University of Zambia Medical Library

HIV/AIDS in Zambia: April -- June 1997

"Truckers Attend AIDS Seminar"
Zambia Today, Electronic News from Zambia: June 20, 1997

The Ministry of Health with a little help from the United Nations Development Programme today held a symposium for Zambian truckers on HIV and AIDS in Lusaka. In his official opening remarks, UNDP resident representative Gary Davis, called for commitment to the battle against HIV/AIDS adding that his organisation was the largest single donor to the national HIV/AIDS programme.

"Our motivation for doing this is our recognition not only of the personal and family impact of HIV/AIDS in Zambia, but also because we recognise that HIV/AIDS has enormous consequences for the future development of the country," he said. He noted that HIV/AIDS was striking most on the most productive age group of Zambian society and this means not only do families suffer disintergration because bread winners have died , but entire segments of the work force in industries and communities throughout the country begins to disappear.

Truckers Association of Zambia chairman, Charles Madondo, lamented that widespread use of condoms had failed to halt the spread of the scourge. He consequently called for 'sexual purity' rather than a dependence on a protection which was not fool proof. For sometime now Zambian fighters against the AIDS pandemic have accused truckers of helping spread the disease as they usually have multiple partners on their international routes.

"Society for Family Health (SFH) Launched."
Health-L: June 12, 1997

We are pleased to announce the formation of a new not-for-profit Zambian trust called "The Society for Family Health" (SFH) committed to serving public health needs in Zambia through social marketing and communications. SFH will continue the activities of the Zambia Social Marketing Project (ZSMP) but now under the legal statutes of a Zambian NGO.

The Zambia Social Marketing Project (ZSMP) is part of the government's effort to combat the spread of sexually transmitted diseases (STDs) including HIV, and expand the contraceptive prevalence rate. The project, which is funded by the United States Agency for International Development (USAID), is a collaborative effort between Population Services International (PSI), an international non profit organization, and the Pharmaceutical Society of Zambia (PSZ).

SFH will continue to support and complement the Ministry of Health's effort to combat the spread of sexually transmitted diseases (STDs) including HIV, and promote reproductive and child health including family planning. Establishing SFH as a registered Zambian trust will ensure that a sustainable social marketing institution will continue to be an important long term component of the public health system in Zambia.

HOW DOES SOCIAL MARKETING FIT INTO THE HEALTH SYSTEM IN ZAMBIA?
One of the predominant health problems in Zambia today is how to get needed health products and services to lower income people. ZSMP is at the forefront of the effort to solve this dilemma through social marketing. Through the marketing of health products through retail and wholesale outlets, institutional networks and community-based sales networks, social marketing ensures their wider distribution and access. Further, by the use of attractive packaging, persuasive communication and the promise of high quality health products at an affordable price, social marketing encourages usage of these health products. Hence, social marketing both creates awareness and demand for health products while ensuring their constant availability and easy accessability at affordable prices.

Social marketing complements the traditional programs of the Ministry of Health (MOH). Social marketing reduces the burden on the government hospitals by encouraging clients who can afford to pay small amounts to obtain health products from nearby chemists, private clinics and other outlets. In this manner, health products can be accessed at thousands of outlets and not just in clinics and hospitals.

THE SUCCESS OF MAXIMUM CONDOMS:
On World AIDS Day, December 1st, 1992, ZSMP launched MAXIMUM, a high-quality, low priced condom in Zambia. The social marketing of condoms has played a significant role in making people more comfortable about discussing the dangers of STD's including AIDS and condom usage. Through mass media advertising, community based education and the distribution of promotional items, high awareness of MAXIMUM condoms has been achieved. In just over four years, MAXIMUM has become a household name in Zambia with 25 millions condoms sold in this period. Further, the IE&C campaigns and extensive promotional activities have played an important role in reducing the stigma attached to all condoms. Market research has shown that the introduction of MAXIMUM has encouraged increased condom use among the sexually active population.

EXPANDING CONTRACEPTIVE CHOICE WITH SAFEPLAN:
While knowledge of contraception is very high in Zambia (over 90% of married women know at least one method of contraception), only 14% of them report using any modern method. Recognizing the suitability of social marketing to support the existing efforts to increase the contraceptive prevalence rate, the MOH requested USAID to support the social marketing of oral contraceptives and vaginal foaming tablets as part of the Family Planning Services Project.

