ABSTRACT

More than 70 million people have been infected worldwide with the HIV virus from the start of the epidemic, and since then, nearly 35 million people have died of HIV. Sub-Saharan Africa remains the most severely affected area, accounting for nearly 70% of the people living with HIV worldwide. Approximately 8.8% of women and men age 15 to 49 in Malawi are HIV positive. Socio-demographic factors affecting the HIV/AIDS epidemic in Kasungu district in Malawi are currently unknown. This study aimed to determine the main socio-demographic factors affecting HIV/AIDS propagation and its treatment in Kasungu district in central Malawi. A descriptive cross sectional study involving 1260 adult participants (aged 18+) living with HIV at both the Kasungu District Hospital and St. Andrew's Hospital was conducted. HIV was common among non-pregnant females (40.9%) compared to pregnant females, (19.3%). HIV was also more common among non-pregnant females than men (40.9% vs. 39.6%, respectively). In general, HIV was more common among farmers (38.5%) and businessmen (24.5%). The main reason for starting anti retro viral (ARV's) was a low CD4 count, seconded by World Health Organization (WHO) clinical stage 3. Nine out of 11 clients had negative reactions towards their HIV positive serostatus. Seven out of 11 clients had thoughts related to suicide or attempted suicide. About 50% of the surveyed patients revealed that they had experienced discrimination due to their HIV positive status.

Key words: HIV/AIDS, demographic factors, social factors.

HIV was common among non-pregnant females (40.9%) compared to pregnant females, (19.3%). HIV was more common among non-pregnant females than men (40.9 vs. 39.6%, respectively). Overall, HIV was common among females compared to males, Figures 1 and 2, and the younger demographic was mainly affected by HIV; such that HIV was most common within the ages of 20 to 50 years, Figure 3. Overall, the main reason for starting ARV was a low CD4 count, seconded by symptoms from WHO clinical stage 3 (Figures 4 and 5). Among females, the main reason for starting ART was a low CD4 count seconded by HIV in pregnancy. HIV was more common among farmers (38.5%) and Business people (24.5%).

 

 

 

 

This study revealed that HIV in Kasungu district was more common among females than males, 40.9% vs. 39.6%, respectively. This finding is consistent with MDHS 2015-16 findings whereby the HIV prevalence was also higher among women than men (10.8% versus 6.4%). Compared to men, women are often powerless to negotiate safe sex properly - this is a common phenomenon in several African countries, especially amongst poorer rural populations (Ung et al., 2014). The results indicated that the main reason for patients starting ARV was a low CD4 count f ollowed by WHO clinical stage 3 symptoms. This finding is due to the fact that this survey was conducted before UNAIDs rolled out the “Test All Treat All” campaign in 2016, whereby everyone who tests positive for HIV starts treatment immediately regardless of CD4 count (WHO Progress Report, 2016). The main reason for starting ART for females in particular was a low CD4 count seconded by HIV in pregnancy, Figure 4. More women started ART because of pregnancy as part of prevention of mother to child transmission of HIV (PMTCT) option B+, since it is much more likely for African mothers to experience MTCT (Drake et al., 2014).

 

HIV was common among farmers and business owners (38.5 and 24.5%, respectively), Figure 6. This finding was expected, as most of the population of Kasungu district is made up of commercial farmers and business people who engage in promiscuous sexual behaviours that lead to higher HIV prevalence. Stigma has been described as a dynamic process of devaluation that significantly discredits an individual in the eyes of others. HIV-related stigma is multi-layered building upon and reinforcing negative connotations through the association of HIV and AIDS with already marginalized behaviours, such as sex work, drug use, and homosexuality and being transgender. Discrimination consists of actions or omissions that are derived from stigma and directed towards those individuals who are stigmatized. Both stigma and discrimination often have negative consequences on the lives of those living with HIV, and can promote risky behaviours due to fear of judgement (Valdiserri et al., 2002; Dos Santos et al., 2014, Reimers et al., 2016). Our survey results indicate that internalized stigma and discrimination related to HIV-status is still prevalent in Kasungu, despite the fact that many people receive information about HIV/AIDS before they get tested, via the hospital staff.

 

 

The exact source of this stigma and discrimination are still unknown, but due to the confidential nature of HIV-status in Kasungu, patients may have experienced discrimination from family members, friends, or hospital staff. It is not uncommon for discrimination towards HIV-positive patients to manifest in the form of unprofessional treatment and care (Valdiserri et al., 2002). This is consistent with the findings of Peter Aggleton et al in April 2005, which revealed that people living with HIV and their caregivers reported receiving differential and discriminatory treatment from health-care workers. Discrimination lead to isolation in wards, early discharge from hospital, delays in surgery, and serious breaches of confidentiality—all effectively limiting access to proper care (Aggleton et al., 2005).A little more than half of the surveyed patients had misconceptions about HIV before they were tested. This indicates that the general population of Kasungu is not very well educated about the details of HIV/AIDS, although information is available publicly through radio broadcasts and posters.

 REFERENCES