HIV/AIDS problem for Malawi's developmet - Research Paper Example

HIV/AIDS and Development in Malawi Jake This paper focuses on the problem of HIV/AIDS in Malawi. The central research question is: What are the contributing factors to this significant health problem, and what is the relevance of these factors to development of the country? This paper will also discuss what has been suggested and what is being done to remedy the situation. The paper concludes that Malawi’s development is in grave danger, due to various factors, including broken trust between the government and its people, compromised international support, widespread illness and poverty, CSO marginalization, the labor exploitation of women and children, competition within the health field, and healthcare workers who are ill, overworked and dying. Solution strategies are reviewed. HIV/AIDS and Development in Malawi Southern African countries have the highest infection rates of HIV/AIDS in the world. This paper will focus on the problem of HIV/AIDS in Malawi. The central research question is: What are the contributing factors to this significant health problem, and what is the relevance of these factors to development of the country? This paper will also discuss what has been suggested and what is being done to remedy the situation. Virtually any contributing factor can begin this discussion, because they are all so closely interwoven. For example, because government loans are no longer available for farmers to purchase fertilizer, there are fewer crops and fewer agricultural exports (Bryceson, 2006). This came on top of a terrible drought. Many people have died from AIDS or are HIV+, without reasonable access to treatment. More people have become sick, so there are fewer people to farm the land and process what is harvested. Poverty is increasing. The reality of being poor is that even when the individual or family with AIDS has access to antiretroviral drugs, provided free of charge, they are not always able to take advantage of this opportunity. They cannot necessarily afford travel to and from the point of distribution, fees for diagnosis, and various miscellaneous formal and informal expense requirements (Yu, Souteyrand, Banda, Kaufman, & Perriens, 2008). Because of poverty, they die. Poverty results in increased health vulnerability, and also in more desperate measures being necessary to survive (Bryceson, 2006). Because of the way women’s labor and youth labor are viewed, high risk, exploitative employment contract relationships are engaged in, and this further spreads HIV/AIDS. Research among women in Malawi indicates that risky sexual behavior, while adding to the incidence of HIV/AIDS, is often a means of personal and family survival, given the facts of poverty and family responsibility, complicated by religious institutions, sexual practices and cultural beliefs (Rankin, Lindgren, Rankin, & NgOma, 2005). Transactional sex (sex for material support) is a clear way in which cultural norms drive the AIDS pandemic. Active sexual ties between poverty-stricken women and a patron are justified by the moral value of helping those in need (Swidler & Watkins, 2007). When these women, their husbands, or infected youth go to a medical clinic for treatment, providing they can access one, the shadow of AIDS is there. Well over 20% of government and private health facility workers are infected with HIV/AIDS (Shisana, Hall, Maluleke, Chauveau, & Schwabe, 2004). Those infected are treating those who are infected with AIDS as well as those with Tuberculosis and other infectious diseases. This suggests that infection control procedures need to be reviewed and that more people need to be trained as healthcare providers, to replace those who are becoming too sick to continue providing, and those who have died or will soon be dying. However, these facts suggest something else as well: that there is likely to be a break-down in the underlying faith that people have in their healthcare providers, and the medical system, as a whole. When a person is ill, and goes to a clinic or hospital, they do so because they believe they will be given a treatment that will make them well. Faith in the treatment rests on the assumption that the medical system has the answers on how to become and stay well. The reality in Malawi is that many doctors, nurses, and other healthcare workers are also infected. They also are dying. The treatment they offer is not widely available. They have a high rate of absenteeism, due to illness. This leaves medical facilities dangerously understaffed and non-infected healthcare workers suffering from occupational burn-out (Shisana, Hall, Maluleke, Chauveau, & Schwabe, 2004). In Malawi, there are only two doctors and 36.8 nurses per 100,000 population, although the World Health Organization recommends that there be 250 health workers per 100,000 population (Bemelmans, et al., 2011). Among healthcare workers in Malawi, HIV is a leading cause of death (Bemelmans, et al., 2011). Infected workers have a high likelihood of double infection, due to occupational