury, gender, education and local governments; we have civil society, the faith sector, cultural leaders and technical badistance from development partners, such as UNAIDS, "he said.
It also welcomes programmatic innovations, such as the transfer of physician work to nurses and community health workers, which has reached more people receiving HIV testing and treatment services.
The 2015-2020 National Strategic Plan for HIV / AIDS focuses on the 90-90 goals, with the ultimate goal of ending AIDS by 2030 in Malawi. Malawi has made good progress on the number of people living with HIV who know their status (90%) and the number of people living with HIV who are on HIV treatment (71%). More work is needed to increase the number of people living with HIV whose viral load has been eliminated (61%), which exposes Malawi to not meeting the targets in the next 500 days.
According to Mr. Namarika, the major impediment to achieving Malawi's goals is that people are left behind because of socio-economic and structural disparities due to power struggles, such as poverty, unemployment, and inequalities between women and men. men and women. He also believes that a place-to-population approach is needed to address the vulnerabilities exacerbated by migration and natural disasters, such as the drought cycle – floods experienced by people in the south-east of the country.
The high number of new HIV infections among teenagers and young women aged 15 to 24, who were at the origin of 9,500 new infections in 2017 – more than double that of their male counterparts (4,000 ), is another challenge of the national AIDS response.
"Most young people can not make ends meet. This puts girls at greatest risk – their rights can easily be flouted by older men. It is also necessary to improve the behavior of young men in health research, "said Mr Namarika.
However, Mr Namarika believes that lack of trust is the biggest obstacle to progress in the AIDS response.
"When I was a young doctor, some days, we had 19 deaths in the pediatric ward alone. Not in all the hospital, just in this room. Now young doctors do not see it anymore, so they do not believe HIV is real, "he says.
He believes that it is essential to continue to engage with communities on AIDS with the same urgency as in the early 2000s, so that the significant gains made by the country are not lost. .
"If the cost of AIDS is not considered one of the greatest historical disasters we have experienced in the 54 years of our independence, we have lost our history," he said.
The way forward is mainly to continue funding the AIDS response and to put more emphasis on HIV prevention. This will require a growing national investment, as well as the conviction of development partners to make more external sources of funding for HIV prevention, he said.
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