The oral contraceptive pill is the most popular method of contraception in Zambia. However, the widespread use of the pill has been hampered by the widespread misconceptions, erratic supply and poorly informed providers. The social marketing of SafePlan oral contraceptive pills which began in December 1996 will go a long way in ensuring that a high quality low dose oral contraceptive pill is widely and constantly available across the country at an affordable price of K500 ($0.39) for two months supply. A series of intensive workshops and training sessions for private sector health care providers on better understanding and dispensing contraceptives are being conducted as part of the contraceptive social marketing programme.

THE FUTURE OF SOCIAL MARKETING IN ZAMBIA:
Social marketing is now clearly recognized as an important component of the health delivery system in Zambia. Social marketing is becoming further institutionalized in Zambia with the formation of the "Society of Family Health," a local non governmental trust. In the year ahead, SFH aims to begin socially marketing the following health products and services in Zambia:

• Vaginal Foaming Tablets
• Female Condoms
• Insecticide Treated Nets
• Franchising Health Clinics
• Vitamin Supplements for Pregnant Women

Population Services International (PSI), with social marketing health programmes in 46 countries worldwide, also has the expertise to socially market the following products which are suitable for Zambia:

• Other family planning products, including injectable contraceptives and IUDs
• Oral rehydration salts (ORS) for treating childhood diarrhoeal diseases
• Vitamin A and other nutrients
• Clean birth kits
• Clean water kits.
• Communication services for health programs

For more information, please contact:
Ms. Mpundu Mwanza; Society for Family Health; P.O. Box 50770, Lusaka, Zambia
Phone: (260-1) 286332/286333 and 289005; Fax: (260-1) 286726
General E-Mail: prizam@zamnet.zm

"Gender and Reproductive Illnesses."
Reproductive Health Newsletter: 4 (June 3, 1997)

About half of all Zambians are more likely to suffer reproductive illnesses or bad consequences from those illnesses than the other half. Do you know who they are? If you guessed women, you were right. There are various reasons for this and the major ones are that:

• Females are more susceptible to some reproductive health illnesses. For example, because of their anatomy, women are more likely than men to be infected with sexually transmitted diseases, including AIDS.
• In many countries, including those of southern Africa, girls and women are less likely to receive or use preventative measures. Attending for antenatal care and tetanus toxoid coverage is important but women are not always encouraged by their families to do so. Condom use can protect both partners from STDs and AIDS. Too often, the woman is not in a position to take the decision for her partner to use a condom, even if she suspects that she is at risk.
• Women are more likely to be exposed to certain health hazards. Every time they add to their families, women risk complications of pregnancy and childbirth, such as bleeding and infection. Contraceptives have the potential to improve women's lives, but sometimes cause side effects. Because most methods are used by women, they are more likely to experience contraceptive side effects.
• For some illnesses, women are less likely to be treated once the condition occurs. This may be because less value is placed on women's health, compared to men's or, like STDs, because the disease is less easily noticed and diagnosed in women. Cancers of the female reproductive system are difficult to diagnose at the health centre level until they are far advanced and treatment is difficult.
• Females often suffer different medical and social consequences of certain illnesses. For example, women often become infertile after STDs and this infertility can ruin their lives. Although men can also become infertile after STDs, it is easier for a man to hide his infertility or to put the blame elsewhere.

The Programme of Action that Zambia committed itself to at the Cairo International Conference on Population and Development, called on all societies to end discrimination against women and to promote gender equality. We can't do anything about the physiological reasons that cause women to suffer more. But we can recognise the factors above and try to compensate for them by encouraging prevention as well as early diagnosis and treatment of reproductive illnesses in women.

List of reasons for increased female reproductive morbidity adapted from Fortney, Judith A (1995) "Reproductive Morbidity: A Conceptual Framework. Family Health International."

"HIV/AIDS Bibliography: An annotated review of research on HIV/AIDS in Zambia."
Health-L: May 22, 1997

This UNICEF/NASTLP publication contains over 200 abstracts on all aspects of HIV/AIDS in Zambia. It was published in 1996 and we have some copies left If you did not recieve a copy, or would like extra copies - please contact me, stating how many copies you need, (but we don't have that many!) at dwebb@unicef.zm or through the buffalo network. There is no charge for the documents. If you are in Lusaka, please indicate a physical address, as well as a postal address, so copies can be hand delivered. Hurry hurry while stocks last!

