Malawi, formerly Nyasaland, is a southeastern African country bordering with Tanzania to the north and northeast, Zambia to the west, and Mozambique to the southeast, south, and southwest. The country became a British colony after the voyages of Scottish Medical Missionary and anti-slave trade campaigner, Dr David Livingstone. Later, it was transformed to a British Protectorate colony until it gained political independence in 1964 and became a republic in 1966. The first case of the human immune-deficiency virus (HIV) and the acquired immunodeficiency syndrome (AIDS) in Malawi was diagnosed at Kamuzu Central Hospital (KCH) in 1985. By the end of 1985, a total of 12 adult HIV cases were identified. The first case of childhood AIDS-related illness was recognized in February 1986. The KCH is the second largest referral health facility of the country, the main referral center for Lilongwe City, and the main referral center for the central region of the country. Until recently, the Kamuzu Central Hospital was also the main referral center for the sparsely populated northern region of Malawi. Mzuzu Central Hospital in the northern district of Mzimba and now the main referral center for the northern region, was opened in 2000. The hospital was built and largely equipped with the funding from the Republic of China (Taiwan). Taiwan had also provided about half a dozen physicians until 2007, when the Malawi government sided with the Peoples’ Republic of China (Beijing) in regard to the diplomatic recognition of Taiwan independence from the mainland China. It is important to remember that this was the period when the country was under one-party system of the Malawi Congress Party and the constitutional Life President Dr Hastings Kamuzu Banda, a medical doctor with qualifications from the United States and Scotland. The Kamuzu Central Hospital was just one of the institutions which were named after the first Malawi President (the list Kamuzu International Airport, Kamuzu Procession Road, Kamuzu Highway, Kamuzu College of Nursing Kamuzu Academy, Kamuzu Barracks, Kamuzu View and a dozen or so Kamuzu bridges). Kamuzu was Prime Minister of Malawi between 1964 and 1966 and the president until 1994. In 1993, there was a national referendum in which the citizens voted in favor of a multi-parti system. The period between 1964 and 1994 in Malawi was characterized by monopolization of power and information. The Ministry of Health was, therefore, the only party which could issue reports about any health-related occurrence in the country. Anyone else who would try to warn about epidemic or community health threat faced the danger of ending up in prison. Such an “offense” was characterized as intending to raise public alarm and disrupting public peace or security. This did not mean that rumor mongering was absent; only that people involved in spreading information needed to be careful as to whom they were discussing any aspect of public life. The political and social environment prevailing in the 1985 Malawi colored the discourse and the response toward HIV in the country. Like in many other countries, the first cases of HIV infection emerged in traditionally marginalized groups. While in the United States, the first cases appeared among the members 4 Hs (Haitians, hemophiliacs, homosexuals, and heroine addicts), the situation in Malawi the virus appeared among “innocent men” who got infected from prostitutes. Blaming a marginalized group such as prostitutes was a convenient strategy in a sense that it supported the perception that “good” people needed not to pay attention to the HIV problem, as long as they were good. “Bad” people, on the other hand, deserved to be infected. For the rest of the community, the advice was that people needed to avoid malezala (razor blades) and zotsukira mmano (tooth brushes). Any admission that HIV was becoming a public health threat was met with the usual response of the time that such warnings were coming from government enemies (akapilikoni) aimed to “tarnish the good image of Malawi.”
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