With empirical evidence from Malawi perspective, how does violence against women, gender

issues, traditional medicines and witchcraft contribute to the spread of HIV/AIDS

By:

Alepha Maskiya

Submitted to:

Mr Chirambo

In Partial Fulfillment for the requirement of

HIV&AIDS and community development

Course code: COD2013

Project

Malawi Assemblies of God University

(MAGU)

7 August 2020

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Table of Contents
1.0 Introduction..........................................................................................................................2

2.0 How HIV is Passed..............................................................................................................3

3.0 How HIV is Transmitted and Their Prevention...................................................................3

4.0 Impacts of HIV and AIDS at Different Levels....................................................................4

4.1 Household and Community Level....................................................................................4

4.2 National level....................................................................................................................4

5.0 Impacts of HIV and AIDS on Education.............................................................................5

6.0 Impacts of HIV and AIDS on Health Sector........................................................................5

7.0 Factors that Accelerate Spread of HIV and AIDS in Malawi..............................................5

7.1 Violence against women...................................................................................................5

7.2 Gender Issues....................................................................................................................6

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 7.2.1 Poverty.......................................................................................................................6

7.2.2 Gender Inequalities....................................................................................................7

7.2.3 Social-cultural beliefs and practices..........................................................................8

7.3 Witchcraft.........................................................................................................................8

7.4 Traditional medicine.........................................................................................................9

8.0 Efforts Used in Addressing HIV and AIDS Epidemic.......................................................10

8.1 Developing Information, Education, Communication and Life Skills Programs..........10

8.2 Condom access, distribution and use..............................................................................11

8.3 Voluntary Counselling and Testing (VCT)....................................................................11

9.0 Conclusion..........................................................................................................................11

10.0 References........................................................................................................................12

1.0 Introduction
HIV is the virus that causes AIDS. It damages the immune system, making it easier
for a person to get sick. HIV is spread during sex, but condoms can help to protect its spread.
HIV stands for Human Immunodeficiency Virus. It’s a virus that breaks down certain cells in
the immune system (the body’s defense against diseases that helps a person to stay healthy).
When HIV damages the immune system, it’s easier to get really sick and even die from
infections that the body could normally fight off (Barnett and Whiteside, 2002).

Once a person has HIV, the virus stays in the body for life. There’s no cure for HIV,
but medicines can help an individual to stay healthy. HIV medicine lowers or even stops the
chances of spreading the virus to other people. Using HIV treatment as directed can lower the
amount of HIV in the blood so much that it might not even show up on a test, when this
happens, an individual can’t transmit HIV through sex.

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 Treatment is really important that’s why getting tested is so important. Without
treatment, HIV can lead to AIDS. But with medicine, people with HIV can live long, healthy
lives and stop the spread of HIV to others.

HIV is the virus that causes AIDS. AIDS stands for Acquired Immune Deficiency
Syndrome. HIV and AIDS are not the same thing. And people with HIV do not always have
AIDS. HIV is the virus that’s passed from person to person. Over time, HIV destroys an
important kind of the cell in the immune system called CD4 cells or T cells that helps protect
the body from infections. When a person doesn’t have enough of these CD4 cells, the body
can’t fight off infections the way it normally can.

AIDS is the disease caused by the damage that HIV does to the immune system. A
person acquires AIDS when he has dangerous infections or has a super low number of CD4
cells. AIDS is the most serious stage of HIV, and it leads to death over time (Barnett and
Whiteside, 2002). Without treatment, it usually takes about 10 years for someone with HIV to
develop AIDS. Treatment slows down the damage the virus causes and can help people stay
healthy for several decades. This essay will discuss about the issues that perpetuate the spread
of HIV and AIDS.

2.0 How HIV is Passed

HIV is carried in semen, vaginal fluids, anal mucus, blood, and breast milk. The virus
gets in the body through cuts or sores in the skin, and through mucous membranes. A person
can get HIV from having vaginal or anal sex, sharing needles or syringes for shooting drugs,
piercings, tattoos, and getting stuck with a needle that has HIV-infected blood on it and many
more.

3.0 How HIV is Transmitted and Their Prevention

HIV is usually spread through having unprotected sex with an infected person. Using
condoms when having sex with an infected person can help to stop the transmission of HIV
to the healthy person. If a person has HIV, then treatment is required to lower or even stop
the chances of spreading the virus to other people during sex. If a person doesn’t have HIV,
there’s also a daily medicine called PrEP that can protect the individual from HIV. Pre-
exposure prophylaxis, or PrEP, is a way for people who do not have HIV but who are at
substantial risk of getting it to prevent HIV infection by taking a pill every day.