Douglas_Webb@unicef.zm

"AIDS and Child Health."
AFRO-NETS: May 20, 1997

"We are guilty of many errors and many faults, but our worst is abandoning the children, neglecting the fountain of life. Many of the things we need can wait. The Child cannot. Right now is the time his bones are being formed, his blood is being made and his senses are being developed. To him we cannot answer "Tomorrow". His name is "Today"/ Her name is "Today." -- Gabriella Mistral, Nobel Prize-winning poet from Chile

AIDS is having a profound impact on children's health. By mid-1996, UNAIDS estimated that worldwide, there were: 3 million HIV infections in children - 9 million maternal orphans due to AIDS. In addition, it is likely that at least 30 million children are living with HIV-positive parents, who are at risk of being orphaned in the next few years.

What is AIDS doing to Child Health? I want to first discuss the direct impact of HIV infection on children. Secondly, I want to look at children who are not infected but affected by the indirect impact of AIDS upon them. Finally, I want to discuss implications of the AIDS epidemic on children. For the first part of my discussion, I shall use country estimates published by the US Bureau of the Census in March 1997.

DIRECT IMPACT OF HIV INFECTION ON CHILDREN -- INFANT MORTALITY RATES:
AIDS has led to increased infant mortality rates, especially in countries with severe AIDS epidemics and low non-AIDS infant and child mortality rates. Thus the greatest impact of AIDS on child health will be in countries in southern Africa which have lower non- AIDS infant mortality and severe HIV epidemics, compared to countries in eastern Africa which have less severe HIV epidemics and higher non-AIDS infant mortality rates.

Infant mortality rates have increased due to AIDS, reversing declines that have been occurring in many countries over the last few decades. In 1996, IMR without AIDS would have been 51.7 per 1000; as a result of the AIDS epidemic, IMR is estimated to be 72.8, 40% higher than expected; in Zambia it is 30% higher than expected and in Kenya and Uganda, it is nearly 20% higher. IMR is set to worsen markedly during the next decade as the epidemic spreads to affect more adults and through them more children. By the year 2010, infant mortality rates are estimated to more than double in Zimbabwe from 30 to 71 per 1000 and Botswana from 26 to 66 per 1000. In Kenya, IMR will be 70% higher while in Zambia, IMR will be 60% higher; in Malawi where infant deaths due to other causes are high, AIDS mortality will inflate IMR by 40% with similar increases in Tanzania and Uganda.

CHILD MORTALITY RATES:
Two thirds of AIDS deaths among children occur among those 1-4 years old; consequently, the AIDS epidemic impacts on child mortality rates even more than on infant mortality rates. Once again, the countries with the greatest impact of AIDS are those in southern Africa with the most severe HIV epidemics and lower non-AIDS mortality.

By 1996, CMR without AIDS was estimated in Zimbabwe to be 69.1; with AIDS, CMR was 128.3, some 85% higher than expected; in other words, 1 out of 8 children born would die before 5 years old; CMR in Botswana and Zambia was 75% higher than expected without AIDS. Kenya's CMR was 40% higher while Tanzania and Uganda's CMR was about 25% higher than expected without AIDS.

By 2010, the US Bureau of the Census estimates that about one third of adults will be infected with HIV in Zimbabwe, Zambia, Malawi and Botswana. HIV spread from mother to child in most African countries is around 30% with one half of transmission occurring post-partum due to breast-feeding. This means that some 10% of children will acquire HIV infection from their mothers. With median age of survival of children infected by their mothers of 21 months, increases of the order of 100/1000 in CMR are estimated in these four severest affected countries. In Zimbabwe, without AIDS, the CMR would be expected to have fallen to 37.8; AIDS is likely to lead to a CMR of 152.9, a fourfold increase. The increase will be more than three times higher in Botswana and double that expected in Kenya and Zambia than in the absence of AIDS. Nearly 1/4 of children in Malawi will die before their 5th birthday, with AIDS contributing nearly one half of the mortality.

In 2010 in the most severely affected countries in west Africa, Burkina Faso and Cote d'Ivoire, CMR will be nearly 70% higher. In Guyana in South America, projected CMR will nearly double, in Brazil, it will increase by one third; in Thailand, it will increase by 18%.

