A one-year project with a budget of US$100,000 - 200,000, to build cooperation between the Brazilian and Malawian governments in their responses to HIV, has not got off the ground for three years.
In 2011, a detailed plan for the project was agreed between the two countries. An internal report by Malawi's Ministry of Health and National AIDS Commission (NAC) titled 'Malawi national response study tour to Brazil,' confirms the two countries expected to implement a one-year project in Malawi, based on technical cooperation rather than financial support.
"The HIV project is going to wait for completion of two projects in agriculture that are currently running," states the report. It also refers to a final meeting held in February 2012, led by Dr Cintia Barcellos V. De Freitas from the Department of STD, AIDS and Viral Hepatitis in the Brazil Ministry of Health and Dr Charles Mwansambo, principal secretary in Malawi's Ministry of Health. Two and a half years later, there is still no sign the project is due to start.
Detailed plans for technical support
The internal report gives detailed descriptions of technical support the project was supposed to provide. To support HIV prevention efforts, Malawi expected Brazil to provide ten million male condoms, 500,000 female condoms and HIV test kits for half a million people. It also was due to receive equipment for voluntary male medical circumcision, training for clinicians to carry out the procedure and support to strengthen HIV prevention work in schools.
The project was also intended to provide life-prolonging antiretroviral drugs to treat up to 100,000 people for one year. The plan was for Malawi to learn from progress made in establishing an antiretroviral drug manufacturing plant in neighbouring Mozambique, also supported by Brazil.
The project was expected to enhance laboratory testing and diagnostics by providing HIV test kits, support research and improve Malawi's capacity in nutrition, advocacy and logistics. There was also a proposal to pilot CD4 testing in Malawi, at the point where the patient is receiving care (to find the level of infection-fighting white blood cells in a patient's blood).
HIV profile Malawi and Brazil
Discussions between Brazil and Malawi began in April 2011. Following a visit to Malawi, the Brazilian government expressed an interest in providing technical support in the field of HIV and AIDS.
With very different HIV profiles and responses, Brazil and Malawi have much to learn from each other. Whereas Malawi has a generalised HIV epidemic with high prevalence, Brazil has a concentrated epidemic with low prevalence. Certain high risk activities, such as sex work and same sex practices are legal in Brazil, unlike Malawi.
The Malawi national response has made huge strides in providing prevention, treatment, care and support, despite limited resources. On the other hand, Brazil has stepped up its HIV response to include the local production of essential commodities like condoms, antiretroviral drugs and testing kits.
Malawi team visits Brazil
In February 2012, a six-member Malawian team visited Brazil to learn about the country's response to its own HIV epidemic, share experiences on HIV and AIDS national responses between the two countries and discuss technical cooperation between Malawi and Brazil.
The team comprised Dr Frank Chimbwandira, director of HIV and AIDS and Dr Zengani Chirwa, technical assistant for HIV treatment from Malawi's Ministry of Health, Dr Mwai Makoka, from the NAC, Humphrey Mdyetseni, from the Department of Nutrition, HIV and AIDS in the Office of President and Cabinet and Safari Mbewe, executive director of Malawi Network of People Living with HIV and AIDS (MANET+).
When asked why the project has not yet gone ahead, the Brazilian High Commissioner, based in Zimbabwe, and a spokesperson from Malawi's Ministry of Health refused to comment.
Mbewe, from MANET+, said: "The trip was not organised by us. I was just asked to be part of the visiting team. I think government officials are better placed to comment since the programme was theirs."
Whatever the reasons behind the delay, it is vital this project gets off the ground. By working together, and sharing expertise and skills, countries can achieve far more in their responses to HIV than they can in isolation.