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 Furthermore, HIV can also be passed to babies during pregnancy, birth, or
breastfeeding. The transmission of HIV from a HIV-positive mother to her child during
pregnancy, labor, delivery or breastfeeding is called mother-to-child transmission. Mother-to-
child transmission (MTCT) is the main mode of HIV transmission in children under 15 years
old. A pregnant woman with HIV can take medicine to greatly reduce the chance that her
baby will get HIV.

To add on that, Lifelong antiretroviral therapy (ART) is recommended for all adults
and children from the time their HIV-positive status is known. A woman who started ART
before pregnancy or when tested during pregnancy greatly reduces the chances that her baby
will be infected in the uterus or during delivery. ART for the mother also greatly reduces the
chances of passing HIV to her infant through breast milk. Also, the newborns of mothers
living with HIV should receive 2 antiretroviral drugs (ARVs) for the first 6 weeks of life.
This further reduces the chances of HIV passing from mother to child in the period around
birth.

Again, some people can get HIV from infected blood transfusions. Receiving blood
transfusions, blood products, or organ/tissue transplants that are contaminated with HIV
transmits HIV. This was more common in the early years of HIV, but now the risk is
extremely small because of rigorous testing of the blood supply and donated organs and
tissues. But now, giving or getting blood in medical centers is totally safe. Doctors, hospitals,
and blood donation centers don’t use needles more than once, and donated blood is tested for
HIV and other infections (Mann, Tarantola, Netter, 1992).

4.0 Impacts of HIV and AIDS at Different Levels

4.1 Household and Community Level
At the household level the majority of those who are dying of HIV/AIDS are in the
most productive years and are very often the sole breadwinners in the household. HIV/AIDS
has therefore had a devastating effect through the loss of income and thus leading to poverty,
changes in patterns of household expenditure, limited access to health services and other
social services and the weakening of the family as the basics social unit particularly the
extended family, which is an important social safety net (Okeregbe, 2000).

Not only that, people fall ill, cannot work, and lose income. Their families spend
money on care and treatment and lose further income in taking time to care for them. Women
too fall ill and die, usually at an age considerably younger than men. Given their productive

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role in the home, in agriculture, and in the informal sector of the economy, their loss is a
critical one. Widows and orphans lose their land, shelter, inheritance and are forced to depend
on relatives or migrate to cities and may join an urban underclass of commercial sex workers
and street children. Traditional support systems are stretched and then broken and families
and communities lose their economic, social, and cultural viability and gain a sense of fear,
fatalism, and helplessness.

4.2 National level

The HIV/AIDS pandemic has an impact on labor supply, through increased mortality
and morbidity. This is compounded by loss of skills in key sectors of the labor market. To
add on that, the long period of illness associated with AIDS reduces labor productivity. This
reduces competitiveness and profits. Government incomes also decline, as tax revenues fall,
and governments are pressured to increase their spending, to deal with the rising prevalence
of AIDS, thereby creating the potential for fiscal crises.

Again, there will be reduced exports and increased imports. Lower domestic
productivity reduces exports, while imports of expensive healthcare goods may increase. The
decline in export earnings will be severe if strategic sectors of the economy are affected, such
as agricultural production. Consequently, the balance of payments (between export earnings
and import expenditure) will come under pressure at the same time that government budgets
come under pressure. This could cause defaults on debt repayments and require economic
assistance from the international community (Wren, 2004).

5.0 Impacts of HIV and AIDS on Education

There is a high mortality rate among teachers, which has led to a shortfall of teachers.
The productivity of teachers has dropped as a result of absences due to frequent illnesses,
which has in turn affected the quality of education. Apart from being understaffed, the
productivity of teachers has dropped in part as a result of absences due to illness. Another
related factor is an increase in the average time they take off work to attend funerals. Even
when teachers are present in class, a study has shown that they suffer from exceedingly high
levels of stress attributed to trying to tackle the immense and complex social situations more
and more students are faced with due to AIDS deaths in the family (Walle, 1990).

6.0 Impacts of HIV and AIDS on Health Sector

In terms of the impact of HIV/AIDS on the health sector, this continues to be a great
concern given the consequent astronomical cost involved in the care and treatment. The

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treatment of opportunistic STD infections in HIV infected persons is expensive and has
placed an unprecedented burden on the delivery of comprehensive health care. The services
available cannot meet the demand and Government has been unable to invest adequately into
this sector due to inadequate national resources. Another aspect of the impact on the health
sector has been the high morbidity and mortality among health workers. Thereby affecting
the quality of the health care offered.