DETERIORATION IN CHILD HEALTH DUE TO ORPHANHOOD -- LIFE EXPECTANCY (LE):
AIDS increases IMR and CMR. But its most significant impact on demographic indicators is on life expectancy since many years of life will be lost due to the AIDS epidemic. AIDS has already led to reductions in life expectancy. By 1996: Kenya's LE had fallen from 65 (without AIDS) to 55.6 years, to 86% of that expected without AIDS. Uganda's LE has fallen from 53.2 to 40.3 years, to 75% of that expected. Zimbabwe's LE has fallen from 64.1 to 41.9, to 65% of that expected. The greatest impact to date has been in Zambia, from 57.5 to 36.3 years, to 63% of that expected without AIDS.

By 2010, life expectancy in Zimbabwe would have reached 70 years without AIDS. As a result of AIDS, projected life expectancy in Zimbabwe will be 33.1 years, 47% of that expected. Zambia's life expectancy will fall to 30.3, and Botswana's to 33.4, both 50% of that expected. Kenya and Uganda's life expectancy will both be about two thirds of that expected while Malawi's life expectancy of 29.5 years, 52% of that expected without AIDS, will be the lowest in the world.

ORPHANHOOD:
Life expectancy for females will be even lower than these average figures, since women are HIV-infected and die at younger ages than men. Lowered life expectancy necessarily implies an increasing proportion of orphaned children. I want to present estimates of the orphan epidemic using projections from Zimbabwe which have been developed by Simon Gregson at the University of Oxford in association with Prof Roy Anderson's modelling unit. The first point to note is that the main findings of this model are in keeping with those of the US Bureau of the Census (USBC), despite considerable differences in modelling methodology.

Thus, in this model, life expectancy is estimated to be 30-35, compared to 33.1 in the USBC estimate; fewer than 20% of women can expect to live throughout their child-bearing years; only one third of girls aged 15 years will survive to their 35th birthday. And one third of children under 15 years will be orphans, having lost their mother.

In order to understand the implications of the orphan epidemic, we need to have a perspective of 20 or 30 years. The dark part of this graph represents children who are orphaned due to causes other than HIV. Before the AIDS epidemic, about 2-3% of children are orphans; there was relatively little impact of the epidemic upon maternal orphanhood until the middle years of this decade. Already it is likely there are more maternal orphans due to AIDS than due to other causes. But we are right at the beginning of the orphan epidemic. By the year 2010, the number of maternal orphans is expected to have increased tenfold due to the cumulative impact of over 30% of children under 15 years becoming motherless; although no models have yet incorporated paternal deaths, we know that a large proportion of these orphans will also be fatherless, double orphans.

IMPLICATIONS OF ORPHAN EPIDEMIC:
Orphanhood has profound implications for child survivors. Traditionally the extended family coping mechanism for orphans was their aunts and uncles. As a result of the AIDS epidemic and rapid increases in the number of orphans, the very elderly and the very young are being recruited for childcare by the extended family. Our study of 300 orphan households in Zimbabwe in 1995 found that nearly one half of the care givers of paternal or maternal orphans were grandparents. The average age of grandparent care givers was 62 years old. About 3% of households were sibling-headed; in three cases, older sisters or brothers had taken over childcare following the death of a grandparent.

In a recently completed study of 43 child-headed households, we found that in 86%, both parents had died and in 93%, the mother had died; the youngest unaccompanied household was headed by an 11 year- old child. Older brothers as well as older sisters were involved in childcare. In many cases, relatives provided support to CHH by regular visiting and providing material assistance. We must expect considerable increases in the numbers of CHH in the future, especially in southern Africa where the epidemic has its most profound effect on life expectancy and where traditional extended family coping mechanisms are weakened.

The fact that over one third of children are being looked after by someone other than their mother has implications for child health. In child health in developing countries, we rely upon the mother as the main primary health care worker. We spend time educating mothers about good child health practices. If a child has no mother carer, the child's health is often worse. Elderly and very young care givers may not know about good nutrition. They may not know about oral rehydration in the treatment of diarrhoea. They may be unable to travel with the infant to immunisation posts. And they may be less skillful than mothers at spotting whether a young child is sick from, for example malaria, which requires travelling with the child to a clinic to receive curative treatment. Add to this the fourth wave of the HIV/AIDS epidemic, the twin epidemics of TB and poverty which follow in the wake of HIV/AIDS and orphanhood and we see the scale of the disaster being faced by future generations of children in badly affected countries.

