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Love and survival in Malawi: mixed-status couples thrive with HIV treatment

Christopher Sande

05 June 2024

We hear from mixed-status couples on the realities of living with HIV in long-term relationships

Smiling young woman embracing man
Photos are used for illustrative purposes. They do not imply health status or behaviour. Credit: iStock/ xavierarnau

Alinafe and Chalanguta Mwapha got married in 2002. The couple lives in Chagambatuka village, Chikwawa district in Malawi. In 2007, Alinafe noticed that her husband was frequently ill and encouraged him to go for an HIV test. Chalanguta agreed, and the test came back positive. 

“When I came home and told my wife about it, at first my wife was not happy, she was so upset,” Chalanguta explains. “So, she suggested we go together again as a family to have the test where it was confirmed that I was indeed positive while my wife was found negative.” 

If one person in a couple is living with HIV and the other is HIV-negative, this is called a serodiscordant, or mixed-status, couple. 

Alinafe had difficulties accepting her husband’s status initially, but after some weeks, she decided to continue supporting and loving him. “Doctors counseled us to love and support each other,” Alinafe explains. They explained the importance of antiretroviral treatment (ART) and the need to take antiretroviral drugs (ARVs) as prescribed. “I always encourage my husband to adhere to the treatment and he has since been in robust health,” said Alinafe. 

However, the couple now faces a significant challenge. Chalanguta said the family experiences food shortages exacerbated by harsh effects of climate change and economic problems. “It is true that my wife encourages me to take ARVs daily, and I do that, but sometimes it is not possible to get food. So, we are asking for food assistance or cash subsidies,” he said. 

The couple are farmers, growing maize, sweet potatoes, and cotton. "With the dry spell that has hit the country this year, our crops have dried up. We are hopeless,” Alinafe explains. Sitting on the verandah of their grass-thatched house, anguish is clearly visible in their eyes. They struggle to meet even their basic needs. 

Alinafe and Chalanguta live in an area prone to floods. In 2022, for example, the district was among the worst hit by Tropical Cyclone Freddy. This was before people in the district fully recovered from Tropical Storms Ana and Idai. These natural disasters, coupled with other effects of climate change such as droughts and dry spells, have a grave impact on the livelihood of thousands of households in the district. 

Another young serodiscordant couple, George and Ethel, live in the Mzimba district. George is 30, while his wife is 26. Ethel tested positive in 2017 and is now on ART. The couple’s child is in good health and HIV-negative. 

“When I tested HIV positive, I confided in my husband. We both went for another test where I again tested HIV positive while my husband was negative. He has been so understanding and supportive,” Ethel says. “We later had twins, but one passed on. The five-year-old child you see is the biggest source of happiness in our family.” 

George wholeheartedly accepted his wife’s condition and encourages her to take ARVs daily, which has helped the family avoid serious illnesses. 

In Ntchisi district, another serodiscordant family shares their story. The man, 60, tested HIV positive in 1993. Before marrying his wife, he revealed his HIV status, and the 40-year-old woman accepted. The man looks stronger and says that since 2005, he has never fallen ill. He emphasises that adherence to ART has kept him in good health and given him hope for the future.  

The HPTN 052 research, conducted from 2005 to 2015 on serodiscordant couples in Malawi, Brazil, South Africa, Zimbabwe, Thailand, and the United States, found that immediate ART initiation reduced HIV transmission between serodiscordant couples by 93%. 

Dr. Rachel Chihana Kawalazira, an investigator at the Johns Hopkins Research Project, explains that when someone adheres to ART and the virus becomes undetectable, they cannot pass the virus on to a sexual partner.  

“So, what happens when a person has newly acquired HIV and is not on ARVs, the CD4 count (number of white blood cells) will go down while the viral load (amount of HIV in a person’s blood) will be high… making HIV transmission easy. 

“But once somebody has started taking ARVs, the virus reduces significantly to the levels that it becomes undetectable, and the person remains healthy and cannot transmit to their sexual partner.” 

Executive Director of Malawi Network of People Living with HIV/AIDS (MANET+), Lawrence Khonyongwa, has asked all people living with HIV to disregard pastors and traditional healers who tell them to stop taking ARVs. He emphasises that ART adherence is the only option for them to remain healthy. 

“As MANET+, we ask all people living with HIV to adhere to treatment. We also urge the government and donors to include and support all rural poor people living with HIV in the free food distribution exercise.” 

Some names have been changed. 

HIV in focus  

This news story has been published as part of our HIV in focus news network. This is a network of writers and journalists from our focus countries, dedicated to delivering news on HIV and sexual health. The network aims to amplify the voices of communities most affected by HIV and share the stories that matter to them.  

About the writer  

Christopher Sande is a Malawian award-winning journalist. He has a diploma in mass communication and has been in the media industry for 15 years. His main areas of interest are health, especially HIV, minority rights, environment and climate change. 

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