7.0 Factors that accelerate the Spread of HIV and AIDS in Malawi
7.1 Violence against women
HIV disproportionately affects women and adolescent girls because of their unequal
cultural, social and economic status in society. This means that violence must be tackled in
order to end the global HIV epidemic, and achieve other, broader development outcomes.

Women who have experienced violence are more likely to be infected with HIV than
those who have not. Younger women in Malawi are more likely to experience physical or
sexual violence than older women, generally from an intimate partner. Intimate partner
violence, reinforce unequal power dynamics between men and women. These dynamics limit
women’s choices, opportunities and access to information, health and social services,
education and employment. For example, in some countries women require the consent of a
spouse or partner to access sexual and reproductive health services and of women aged 15
to19 do not have a final say in decisions about their own health.

Violence increases the risk of HIV infection in women as a result of physiological and
psychological reasons. Uninfected women are about twice as likely to contract HIV from
infected men. Women are more vulnerable to infection and forced sex further increases the
risk of HIV transmission especially in adolescent girls (Armstrong, Boss, 1992). However,
even the threat of violence can have serious negative consequences. Women fearing violence
are less able to protect themselves from infection. These women do not have the power to
negotiate for safe sex or to refuse unwanted sex, they do not get tested for HIV, and they fail
to seek treatment after infection. In Malawi, HIV-positive women chose not to receive
treatment at a clinic because they fear violent behavior and abandonment by their family.
Women report fearing discrimination, physical violence, and rejection by their family if they
disclose their HIV-positive status.

Not only that, stigma and discrimination further exacerbate women’s vulnerability to
HIV and undermine the response to the epidemic. In particular, women in key populations

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face numerous and specific challenges and barriers, including violence and violations of their
human rights, in health care settings and from uniformed personnel.

7.2 Gender Issues

7.2.1 Poverty
Poverty is an overarching factor that increases vulnerability to HIV and is further
complicated by gender inequalities. Poor women are often economically dependent on men.
The need for economic support may partly drive earlier marriage and existing gender
inequalities may make it difficult for young women to insist on safer sexual practices
(Barrington, 2004). The poorest women may have little choice but to adopt behaviors that put
them at risk of infection, including transactional and intergenerational sex, earlier marriage,
and relationships that expose them to violence and abuse.

In many parts of rural Malawi, food insufficiency can also drive the adoption of high-
risk behaviors such as commercial sex. Women tend to have more sexual partners in order for
them to have material or financial support. Women who reported having insufficient food
were more likely to report two or more high-risk behaviors than women with sufficient food
supply.

Again, poverty can also push girls into relationships with older men for the promise
of money or gifts. Age-disparate sexual relationships between young women and older men
are common in Malawi. This is more likely to expose young women to unsafe sexual
behaviors, low condom uses and an increased risk of sexually transmitted infections.

The risk of trafficking and sexual exploitation is also higher for young women and
adolescent girls living in poverty. Poverty also increases the risk of child marriage.
Worldwide, girls belonging to the poorest are more likely to be married as children compared
with girls in the richest.

7.2.2 Gender Inequalities

Community acceptance of norms of masculine behavior and men’s use of power over
women promotes power inequality between the genders, which can lead to violence. Several
forms of male dominance, while supported in greater numbers by men, are also widely
accepted by women. For example, men believe that a girl does not have the right to refuse sex
with her husband. And, some males and female’s views sexual violence as something that
does not include forcing sex with someone you know

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 In addition, the unequal power dimension is distorted further by large age differences
in relationships. It is common for women in Malawi to marry at a young age or have older
intimate partners who are sexually more experienced. Older men are also more likely to have
been exposed to HIV/AIDS and more likely to infect their younger female partner, especially
if women feel like they cannot negotiate for safe sex because of unequal power in the
relationship. Married women believe that they do not have the right to ask their husband to
use a condom, even if they knew his infected with HIV. However, less women have a right to
refuse to have sex with him. Not only that married women believe that a man is justified in
beating his wife if the woman argued with him although other women agree that a beating
was justified if a wife refused to have sex with her husband (Armstrong, boss, 1992).

Women lack control over their lives and are taught from early childhood to be
obedient and submissive to males, particularly males who command power such as a father,
uncle, husband, elder brother or guardian. In sexual relations, a woman is expected to please
her male partner, even at the expense of her own pleasure and wellbeing. Dominance of male
interests and lack of self-assertiveness on the part of women puts them at risk of getting HIV
and AIDS.

7.2.3 Social-cultural beliefs and practices

The social cultural beliefs, which subordinate women in society make them more
vulnerable to HIV infection. For example, a woman is taught never to refuse sex with her
husband even when he is known to be involved in extra marital sexual liaisons, or is
suspected to have HIV or any other STI.