CHALLENGES IN CHILD HEALTH:
Ensuring adequate treatment of children with HIV infection will remain a challenge to front line health workers in the next decade. But the number of cases of paediatric AIDS will not go on increasing indefinitely. Already in urban areas there are signs that we are witnessing a plateau in the number of new cases of HIV infection in children. Paediatric HIV impact in hospitals may be manageable. However better data collection on HIV impact on children is required. Recent cohort studies suggest over 80% of deaths in young adults in Rakai and Masaka are due to AIDS. No such information is available on children.

To improve child health due to HIV, a number of measures are required.

• We need to reduce the number of children developing HIV infection. The most effective method of reducing the number of children developing HIV infection is to establish programmes which reduce HIV transmission to mothers. In addition, urgent research into interventions to reduce mother-child transmission in developing countries such as vaginal disinfection, vitamin A supplementation, breast-milk substitution in the first 5 days and after 6 months and traditional alternatives to breast-feeding.
• We need to identify measures which prolong HIV-positive mother's life expectancy. Infants and young children need their mothers to ensure their health and well-being. Extending the lives of HIV-infected mothers by one or two years will help to reduce the number of orphaned children being looked after by alternative caregivers.
• We need to develop effective low cost community support programmes to orphans. We are witnessing a rapid increase in the number of orphaned children who are particularly vulnerable to HIV infection. Orphan support programmes can help to improve their situation substantially, by ensuring at-risk households are regularly visited, children's health is supervised, food supplements and income generating inputs are provided and primary school enrolment can be maintained.

G. Foster, M.D., Family AIDS Caring Trust, Mutare, Zimbabwe

"Artists Unite Against AIDS - Future Activities."
Health-L: May 14, 1997

Yesterday, 12 May 1997, the "Artists Unite Against AIDS" project, chaired by musician Brian Chengala, held a one day workshop at the Hotel Intercontinental to discuss future activities to contribute to the fight against HIV/AIDS in Zambia. There were about 50 participants: singers, musicians, drama & theatre groups, script writers, poets and others interested.

It was generally agreed that so far the main messages that have been conveyed by songs, drama and theatre have often been too negative, e.g. only stressing the fact that AIDS is a "killer disease", leaving little room for positive messages on prevention and support for people affected by HIV/AIDS. Artists can play a key role in "breaking the ice" and initiate discussions on sensitive issues and taboos. This does not only relate to specific AIDS related messages, but also on social problems that promote the spread of AIDS, like poverty, alcohol abuse, and the position of women in Zambian society.

The participants discussed possible new messages that would focus more on hope, and positive action. Hopefully these new ideas will soon result in songs, drama, TV programmes that aren't only entertaining, but most of all have a positive message.

"AIDS Orphans: Malawi and Zambia."
Health-L: May 8, 1997 (note: see original article below)

I agree to a great extent with what you commented on orphanages not being the solution. The fact that 99% of the AIDS orphans are taken care of by relatives is perhaps because of lack of institutional capacity (such as orphanages), but experience in richer countries has shown, as you say, that this is often not the best solution. In the end, children need to grow up in normal situations, i.e. in a family that can give them the attention and personal warmth they need.

Another example, which is similar to the one of orphans, comes from mentally disabled people. One used to think that these people needed special institutions who could best take care of their physical, mental and social needs. In many countries, this has led to 'institutionalisation' of patients, clients (or whatever word you would want to use for this), and only since a couple of years one has come to realize that the best 'institution' is the family and the community. This has led to all kinds of initiatives to enhance the incorporation of mentally disabled into society.

Here in Zambia there are - as far as my information goes - no big institutions for the mentally disabled. There is, however, a project supported by the Finnish Volunteer Service (FVS), which aims at strengthening the family's capacity to give their mentally disabled family members the best care they can afford. I could give similar examples regarding the elderly.

It all comes down to the fact that in the end the BEST (not only because there's no money for institutional support) solution for AIDS orphans, mentally disabled etc. is a family and community based one. 'Fortunately' perhaps, Zambia cannot afford these big institutions, that wouldn't be the answer. I think we have to congratulate all those Zambian (and Malawian in this case) families that are taking care of their family's (and others') orphans.

I would, however, also like to mention the fantastic work people like the Sisters of Kasisi orphanage are doing: unfortunately, sometimes orphanages provide the only 'escape' for poor families and children who have been abandoned for all kinds of reasons. I'm sure your comments on the negative sides of orphanages don't apply to Kasisi.

