Africa: Enter Malaria, Another Companion of HIV/Aids

from All Africa

Inter Press Service (Johannesburg)

Ruth Ansah Ayisi
Boane, Mozambique

Anita Elena looks frail after months of chronic diarrhoea. "I prefer this illness to malaria because malaria kills you rapidly," says Elena, sitting on a reed mat in front of her makeshift two-roomed stick and mud home, which she shares with her husband and three children. "My older brother died of malaria five years ago. He went rapidly."

The 30-year-old Elena, whose name has been changed to protect her privacy, is HIV positive and was close to death before she began antiretroviral therapy (ART) in February this year. Although she still looks sickly, Elena says, "I am much better now that I have started to take the drugs."

However, Elena is right to be concerned about malaria. People living with HIV/AIDS are especially vulnerable to the disease.

"Patients suffer more often and more severely from malaria once their immune system starts to decline and they will respond less quickly to treatment," says Albert Kilian, a senior technical advisor to the Malaria Consortium, an international non-governmental organisation (NGO).

"Research in the past five years has suggested that a severe malaria infection suppresses the immune system of an HIV-positive person even more," he points out.

Some 16,6 percent of Mozambique's population group aged 15 to 49 years is infected with HIV, one of the world's highest prevalence rates. Malaria is also endemic and is transmitted all year round, peaking towards the end of the rainy period which usually starts late September and lasts until April or May.

Tuberculosis (TB) is more often talked about in relation to HIV/AIDS because it is the main killer of people with AIDS and, unlike malaria, it rarely afflicts healthy people. However, recent research has highlighted the critical relationship between malaria and HIV.

"A pregnant HIV-positive woman who is infected with the malaria parasite is likely to have more severe malaria symptoms, and runs the risk of developing life-threatening anaemia. She is also more likely to give birth to a low birth-weight baby," according to Kilian.

"Moreover, malaria appears to increase the HIV viral load and may heighten the risk of mother-to-child transmission of HIV, although there is no solid evidence yet."

Malaria in HIV-positive children is also a major concern. It is already the main cause of death for children under five, accounting for 30 percent of hospital deaths. "Anaemia, common in children suffering repeated episodes of malaria as well as other illnesses, is associated with increased mortality in HIV-infected children," Kilian adds.

Those living with HIV/AIDS can lessen their vulnerability to malaria if they take prophylactic treatment against opportunistic infections using co-trimoxazol, in addition to taking ART if their CD4 count is below 200, explains Kilian.

In Mozambique, 53,414 people were recorded to be on ART by March 2007, according to the Mozambican Treatment Access Movement (MATRAM). It is estimated that over 200,000 people need to be on ART to prolong their lives.

The government is committed to fighting both HIV/AIDS and malaria, but the challenges are huge in one of the world's poorest countries. Over 50 percent of the population live in poverty, and 50 percent do not have access to basic health care as the nearest health care unit is over 20 kilometres away.

Although Elena has a health centre nearby, she has to go into Maputo for her ART. "I leave home at five am and usually reach the hospital at ten am, she says. "I have to walk and then wait a long time for the chapa (a public taxi). My legs hurt so much the next day."

Distributing insecticide-treated nets has proved to be an effective intervention in the battle against malaria. The government distributes free nets to pregnant women and recently has extended this free distribution to children under five years old.

In the rural railway town of Boane (west of the capital Maputo) where Elena lives, NGOs have also begun to distribute free nets to people living with HIV, but only a few have benefitted.

Celia Vilanculos, a volunteer of the local Boane branch of Kindlimuka, an association for people living with HIV/AIDS and "sympathizers", visits the sick.

"Many of the people suffer from malaria but they do not work and cannot afford mosquito nets. Only five of the ten sick people I visit have nets. I tell them to make sure that they stay away from stagnant water and keep their yards clean," says Vilanculos.

The national director of MATRAM, Cesar Mufanequiço, would like to see the distribution of free bed nets to people living with HIV/AIDS scaled up.

"Many people living with HIV/AIDS die of malaria, especially in the rural areas. Most do not have nets. We talk about fighting HIV/AIDS together with malaria and TB but in practice we often treat them separately," he argues.

Elena says she cannot afford a net. "When I was well, I worked as a domestic worker. My husband is only a petty trader. My dream was always to have a good home for my children," she says, sighing as she looks at what is more like a shack.

"The mosquitoes are a big problem. My husband finds egg shells, which we burn at night to try to chase off the mosquitoes before we sleep, but it does not work well."