Hannah Raval, second year, reflects on her Malawi trip with other students and shares her views about the state of HIV in the country.
Over the summer, a group of students from the St Andrews medical school went out to Malawi to observe healthcare in one of the poorest countries in the world.
Malawi has a population of about 16,00,000 people and a life expectancy of 53. The main killers are TB, Malaria, Meningitis, malnutrition and HIV/AIDS. Although it’s a small country, it is in the top 10 countries in the world for the highest HIV prevalence and also for deaths due to AIDS related illnesses. It is a very religious country and sex out of marriage is frowned upon (yet commonly practiced), and condoms are not readily accepted. Antiretroviral therapy (ART) is free from a local HIV clinic, yet failure to comply to medication is a concerning issue.
During our time in Malawi, we shadowed different health care workers on various hospital wards. It was shocking to see the condition of the hospital, the adults wards especially that experienced a shortage in all basic supplies. It was impressive to observe how the doctors still managed to work in these conditions, finding ways around the obstacles to still deliver treatment.The doctors however were not only fighting against a lack of resources, they were also trying to operate in a culture that is so very different from ours, and which is therefore hard to fully understand.
During the trip we spent a few days teaching in a local primary school where our lesson plan was structured around sexual education, a practice not commonly seen in religious countries. It was surprising to see how much the children from poorer parts of the country were already aware of different STIs, and about condoms and the protection they can provide. It was hard to understand why people who seemed to know and have easy access to contraception would still seem so reluctant to use something that could help reduce this devastating pandemic.
Through talking to various healthcare workers and psychologists, we started to learn more about the Malawian culture and the stigmas surrounding sex. It was learned that in Malawi it is assumed that sex outside marriage is not practiced and as sex and contraception is not discussed, people feel embarrassed to ask for it, even at an HIV clinic. We met many patients who refused contraception as it was better than admitting to being sexually active. Children learn about sexual health in primary school (which is free for all), yet outside of an educational setting, they feel unable to discuss it. We feel that this lack of communication that has contributed to the misconception that condoms are only used when having sex with a prostitute- and therefore some women find the notion of contraception insulting. Currently only 30-40% of young people who are sexually active and have many partners are using contraception.
Another influencing factor is the low position women hold in society. Many men have little respect for women or their wishes. There is an extremely high prevalence of rape and a high proportion of men are unfaithful. Many women go into prostitution as a way to escape poverty and it is also common practice for girls to be married at ages as young as 14. In such cases women would usually have no say in the usage of contraception, which further heightens the spread of HIV. HIV/AIDS affects all in the country. It was heartbreaking to see tiny babies born with the infection, children growing up having to undergo constant treatment and stigma and the elderly, dying alone having lost so many relatives to this devastating disease. HIV spread has hopefully reached its peak and is now slowly on the decline.
People are living longer as ARTs are becoming more accessible and easier to take. There is a positive future for HIV, vaccines are on the horizon and more people are being educated and there is far greater access to contraceptives. However, in a country like Malawi, it is the social makeup of the population and their stigmas that is allowing HIV to remain such a great problem. External aid can only help the problem of AIDS to a certain extent in Malawi – a real difference can only be made by the people within.