Ethical issues in voluntary HIV testing in a high-prevalence area-the case of Malawi

Type Journal Article - South African Medical Journal
Title Ethical issues in voluntary HIV testing in a high-prevalence area-the case of Malawi
Volume 93
Issue 3
Publication (Day/Month/Year) 2008
The first adult case of HIV/AIDS in Malawi was identified in
April 1985,1,2 with the first paediatric case in January 1986.3
From that time to 1997, at least 10% of the general population
and 15% of the 15 - 49-year age group were infected.4,5 Up to
30% of women attending prenatal care at the Queen Elizabeth
Central Hospital, Blantyre, are HIV-infected.6,7 HIV/AIDS has
been associated with a rise in the number of orphans, now
estimated at between 400 000 and 1 000 000 as no reliable data
are currently available. The maternal mortality ratio, which had
been estimated at about 620 deaths per 100 000 live births in
the 1992 Demographic and Health Survey (MDHS),8 has now
risen to 1 120/100 000, 9 due inter alia to the HIV pandemic. Up
to 70% of admissions in the medical wards of Blantyre and
Lilongwe are HIV/AIDS-related and tuberculosis (TB) has
resurfaced as a major public health problem. 10 The education
sector has been affected, and has resulted in an estimated 25%
of the Ministry of Education budget for the 2001 - 2002 fiscal
year being spent on funerals and payment of pensions to
families of deceased teachers.11
Malawi’s application to the Global Fund to fight HIV/AIDS,
malaria and TB has been successful. The country will receive
US$12 million in the first year and about US$196 million over a
5-year period. There are six components to Malawi’s strategy:
(i) voluntary counselling and testing (VCT) for HIV; (ii)
prevention of mother-to-child transmission (PMTCT) of HIV;
(iii) community/home-based care; (iv) management of
opportunistic infections and access to antiretroviral (ARV)
therapy; (v) cross-cutting issues such as human resource
development, management of drug supply, health information
management systems, and strengthening of laboratory services;
and (vi) management and institutional support with regard to
improved programme planning, co-ordination, monitoring and
Traditionally accepted HIV/AIDS prevention messages have
been: sexual abstinence first, the be faithful, and if either fails,
use condoms (ABC). As the pandemic progresses condoms
have been promoted and VCT for HIV has been advocated by
the National AIDS Control Programme and the Ministry of
Health and Population.12,13 While counselling and testing have
been encouraged, there is also the possibility that testing may
fail to empower the client/patient.

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