‘This is the time to act’

As World AIDS Day approaches on December 1, Carol Finlay highlights the need for vigilance and reflects on work in Malawi.

IN Malawi there are nearly one million people who are known to be HIV positive, which is around one in 20 of the population.

According to the Malawi AIDS Commission’s (MAC) 2022 statistics more people are becoming infected with HIV than are dying now of AIDS.

In a country which has a median age of 17.8 years and getting younger by the year, this is a desperate trend. (https://www. worldometers.info/demographics/malawidemographics/#median-age)

On a recent visit to Ekwendeni I worried about the number of young people hanging around in the trading centre with little or nothing to do. Young people told me they had completed education with no prospect of employment. This included teachers and nurses. Despite the need, there is no funding from government to pay them. How demoralising is that? Visiting Ekwendeni Hospital AIDS programme (EHAP) I heard that the number of young people becoming infected with the virus is rising. I was told that the number of people receiving Antiretroviral medication in the area is now around 3000. This is free and available to all but needs to be accessed and taken regularly so the number reflects around 90% of those infected with the virus.

After over 30 years of being involved in HIV and AIDS in Malawi, it could have been easy for me to feel downhearted about the present situation but on reflecting back to the 1990s the picture is so different. It is unusual now to sit at the bedside of people and watch them die from what was ‘the silent killer’ as no-one wanted to say their relative was dying of AIDS and the term ‘AIDS related illness’ was not yet used. That was the time when there was no treatment and when you looked in people’s eyes and saw no hope. When did we last hear of a baby developing HIV from a positive mother as screening and treatment in pregnancy is now the norm? Access to ARVs is now commonplace with a dedicated clinic in the hospital.

So why is HIV on the rise again in young people? Firstly, I think it is because we have become complacent – have we the older generation forgotten the past? Is there less education about HIV than before? Has access to treatment meant that people feel there is a ‘cure’? Has HIV been too medicalised? Then, of course, there is youth culture to consider – there is not enough youth-only clinics, lack of sex education, more out of school or employment to young people and more.

Back to the 1990s – one of the things that took up my free time was working with EHAP to support the orphan care programme. At first it was ensuring that the orphaned babies were cared for, that was about survival for them. The beginning of community-based child care centres was a real triumph. Only after that did the alarm bells go off and we realised we were missing out an important part of the HIV jigsaw – caring for the youth. Rolling out of life skills training and setting up of children’s corners with mentors for the orphans and young carers – that was how I filled my Saturdays along with my Malawian colleagues.

“AIDS-related deaths are still the highest cause of death in Malawi. We need to continue to highlight the need to support this very important work carried out by our partners at EHAP and other partners around the world.

The young people today are no less important and we must not lose sight of this new generation of youth. Many are not orphans but there are still too many risk factors which make today’s young people in Malawi a particular ‘at risk ‘group. During my visit to Malawi, my path crossed with friends from the Church of Scotland in Geneva who were on a twinning visit to Ekwendeni Hospital Community AIDS Resource Centre. One of the last pieces of work I did before leaving Ekwendeni in 2001 was to enable the building of the centre, funded by them. This partnership has continued since then and particularly funds the salary of the Centre Co-ordinator along with other pieces of work. Together, the centre staff, the Geneva group and of course, the youth were spending time drawing up a new strategic plan, considering all the challenges of today.

AIDS-related deaths are still the highest cause of death in Malawi. We need to continue to highlight the need to support this very important work carried out by our partners at EHAP and other partners around the world. This is not an easy task as HIV and AIDS is not often in the news or enters in most people’s sphere of influence these days in Scotland. It has also become mainstreamed into wider health programmes and somehow lost its place in our consciousness if we are not directly affected. We will never go back to the terrible effects of the pandemic on individuals, families and communities in the 1990s but, if we are not careful, some of the work undertaken will be undermined. Surely alarm bells should be sounding just now as the numbers of youth newly infected rises. This is the time to act once more and implement new youth-friendly strategies for HIV prevention.

“It is important to invest in new generations of youth leadership to ensure the sustainability of the HIV response. This can be done by engaging and supporting young people in all their diversity, particularly those affected by HIV, to influence and lead HIV service delivery, decision-making, monitoring, accountability, research and advocacy. Young people must be empowered to play leadership roles in shaping new social norms around gender, sexuality, identity and consent.” – Young people and HIV (unaids.org)

Carol Finlay is Congregational Engagement Manager with the Faith Action Programme of the Church of Scotland.

The Church of Scotland HIV Programme has supported Ekwendeni Hospital AIDS Programme (EHAP) since its inception. The funding given has mainly been for the support of orphan care. In the 1990s there were 10,000 orphans being supported in the catchment area. One of the areas of support has been for young people to gain educational qualifications. It is always good to hear a success story.

“My name is Aubrey Kumwenda, and I am a qualified primary school teacher currently pursuing a Bachelor’s Degree in Educational Sciences at Mzuzu University. I lost both the parents at the age of 12. My uncle supported me through my secondary school and I obtained good grades however he was not able to help me further.

“I was able to secure land to grow crops, I was doing all this hoping that if I sell my harvest I will be able to pay for college fees and also support my siblings. However, this did not work out. With God’s amazing grace, in 2018, I was identified by the orphan care committee in my area as one of the people to be supported with fees to pursue a two-year teaching course at Loudon Teachers Training College (TTC). That was a remarkable day for me, a turning point in my life. I went from feeling like nobody to being somebody with a future ahead of me. I worked very hard and I obtained my teaching certificate. I am currently employed as a primary teacher at Kanjuchi Primary School. With a heart of upgrading myself, I applied for a Bachelor’s Degree in Educational Sciences at Mzuzu University last year and I was selected to continue my studies. Now, I am managing to pay my tuition fees on my own from the salary I receive.

“I am deeply grateful for the education support the Church of Scotland through EHAP and I pray that God blesses you and grants you a long life so that you can continue helping vulnerable children around the world.”

World AIDS Day is December 1 and each year this day gives opportunity to reflect and remember people known and unknown from the more than 42 million who have died from AIDS related illnesses. A red ribbon is the universal symbol of awareness and support for people living with HIV.