VZCZCXRO5762
RR RUEHBZ RUEHDU RUEHJO RUEHMR RUEHRN
DE RUEHLG #0038 0180738
ZNR UUUUU ZZH
R 180738Z JAN 08
FM AMEMBASSY LILONGWE
TO RUEHC/SECSTATE WASHDC 4976
RUCNSAD/SOUTHERN AF DEVELOPMENT COMMUNITY COLLECTIVE
RUEAUSA/DEPT OF HHS WASHDC
RUEHPH/CDC ATLANTA

UNCLAS LILONGWE 000038 
 
SIPDIS 
 
SIPDIS 
 
STATE FOR S/GAC - KATIE CROWLEY 
USAID FOR AFR/SA, GH/OHA, GH/HIDN 
CDC FOR CCID/NCHHSTP - DEBBIE BRIX, RJ SIMMONDS, T DIAZ 
 
E.O. 12958: N/A 
TAGS: EAID KHIV SOCI MI
SUBJECT: REVISED HIV PREVALENCE RATES FOR MALAWI 
 
 
¶1. Summary:  A new survey conducted with UNAIDS' revised methodology 
shows 2007 HIV prevalence rates in Malawi for adults ages 15-49 at 
12%.  The GOM will likely release the survey soon.  As part of the 
new study, the HIV prevalence rate reported in 2005 has been revised 
from 14% to 12% for adults ages 15-49 as a result of the new UNAIDS 
methodology.  While prevalence rates declined between 1998, when the 
overall HIV prevalence was estimated at 13.9%, and 2005, they have 
remained stable since 2005.  Malawi continues to register an 
increase in overall numbers of infected adults due to the growing 
population, and increased lifespan of infected persons now able to 
access antiretroviral therapy.  The survey suggests that new 
infections in urban areas have continued declining, but new efforts 
will be needed to prevent transmission in rural areas.  End Summary 
 
¶2.  The 2005 "HIV and Syphilis Sero-Survey and National HIV 
Prevalence Estimates Report" had previously estimated HIV/AIDS 
prevalence in adults (15 - 49 years) in Malawi at 14.02%, with a 
range from 12 to 17%.  A total of 790,000 adults were reported 
infected; 96,552 new infections were estimated to occur each year. 
These data were modeled using sentinel surveys which focused on a 
small sample of pregnant women in a defined set of antenatal 
clinics. 
 
NEW UNAIDS METHODOLOGY YIELDS NEW BASELINE 
------------------------------------------ 
 
¶3. In 2007 however, UNAIDS reported that prevalence estimates from 
ANC sentinel survey data were too high because they focused on a 
high risk group of the population, i.e. pregnant women who tended to 
have higher infection rates.  UNAIDS suggested that countries adjust 
ANC sentinel survey data to levels projected by DHS data, which 
randomly select individuals from the entire population and 
consequently are more accurate.  Ultimately UNAIDS recommended a new 
methodology to estimate HIV prevalence rates using both newly 
available Demographic and Health Survey (DHS) data and the Antenatal 
Clinic (ANC) Sentinel Survey data.  Malawi integrated this 
recommendation into its 2007 HIV prevalence estimation. 
 
¶4. In November 2007, Malawi convened a panel of experts to 
recalibrate HIV prevalence estimates using the newly available 2007 
ANC sentinel data and 2005 DHS data.  The "HIV and Syphilis 
Sero-Survey and National HIV Prevalence Estimates Report for 2007," 
due to be released shortly, will show prevalence rates for adults 
15-49 years of age at 12%, with a range from 11.1% to 12.9%, giving 
a total of 809,833 infected adults (15+), 89,055 infected children 
(0 - 14 years) and ~85,000 new infections each year, including both 
adults and children.  Furthermore, the GOM has revised its 2005 
HIV/AIDS prevalence in 2005 in adults (15 - 49 years) to 12% from 
14.02%, giving a total of 792,754 infected adults (15+) and 74,105 
infected children (0 - 14 years). 
 
LIMITED USG PARTICIPATION IN SURVEY 
----------------------------------- 
 
¶5.  Due to ethical concerns, OGAC adopted CDC-issued guidance that 
prevents USG participation in non-consensual HIV testing.  Sentinel 
surveys at ANC clinics do not ask for consent in testing anonymous 
specimens, and thus cannot alert a patient of their HIV status.  As 
a result, USG did not take part in the survey's specimen collection 
phase or actual lab analysis, but did assist in the evaluation of 
data.  Technical support was provided to Malawi both from the PEPFAR 
Country Team and from colleagues at CDC headquarters in Atlanta to 
develop the critical national and regional figures for HIV program 
planning and advocacy, capacity development, and for preparing HIV 
estimates for national and international reporting needs. 
 
PROGRESS GOOD IN URBAN AREAS, SLOW IN COUNTRYSIDE 
--------------------------------------------- ---- 
 
¶6.  These new numbers show that though prevalence rates and trends 
steadily had declined from around 14% to 12% between 1998 and 2005, 
there has not been a significant decline in overall HIV prevalence 
rates in Malawi between 2005 and 2007.  (The original figure for 
prevalence in 1998 was 22.2%, but the recent study recalibrated this 
figure down to 13.9%.)  Malawi continues to register an increase in 
numbers of infected adults, attributable to the ever-growing 
population (2007 population estimated at 13.6 million people), and 
the increased lifespan of people living with HIV due to expanding 
availability of antiretroviral therapy.  There are some encouraging 
trends in the new numbers, however.  For example, estimated HIV 
prevalence in urban areas (where approximately one fifth of Malawi's 
population lives) has continued to decline from an estimated 22.2% 
in 1998 to 17.4% in 2005, and to 15.6% in 2007. 
 
EASTHAM