1. Historical Mapping of HIV Programmes 1985 – 2012 in Malawi Presented at the 20 TH INTERNATIONAL AIDS CONFERENCE, MELBOURNE, AUSTRALIA 24 th July 2014 By Dr Thomas Bisika

2. Outline Background: Trends in HIV prevalence & incidence Objectives of the Historical Mapping Exercise Methodology Findings Conclusion

3. Background  Declines in both prevalence and incidence  Decline in annual deaths from 99,000 in 2004 to 48,000 in 2013  Sharp decline observed in HIV incidence  Study was therefore initiated to understand reasons for decline in HIV incidence

4. The Historical Mapping Exercise Objective: To collect information on HIV prevention programs in order to complement the HIV incidence modeling exercise currently underway. To determine which specific HIV prevention programmes contributed to changes in HIV incidence Methodology: Desk review: Policies, strategies, plans, reports etc Key informant interviews to get expert opinion and triangulate findings from desk review

5. FINDINGS

6. Policy, leadership & programming milestones From 1995 to 2012 – a conducive environment for HIV prevention programmes was created and facilitated comprehensive programming with wide coverage (E.g. establishment of NAC, advent of Multi party democracy) A number of key strategic documents to support HIV prevention programming between 1987 and 2012 were developed (e.g. NSP, HIV policy, prevention strategy, condom strategy, HTC scale up plan, ART scale up plan)

7. Coverage & potential effect of behavior change programs Proportion of people who had ever heard of HIV was 95% in 1992 and 99% in 2010 (DHS) Comprehensive knowledge of HIV and AIDS has increased from 22.4% in 2004 to 41% in 2010 (DHS) Modeling by Bello et al 2011 reported a decline in HIV prevalence due to changes in sexual behavior Reduction in proportion of men with multiple sexual partners from 11.8 in 2004 to 9.2% in 2010 (DHS)

8. Increased uptake of HTC

9. Increased Number of sites offering ART

10. Increased ART registrations and retention

11. Increased condom use for higher risk sex

12. Reduction in STI prevalence Syphilis Prevalence among pregnant women attending ANC

13. Conclusion Identified factors contributing to decline in HIV incidence in Malawi include: Improved coordination of the national response to HIV & AIDS (NAC, policy framework, strategic guiding documents) Uptake of ART services Achievements in behavior change+ as demonstrated by increased uptake of HTC and condom use Evidence of reduced stigma leading to increased uptake of services. Decline in STI prevalence

14. Next steps Presentation of the modeling results in the context of results from the mapping exercise. Results to be discussed with various stakeholders Results will be used to optimise HIV prevention interventions with high impact Results to be used for decision making

15. THANK YOU FOR YOUR ATTENTION