exposure. They fall victim to other opportunistic infections, the most common being TB (Shisana, Hall, Maluleke, Chauveau, & Schwabe, 2004). Healthcare workers have difficulty accessing HIV testing, counseling and treatment, due to social stigma. Yet a research study done in 2009, at a government hospital clinic for healthcare workers and dependents, in Thyolo, found that 63% of those tested for HIV were in fact positive for the virus (Bemelmans, et al., 2011). The health experts, upon whom the community depends for health care, are themselves sick and often helpless. Worse than that, treatment does not save anyone, healthcare worker or villager, long term, only short term. So how can a patient continue to place trust in the medical system? Everyone, medical professionals and patients alike, are in a sinking boat together. Rather than competing for scarce treatment and struggling to survive the disease, for which there is currently no hope, there had to be an adjustment in attitude. Patients are forced to think about treatment interventions that sustain them as long as possible, because the community needs support. Healthcare workers have responsibilities toward a never-ending stream of patients who come for help, whatever the state of their own health. Women have responsibility to exchange labor, in order to support family members as long as possible. They have to care for dying husbands, children, grandchildren, relatives, neighbors. Community care will not save patients and their loved ones from certain death, so in that sense it is a task without hope. But this has become what life is in Malawi. This has become the frame through which life is experienced. In this frame, community support becomes vital. Research has shown that antiretroviral treatment outcomes are significantly better with community support, and are accompanied by a lower death rate (Zachariah, et al., 2007). The researchers suggest that the community is a mostly unrecognized and untapped resource in countries like Malawi, where resources are severely limited and antiretroviral treatment is not widely available (Zachariah, et al., 2007). This reference is made in regard to those who develop strategies and provide funding for meeting the challenges of the HIV/AIDS epidemic in Malawi. There are constant changes in the community, and it is no longer a stable base. In addition to death, illness, and decreasing resources, already mentioned, another feature of the AIDS environment in Malawi is children’s migration. Children are relocated to other households and other areas due to loss of parents or caregivers, the need to provide support for relatives, to meet ever-changing family needs, and due to child preference (Ansell & Blerk, 2004). Families use this as a coping strategy for the outcomes of HIV/AIDS (Ansell & Blerk, 2004). This practice threatens the development of the country. When families are fragmented, so are communities, and when communities are fragmented, so is the nation. Children’s migration means more loss in a country where people are reeling from loss. Changing locations is destabilizing to their identity, disruptive to education and friendships, and it means separation from everything that is familiar. It adds to the loneliness of loss already experienced. These are children who no doubt have emotional and psychological issues. But with less money available for health concerns other than HIV/AIDS, there is little hope of these children getting the counseling help they need. Consequently, it is to be expected that they will grow up to be adults with emotional and psychological problems. The future development of the country will be adversely affected by these challenges and limitations. In addition to those living with HIV/AIDS, economically disadvantaged women who engage in risky transactional sex for material resources required for survival, infected and non-infected healthcare workers, and children without security and consistency, there is another community active in this disaster, and that is government and development partners whose responsibility is to prioritize, authorize and direct funding to HIV/AIDS service delivery. They have responsibility, to relieve suffering, reduce deaths, and keep Malawi’s social and health services focused on primary issues, yet they engage in endless debates and are even accused of bringing more harm than good (Yu, Souteyrand, Banda, Kaufman, & Perriens, 2008). Universal access to appropriate and adequate HIV/AIDS services, especially to HIV testing and antiretroviral treatment, has not yet been achieved, so it is important to hold steady the focus on funding direction. Progress has been made. The government has better awareness and concern for the HIV/AIDS issue. Healthcare workers have been provided antiretroviral treatment. Services have expanded (Yu, Souteyrand, Banda, Kaufman, & Perriens, 2008). On the other hand, the healthcare services funding and delivery, in Malawi, has left people with a concern that HIV/AIDS programs have flourished at the expense of ignoring reproductive health services, which are