Surveillance in antenatal clinics has been the primary source of data for monitoring trends of HIV and syphilis to provide estimates for tracking the epidemic in Malawi. The 2007 sentinel surveillance sites were increased from 19 to 54 so as to ensure district representation in the country’s HIV prevalence estimates.

The main objective of the sentinel surveillance was to monitor HIV and Syphilis prevalence trends in Malawi.

Between 20th August and 15th October 2007, women attending routine antenatal services in the selected 54 sentinel sites were consecutively sampled. Dried blood spots were prepared from the residual blood samples of the routine syphilis testing of the sampled ANC clients. These were sent to the Central Reference Laboratory at CHSU for HIV testing, using Vironostika HIV Uni-Form II Ag/Ab (Biomerieux, Boxtel - Netherlands) EIA test kit, which detects antigens and antibodies to HIV.

Data entry and cleaning were done using Epi-Info for windows. SPSS was used to calculate site HIV prevalence rates and other important demographic factors. EPP and Spectrum were used to estimate national HIV prevalence in the general population by taking into account the epidemiology of HIV infection, impact of ART and PMTCT programs, and HIV prevalence from the 2004 Demographic and Health Surveys.

The overall median HIV prevalence in 54 sites was 12.6% and in the 19 original sites was 13.5% which is lower than the 15% in 2005. In the 54 sites, HIV prevalence ranged from 2% to 38.0% at Nthalire health centre in Chitipa district and Thyolo District Hospital respectively. Whereas, in the 19 sites it ranged from 5.9% to 26.7% at Thonje Health centre in Dowa district and Mianga health centre in Thyolo district respectively.

Pooled HIV prevalence was high in the Southern Region at 20.5% (19.7 - 21.3%) followed by Central Region at 10.7% (10 - 11.4%) and the Northern Region was the lowest at 10.2% (9.4 - 11.2%). HIV prevalence in the urban sites continues to be high at 17.1% (15.9 – 18.4%) followed by the semi-urban sites at 16.4% (15.8 – 17.1%) and rural sites at 12.1% (11.4 – 12.9%).

Overall, there is a downward trend in HIV median prevalence from 22.8% in 1999 to 13.5% in 2007 in the original 19 sites. Similarly, urban and semi-urban sites showed declining trends in HIV prevalence. However, in the rural sites HIV prevalence remained stable.

Overall syphilis prevalence in 2007 was estimated at 1.1% which is lower than 1.9% in 2005. It ranged from 0% to 12.7%. Using EPP and spectrum, the reported national HIV prevalence in 2007 was estimated at 12.0% (CI:11.1 – 12.9%) among those aged between 15 and 49 years. The regional prevalence rates were estimated at 6.5% in the north, 8.6% in the centre and 16.5% in the south. It should be noted that this is not a decline in prevalence compared to the 14% that was estimated in 2005, but rather due to an improved methodology of estimating prevalence. The 2007 HIV prevalence estimates were adjusted by the 2004 DHS results.

Using Spectrum, it was estimated that in 2007, a total of 898,888 people were living with HIV and of these 89,025 were children aged less than 15 years. It is projected that in 2008 these figures would increase to 924,248 and 101,939 people living with HIV and children with HIV aged less than 15 years respectively. It is further projected that in 2008, 263,334 adults and 26, 454 children living with HIV will be in need of ART.

Overall HIV prevalence in Malawi has stabilized at around 12.0% for the past 9 years. However, there is a decline in urban areas although prevalence is still higher than national average. Although HIV prevalence rates in rural areas are lower than in urban, the majority of the population are in the rural areas. Consequently, greater numbers of people infected by HIV in the country are in the rural areas. Hence, there is urgent need to scale up and intensify HIV prevention activities that target rural communities.

The Southern Region needs special attention since it has continuously reflected higher HIV prevalence than the other two regions. Although prevalence declines are being noted in young women, there is still need to increase the coverage of prevention services targeting the youth in particular to sustain and accelerate the declines. Studies to find out reasons for geographical disparities in the distribution of HIV infection need to be carried out so as to aid in the planning of appropriate interventions