Malawi 2015-16

Trends: Participation in HIV testing is slightly higher in the 2015-16 MDHS than it was in the 2010
MDHS. The HIV testing response rate increased from 87% to 90%, from 91% to 93% among women, and
from 84% to 87% among men.
Patterns by background characteristics
• The HIV testing response rate is higher among men in rural areas compared with urban areas (88%
versus 83%). For women, the response rate is slightly higher in the rural areas than in urban areas
(94% against 93%) (Table 14.1).
• By region, the HIV response rate is highest for women and men in the Central region (93%) and
lowest in the Northern region (86%).
• A lower proportion of men with no education consented to HIV testing (77%) compared with men
with primary (87%), secondary (88%), or higher education (83%). Similar patterns in participation
according to education level were observed among women (Table 14.2).
14.2 HIV PREVALENCE
14.2.1 HIV Prevalence by Age and Sex
HIV prevalence
Percentage of women and men who tested HIV positive among those tested
for HIV as part of the DHS survey.
Sample: Women age 15-49 and men age 15-54 tested for HIV as part of the
survey
Table 14.3 shows that 8.8% of women and men age 15-49 in Malawi are HIV positive. The HIV
prevalence is higher among women than men (10.8% versus 6.4%).
Among women, HIV prevalence increases with age
from 3.3% among women age 15-19 to 19.8%
among women in the 40-44 age group, before
decreasing slightly among those age 45-49 (16.9%).
Among men age 15-19 and 20-24, HIV prevalence is
1% and then increases to 6.4% in men age 25-29,
with the highest prevalence in men age 50-54 at
20.5% (Figure 14.1).
25
20
15
Figure 14.1 HIV prevalence by age
Percentage of women and men who are
HIV positive
Women
Men
10
Trends: To assess trends in HIV prevalence over
time, it is important to note that the HIV testing 5
algorithm for the 2015-16 MDHS differs from the
algorithm used in the 2004 and 2010 MDHS surveys. 0
The 2004 and 2010 MDHS surveys used an
15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54
algorithm in which specimens with positive results
on two ELISAs were classified as positive (NSO and ORC Macro 2005; NSO and ICF Macro 2011). The
new algorithm in the 2015-16 survey reflects the change in the international recommendations for HIV
testing. This change responded to concerns that the old HIV testing algorithms produced too many false
positives and overestimated HIV prevalence because of the reliance on only two enzyme immunoassays
(ELISAs) to classify specimens as HIV positive (CDC 2014; UNAIDS/WHO 2015). The 2015-16 MDHS,
in accordance with the new guidelines, tested specimens that were positive on two ELISA with a highly
specific confirmatory assay, the InnoLia HIV I/II Score line immunoassay. The specimen was labeled as
positive only if the InnoLia result was also positive. More details on the HIV testing algorithm are found in
the introductory chapter.
230 • HIV Prevalence