Malawi has made many notable accomplishments in addressing the burden of HIV and AIDS. According to the Global Burden of Disease new cases have been dropping considerably since a peak in 1993 of 130,000, down to an estimated 32,300 new cases in 2019. The amount of disability-adjusted life years (DALYs) attributable to the HIV and AIDS has fallen by 70% since 2007 primarily from increasing ART coverage. However, as of 2017 HIV and AIDS is still the number one source of DALYs in the country, mostly due to legacy infections – more than 1 million Malawians currently live with HIV. While overall HIV incidence has declined considerably, now estimated at 2.28 overall per 1000 population, new infections are not generalized and appear to be concentrated around youth and women (AIDSinfo/UNAIDS). HIV incidence per 1000 population, for people aged 15-49, is 4.4. Just under one-third of all new HIV infections (14,000 out of 38,000) in Malawi in 2018 occurred among young people, aged 15-24. Just over half of new infections are women (20,000 of the 38,000), aged 15 and older; 9,900, for women aged 15-24. The analysis presented in this report suggests that interactions with FSWs contributes to around a fifteen percent of new cases in those aged 15 years and above, indicating that focusing on this specific group would lead to substantial reductions in HIV incidence going forward. However, FSWs face specific sociocultural barriers, which make stemming the onset of infections challenging.
