Key Findings & Lessons Learned From Malawi First Round Behavioral Surveillance Survey (BSS) 2004

Background: It is estimated that over 720,768 adults and children have died of HIV/AIDS related diseases since 1985 in Malawi. Current prevalence rates are estimated at 14.4% among adults aged 15-49 years. Over 50% of the new HIV infections are occurring in young people aged 15-24 years (Malawi National AIDS Commission Spectrum AIDS 2003).

Objectives: The main aim of the BSS was to provide baseline information on behavioral patterns where interventions are planned or operating, and for the development of behavioral trend tracking system among vulnerable and high-risk groups.

Methodology: Thirteen target groups (police officers, primary and secondary school teachers, estate workers, male vendors, fishermen, male truck drivers, female sex workers, and female border traders) in nine districts of Malawi were surveyed. Firstly, standardized structured questionnaires were administered to 7,660 respondents, and soon after, 20 focus group discussions and 6 in-depth interviews were undertaken to augment and triangulate the quantitative data. Knowledge, opinions, and attitudes about HIV/AIDS transmission, prevention, and risk behaviors were assessed.

Results: Misconceptions about HIV transmission were found to exist among some target groups e.g. over 85% of police officers agreed that HIV can be transmitted through sharing a meal. Almost 50% of all target groups had full knowledge about the three methods of HIV prevention (abstinence, faithfulness, and condoms), except police officers (i.e. 3% male, 7% female). Most male respondents had multiple non-regular sex partners, e.g. 73% of male vendors. Thirty-three percent of all respondents who had boy/girlfriends used condoms. Forty-six percent of all target groups had accepting attitudes towards those who had HIV/AIDS. Female sex workers and males were highly stigmatized as it was perceived that “they reaped what they sowed”. Awareness of confidential HIV testing sites was high (90%). However only 30% of all target groups were willing to get tested for HIV and of these, 25% accessed counseling and testing.

Conclusions: Despite over a decade of consistent HIV/AIDS messages in Malawi, misconceptions about transmission persist, risky behaviors remain high in some population groups, and condom use remains low particularly among regular sex partners.

Recommendations: It is important to continue monitoring these target groups through bi-annual behavioral surveillance survey. There is need to re-evaluate and improve HIV/AIDS message development and dissemination campaigns in Malawi.