Difficult socio-economic conditions compel women to exchange sex for money or

gifts. Other cultural practices such as dry sex and the traditional practice of widow widower
cleansing also facilitate the transmission of HIV.

7.3 Witchcraft
Witchcraft is believed to be responsible for influencing the spread of the HIV
pandemic. Witchcraft is a term used more popularly and broadly to describe all sorts of evil
employment of mystical power, generally in a secret fashion.

In many countries throughout the world belief in witches is common, and black magic
is considered part of everyday life. Witch doctors are consulted not only for healing diseases,
but also for placing, or removing, curses or bringing luck. Widows in some parts of Malawi
are expected to engage in unprotected sex in order to "cleanse" them which can lead to the

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spread of HIV and AIDS. The belief is that the husband's spirit will return otherwise, cursing
the family.

It’s a mindset issue that the widows have been told to be cleansed since that they
don’t want a curse to come in their lives. Because this spiritual cleansing involves
unprotected sex, this has also been the factor that leads to the spread of HIV and AIDS.
(Caldwell, Caldwell, Quiggin, 1989). The widows are placed at increased risk of contracting
HIV, which is endemic on the continent. There are even professional "cleansers" who charge
high prices for their services, which the widows are often eager to pay to avoid a curse on
their families.

This definition of witchcraft is sufficient enough to explain the concept of witchcraft

from a Malawian perspective. This phenomenon is always the answer to any misfortune
which may befall an individual or family. This evil force is also blamed for natural disasters
such as poor crops and drought. It is also believed to be responsible for sickness and death.
Arguably, this phenomenon is not an ancient philosophy. It is common even in today's life.
The importance of this paragraph is to show how the Malawian females fail to access modern
medicine when they test HIV positive.

In view of this, no Malawian falls sick without someone being labelled a witch. Even
where one is suffering from HIV, the conclusion is that the person is bewitched. It is a
conflict of two worldviews, that is the Malawian and the western philosophies. The western
philosophy subscribes sickness and death to a scientific cause while Malawian philosophy
points to human beings as the cause of any kind of sickness and death.

Culture and its aspects such as ancestors, witchcraft and other religious beliefs were
held responsible for influencing the spread of HIV among the females. Because all illness is
attributed to some evil spirits or power which is believed to be caused by a member of the
family, no western medicine can be of any help. Although it could be over-emphasizing to
claim that all people did not go for HIV testing, the focal point was the belief in witchcraft
and other evil spells as the cause of the disease. Problems associated with this ideology is that
many people will be reluctant and not value visiting medical clinics and hospitals for HIV
testing hence continuing the spread of HIV and AIDS. Even those who got tested by any
means would not believe that it was true that they were suffering from AIDS. A number of
these people suffered from the disease and eventually died of it (Mann, Tarantola, Netter,
1992).

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 The sex act is believed to have protective powers as well. Custom also dictates that
because a widow is "unclean" she is obliged to undergo a cleansing ritual immediately after
her husband's death. Other women who refuse to have intercourse with another man are
thought to be unlucky or cursed and are usually ostracized by the community.

7.4 Traditional medicine

In both rural and urban Malawi, traditional healers typically hold positions of
authority within their communities. Traditional forms of illness are understood to result from
supernatural causes such as bewitchment or ancestral wrath. Healing of illness largely
involves traditional medicinal remedies Unlike physicians, traditional healers are thought to
be able to diagnose ailments resulting from such sources as social transgressions, spirits,
curses, and sorcery. People seek care from traditional healers due to social acceptability,
perceived source of illness, personal relationships between healers and their patients, as well
as the perceived fit of a healer's explanation of illness with patient expectations. Hence, many
people who seek traditional medicine until they experience severe HIV symptoms do not
benefit from earlier care and treatment.

Some traditional healers lack the biomedical skills and knowledge to diagnose and
treat and hence they don’t give the right medication on HIV and AIDS. Traditional healers
are older and have less formal education than the general population. Traditional healers use
the same razors to different people in order to rub traditional herbs into bloodied skin and
healers use razor cutting as a routine practice. The continuous usage of unsterilized
instruments and cross contamination with patients' blood and body fluid in their practices
increases the spread of HIV and AIDS.

Not only that, the traditional Healers do not refer HIV patients to clinics for two
principal reasons. These are; patient symptoms or signs of HIV are not unrecognized better at
the clinics and they also believe that they can treat the illness effectively themselves.
Traditional healers are far more likely to believe in a spiritual than an infectious origin of
HIV disease (Chakaza, 1993).

