HIV Bill Threaten Malawi’s Certification of Elimination of Mother to Child Transmission of HIV by WHO

Posted by Editor on June 29, 2017

HIV Bill Threaten Malawi’s Certification of Elimination of Mother to Child Transmission of HIV by WHO

In 2010 Malawi invented and started the implementation of the option B+ strategy to reduce HIV transmission from mother to child and offer HIV infected women lifesaving drugs (ARVs) regardless of their CD4 Counts. This flagship strategy has resulted in significant reduction in HIV transmission from mother to child in the country. Currently, 95% of pregnant women are offered HIV counselling and testing services across the country as part of prenatal services. Recognizing its effectiveness, the World Health Organization (WHO) has adapted this strategy as the most effective approach for eliminating HIV transmission from mother to child globally. Sadly, the 2017 HIV and AIDS Prevention Management (Section 18, 2b), which imposes compulsory testing of pregnant women and their partners, could reverse progress achieved and make it impossible for WHO to certify Malawi as a Mother to Child Transmission (MTCT) of HIV free Country. As clearly indication in its report “Elimination without Violation” WHO and UNAIDS clearly object form of compulsory testing of pregnant women and would not certify Malawi as MTCT free country, if compulsory HIV testing of pregnant women is introduced in the country. 

Malawi is one of 21 countries targeted by UNAIDS and WHO for the elimination of mother to child transmission of HIV. These countries are expected to go through the WHO validation and certification process before they are declared as MTCT free country.  Malawi has made significant progress and is on track to achieve the elimination of mother to child transmission target before 2020. Thus, imposing compulsory testing will only derail the validation and certification process. It is therefore imperative that Parliament does not approve the compulsory testing of pregnant women or any other provision that criminalizes and discriminate against  women and girls. 

Women are often the first to know their HIV status due to their health seeking behaviour and are often at greater risk of facing prosecution and abuse. Arguments that compulsory HIV testing will protect the child from HIV infection has no basis in public health. It is the behaviour and decisions of the mother rather than compulsory HIV testing that will protect the baby from HIV infection. The current option B+ strategy has clearly shown that where women are counselled and provided with appropriate information they will go for an HIV testing; and where they test positive start antiretroviral treatment and ensure they deliver in a health facility. Imposing compulsory HIV testing of pregnant women and their partners coupled with other criminalization provisions in the bill will only push women away from health services and make them subject of violations and abuse.  The question that arises is that if a pregnant woman refuses to go for HIV testing what punitive measures will be imposed? Are we going to fine or imprison pregnant women for not taking compulsory HIV testing? What will the global community say about Malawi for this gross violation of the pregnant women rights, which has no basis in public health?

We strongly urge Parliament to delete Section 18, 2b of the bill that calls for compulsory testing of pregnant women and their partners and other provisions that calls for pre-recruitment testing of domestic servants  (section 27 b) and the overly broad criminalization of HIV transmission as stipulated in Part X of the bill.  These provisions are discriminatory, disproportionately impact on women and girls and undermine national effort at ending mother to child transmission and reducing HIV infections among women and girls. Globally, criminalization of HIV transmission has only pushed key affected and vulnerable populations underground and any attempt to compulsorily test pregnant women for HIV will not only be counterproductive, bring the country name into disrepute, and undermine the national efforts at ending AIDS by 2030 in Malawi.

The Coalition of Women Living with HIV and AIDS in Malawi look forward to Parliament passing an HIV and AIDS Prevention and Management Act that ensure that all Malawians have equal access to quality HIV and AIDS services in an environment free of stigma and discrimination.  Together we can make Malawi a place where HIV and AIDS is no longer a public health threat.

By Edna Tembo, Executive Director of the Coalition of Women Living with HIV and AIDS (COWLHA) in Malawi, as appeared in the Nation Newspaper, Malawi.