Malaria, HIV and Humanitarian Response Challenges in Southern Africa 2003-2004

Southern Africa continues to experience a chronic emergency as a result of abnormal meteorological conditions that have occurred over the past recent years resulting in prolonged drought, devastating impact of HIV/AIDS pandemic and a state of socio economic decline and increasing poverty. The need for a joint Malaria, HIV and Humanitarian response in Southern Africa for the 2003/2004 malaria season is important to consider.

In this context, the response to strengthen existing or establish a new area in malaria control for the vulnerable groups cannot be over emphasized. More resources to scale up integrated approaches and strategies for malaria and HIV are apriority to pregnant women, children under five and others living with HIV/AIDS. 
This has an adverse effect on the Southern Africa region resulting in humanitarian crisis, which is placing the lives of 14.4 million people at risk of malaria in Malawi, Mozambique, Swaziland, Zambia, and Zimbabwe. . According to the WFP /FAO assessments undertaken in May 2002, this represents a 12.5 % increase in the number of people in need of food aid. It is estimated that within 10 countries of the WHO Southern Africa region, 88, 504, 280 people are at risk of malaria, which makes 63% of the total regional population. Included in this number are 15, 583 260 children under five and 3, 723, 440 pregnant women, which are particularly vulnerable to malaria.

It is estimated that 200,000 to 300,000 people die of malaria within the region annually.

HIV/AIDS and Malaria -The interaction between HIV and malaria is unique in that both diseases can be acute and chronic and can lower the immune system. This seriously compounds the general picture of people with HIV co-infected with malaria, in particular children under 5 and pregnant women. Evidence suggests that such co-infection contributes to faster rates of HIV disease progression and hence the need to prioritize HIV infected patients for prevention, early diagnosis and treatment of malaria. Malnutrition negatively impacts on the HIV and malaria. Anemia (low blood levels) and micronutrient deficiency (lack of vitamins and minerals) further contribute to enhanced HIV progression and severe malaria.

Malaria and Drought - The relationship between drought and malaria is frequently misunderstood but has implications on the populations in malaria areas both during and after the drought. Experience from Southern Africa suggests that malaria can increase in stable malaria areas affected by drought, due to a reduction in population immunity, exacerbated by malnutrition. However, once the rains return, the risk of malaria epidemics rises significantly in areas of unstable malaria transmission due to an increase in breeding sites, resulting in a significant increase in the vector population with explosive epidemics.

Malaria and Poverty - The high level of poverty in remote rural areas and in peri-urban areas with socio-economic difficulties within the region varies from country to country in both cause and effect, however the impending results include a serious brain drain from public health institutions with a decrease in the capacity and sustainability of the national malaria control programs in the affected countries. Efforts are being made to address these needs; National governments such as Botswana, Angola, Namibia, Swaziland, etc are raising the resources to combat malaria where they are available. Additional external support of key partners (DFID, USAID, JICA, Italian Corporation, etc) through the RBM initiative and the Global Fund is also assisting. However the current humanitarian crisis has created an additional need which is threatening the success of these activities and thus emergency appeal are being made to compliment existing long term development efforts with rapid emergency interventions in target areas and targeted vulnerable populations.

Malaria and the Economy - Malaria affects the health and wealth of nations and individuals alike. Malaria is understood to be a disease of poverty and a cause of poverty. The indirect costs of malaria include lost productivity or income associated with illness or death. The simple presence of malaria in a community or country also hampers individual and national prosperity due to influence on the social and economic decisions. Examples of the impact of malaria on the economy may include:

	School children absent from school, farmers unable to work in the field and families spending money to treat malaria
	Under developed tourist industry due to reluctance of travelers to visit malaria endemic areas
	Underdeveloped markets due to traders ‘s unwillingness to travel to and invest in malarious areas travelers

Malaria is also becoming an important topic within discussions of poverty reduction and malaria control should be seen as important element of national poverty strategies for malaria prevention and control. 

Integrated and Community Based Malaria and HIV Diseases Control - In view of the underlying poverty and increased vulnerability of the populations due to high prevalence of both malaria and HIV, it is also important to consider an integrated community disease control approaches. There is need to focus on linking malaria control with HIV control and protecting people living with HIV/AIDS (children, pregnant women) by:

	Using insecticides treated nets (ITNs) (mosquitoes nets) and anti-malaria drugs for children with HIV/AIDS at all health facilities
	Using ITNS (Mosquitoes nets) and re-treatment kits, prophylactic drugs for pregnant women and children with HIV/AIDS
	Identifying children attending supplementary nutrition feeding in drought affected areas and assessing them for malaria and treating them for malaria
	Working with volunteers, community health workers, providing home based care for HIV/AIDS and mobilizing to provide for malaria control interventions

The food needs in Southern Africa must be complimented by the health needs (drugs, insecticides and mosquito nets) in the region.

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