On the other hand, Traditional Healers claim that ancestors did not condone behavior
which made people vulnerable to HIV, such as having multiple sexual partners. Furthermore,
ancestors did not protect people from acquiring HIV and once they had HIV, they needed to
go to the clinic for care and treatment. The traditional healers share that their healing power
was not self-determined but was derived from the strength of their relationship with

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ancestors. Diagnosis and treatment of patients was acquired through communication with the
ancestors. This way of healing can cause the spread of HIV and AIDS since that mostly the
traditional healers will use traditional medicine and power to cure HIV and AIDS. For
example, the traditional healers may tell an infected man to have intercourse with his
daughter so that he can get cured. Upon doing this, the infected man will transmit the virus to
the healthy daughter hence spreading the risk of HIV and AIDS.

8.0 Efforts Used in Addressing HIV and AIDS Epidemic

8.1 Developing Information, Education, Communication and Life Skills Programs
The main thrust of the programs is the use of mass media to inform the general public
about HIV/AIDS. The channels used include television, radio, billboards, and use of
pamphlets. The programs also include introduction of applicable materials in school
curricula. The Government through the Ministry of Education has adopted a number of
HIV/AIDS and reproductive health teaching materials in the mainstream school curriculum at
national level. This is within the context of Life Skills education for boys and girls from
primary school up to tertiary levels. Special life skills programs are also developed and
targeted at special groups such as commercial sex workers, truck drivers, out of school youth,
military etc., by the NGOs. (Hausermann, 1990).

8.2 Condom access, distribution and use

Although the knowledge on condom is high but use is low. Social marketing has to
date been the primary strategy for increasing the access, acceptability and use of condoms in
Malawi. Male condoms are actively marketed through mass media promotions. Traditional
outlets such as health centers, pharmacies and drug stores have been used for condom selling.
Non-traditional outlets have also been targeted for condom sales and these include bars and
provision stores.

8.3 Voluntary Counselling and Testing (VCT)

Voluntary Counselling and Testing (VCT) is the entry point for diagnosis and
management of infected persons. It has now become part of a wide range of interventions
such as prevention of Mother to child transmission of HIV, TB programs, STD programs,
treatment, and home based care. VCT also helps to challenge denial of infection and helps
members of society to recognize and accept that one can live with HIV infection and show no
outward signs and symptoms (Hausermann, 1990).

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 Government through the National AIDS programmed has trained counselors
throughout the countries though this has not adequately satisfied the need. The vision is to
decentralize counseling and testing facilities and make them readily available in public and
private institutions within the communities. The service both institution and community
based is currently limited to major centers.

9.0 Conclusion
It is possible to stop the spread of HIV and AIDS if the people can avoid
promiscuous behaviors and become wiser. Not only that there are presently drugs that inhibit
and therefore delay the development of HIV into full-blown AIDS in the developing
countries. The governments also have roles to play. They need to provide better healthcare
services to the people living with HIV and AIDS and raise the disease awareness. So
everyone has to play the role in fighting the epidemic

10.0 References
Armstrong, J., Boss, E., 1992. The Demographic, Economic, and Social Impact of AIDS.
Cambridge: Harvard University Press.

Barnett, T., and Whiteside, A., 2002. AIDS in the Twenty-First Century: Disease and
Globalization. New York: Palgrave MacMillan.

Barrington, R., 2004. Poverty is Bad for your Health. Dublin: Combat Poverty Agency.

Caldwell, J., Caldwell, P., Quiggin, P., 1989. The Social Context of AIDS in Sub-Saharan
Africa. In Population and Development Review, vol. 15, no. 2, June, pp. 185- 235.

Chakaza, J. 1993. The Impact of HIV/AIDS on Education. Nairobi: International

Development Research Centre.

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Hausermann, j. 1990. Ethical and Social Aspect of AIDS in Africa. Commonwealth

Mann, J., Tarantola, D, Netter, T., 1992. AIDS in the World. Harvard University Press:
Cambridge.

Mann, J.; Tarantola, D.; Netter, T., 1992. AIDS in the World. Cambridge: Harvard University
Press.

Okeregbe, T., 2000. Global AIDS Pandemic Assumes Scary Dimension. The Sunday
Guardian, 3/12/00, p 6.

Walle, E., 1990. The Social Impact of AIDS in Sub-Saharan Africa. In The Milbank
Quarterly, vol. 68, suppl. 1, pp. 10-32.

Wren, M.A., 2004. Unhealthy State: Anatomy of a Sick Society. Dublin: New Island Books.

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