now severely cut. There is also widespread belief that healthcare workers leave other service delivery programs to accept higher wage positions in HIV/AIDS service programs, leaving other programs in increasingly worse shape. Others respond with the argument that it is merely a coincidence of timing, that funding for the HIV/AIDS crisis is coinciding with a stagnation of funding for other healthcare services, but that there is no causal relationship (Yu, Souteyrand, Banda, Kaufman, & Perriens, 2008). Another source of conflict among government and non-government agencies, dealing with the HIV/AIDS crisis, is the marginalization of civil society organizations. Although civil society organizations have led the front lines of response, still their contributions and models for action have been marginalized by governments and international aid agencies (Rau, 2006). Politicians worry about empowering organizations that may turn against them in the future, to criticize their handling of the crisis and development failures. Government bureaucrats are worried about possible challenges to their own claims of expertise and to their own solution strategies. Even when community-based organizations are authorized by the government for action, in overlooked areas of the crisis, the government always claims credit for anything good that comes out of their HIV/AIDS control efforts (Rau, 2006). The contributions of civil society organizations (CSOs) are being undermined by changing international management and funding methods (Kelly & Birdsall, 2010). For example, the Paris Declaration on Aid Effectiveness has reshaped international funding for HIV/AIDS relief. Changing modalities include national performance strategies and goals, budget support, joint funding, etc. These modalities limit CSO contributions, and they are reduced to being service deliverers for international programs. This cuts down on the potential diversity of CSO services, impairs the construction of long term local CSO economies, and CSO potential to respond locally, based on local preferences and cultural needs (Kelly & Birdsall, 2010). This has an adverse effect on the development of Malawi. In 2010, in response to the needs of the 12.6% of HIV+ pregnant women, and the short life spans of their babies (van Lettow, et al, 2011), and in alternative response to the World Health Organization’s recommendation that treatment should begin earlier, in the HIV/AIDS progression, the government of Malawi announced a new policy in which all pregnant women would be tested and, if HIV positive, immediately be given antiretroviral drugs for the rest of their lives (Fleischman, 2011). This is an ambitious plan, and requires the cooperative assistance of the international community, and better ART documentation (Makombe, et al, 2008). Before this ambitious plan could be implemented, the government of Malawi used undue force against peaceful demonstrators, losing a lot of international support, especially from the USA and UK (Fleischman, 2011). Nor was this the government’s only act of aggression and suppression against civil society. No one is sure, now, about the potential success of Malawi’s test-and-treat project, given the politically volatile and adverse economic situation. A successful government strategy to raise AIDS awareness among schoolgirls by paying them to attend school and remain celibate throughout, is promising (Harmon, 2011), as are knowledge-based intervention programs for healthcare workers (Mbebe, et al, 2011) and for general householders (Rimal, et al, 2009). Testing and providing antiretroviral drugs to all healthcare workers, their dependents, and pregnant women, and the government’s plan to build significantly more HIV/AIDS facilities, give further training to at least two thirds of all healthcare workers in the country, and to work toward wider testing, all sound good. But these strategies depend upon cooperation and trust between the government and the people, as well as appropriate use of international support. Trust has been violated between the government and its people. International support has been at least partially compromised. Sickness, poverty and death are wide-spread. Community-based support has been marginalized, undermined, rejected, and inaccurately credited. Women and children have their labor exploited. The healthcare field competes with itself, and healthcare workers are ill, overworked and dying. Malawi’s development is in grave danger because of these factors, as they all have significant impact. References Ansell, N., & Blerk, L. V. (2004). Childrens migration as a household/family strategy: Coping with AIDS in Lesotho and Malawi. Journal of Southern Aftican Studies, Vol. 30(3) , 673-690. Bemelmans, M., Akken, T. v., Pasulani, O., Tayub, N. S., Hermann, K., Mwagomba, B., et al. (2011). Keeping health staff healthy: Evaluation of a workplace initiative to reduce morbidity and mortality from HIV/AIDS in Malawi. Journal of the International AIDS Society, Vol. 14(1) . Bryceson, D. F. (2006). 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