Remains the fact that for the majority of Zambian families AIDS and all its consequences (taking care of orphans is just one aspect) places a very big burden on an already very limited family budget. It's not enough to conclude families have to tackle the problem themselves. The challenge is to find affordable community AND state based support to these families.

Joost Hoppenbrouwer, Associate Professional Officer, World Health Organisation Zambia National AIDS/STD/TB/Leprosy Programme (NASTLP)

"Malawi: Extended Family Overwhelmed by Orphans."
Africa Information Afrique: May 7, 1997

Widespread incidence of AIDS and official disdain for orphanages in Malawi are contributing to an escalating crisis regarding child supervision in the country. According to the National AIDS Control Program, AIDS could orphan as many as 300,000 children by the year 2000. Meanwhile, the impoverished state government refuses to augment the nation's 10 existing orphanages for fear that they stigmatize children and break up the family

Reference to the above: Zambia also has a major problem of those who have some resources having to take on more dependants. However, expanding the number or capacity of orphanages is not an answer. Firstly, there are so many children! It would be impossible to meet the need this way. Secondly, children who grow up in institutions are often unprepared for life outside the institution and have often lost contact with the relatives they do have, leaving them effectively rootless. Thirdly, experience in other parts of the world has been that institutions for the care of children attract individuals who abuse children physically, psychologically, sexually or all three. The larger the institution, the harder it is to detect these individuals. British children I have worked with have told me it is somehow worse when a stranger employed to look after then abuses them than when the abuse comes from members of their own family. I hope the Malawian government continue to view orphanages with disdain, although I hope that the children in the existing ones are being adequately cared for.

Cathy Poulter, PJP Associates LTD. Deveploment Consultants.

"How safe are condoms?"
Times of Zambia: May 6, 1997

CONTRARY to popular belief that condoms are not safe at all, they provide good but not perfect protection against sexual transmission of STDs including HIV, the virus that causes AIDS, if used correctly and consistently.

The big challenge today is how to prevent and control the spread of HIV/AIDS in a practical and tangible way. The condom offers that solution, of course bearing in mind that it is not the absolute solution to protection against HIV transmission. The condom, unfortunately, has generated much controversy about how much protection it offers. For instance, there have been unsubstantiated claims that condoms are not safe and that they tear. The result is that rather than looking at the condom as a practical way to prevent transmission of HIV, it has been seen as another Western invention which only encourages promiscuity, even though no evidence exists to prove this.

Fortunately, there is evidence from investigations in both laboratory and field situations in the US and Europe, that condoms can prevent transmission of HIV and other STDs. Laboratory studies have shown that the HIV virus cannot pass through the thin membrane of the condom (even air and water cannot pass through the condom and these molecules are even smaller than the HIV virus). Observational studies in Europe, the US, Zaire and Kenya, of people using condoms have demonstrated that condoms provide high levels of protection against STDs and the HIV virus with perfect use (i.e. consistent and correct use).

Regular users are less likely to become infected with STDs and HIV. A study from Zaire reported an annual condom-user HIV failure rate in discordant couples (one partner is HIV+, the other is not) of 3.1 in 100 (about one in every 32 couples). A follow-up of 24 uninfected sexual partners of AIDS patients for two years revealed that among 10 couples who routinely used condoms, only one partner became infected with HIV, a risk reduction for HIV of 80 per cent or better. However, in the 14 couples who did not use condoms, 12 partners became infected. It is important to note that failure rates generally speaking could be higher among users who do not use condoms consistently and correctly - key to preventing the sexual transmission of HIV.

Nevertheless, condoms appear to be gaining wider acceptance in Zambia, despite moral and religious arguments against their use. In fact evidence from Government hospitals and health centres, as well as recent media reports, all indicate a definite increase in demand for condoms.
Aside from the moral issues surrounding condom, there is the 'safety' issue. There have been claims, wrongly, that condoms are not safe because they break and that they have holes in them. One African researcher in HIV/AIDS claimed recently: "If you examine the condom under a microscope when it is stretched, you will see it has pores larger than the size of the HIV virus". However, scientific evidence has demonstrated that the HIV virus is about 30 times smaller than the head of a human sperm. It has been proved that the sperm cannot pass through a condom. Studies of people who use condoms for contraception report failure rates ranging from less than one per 100 to 16 per 100 users per year. The importance of proper condom use is evident from a recent report of Britain's Oxford Family Planning study, in which condom-user failure rates for pregnancy among married women, more experienced users were predicted to be as low as six per 1000 users per year. On the same issue of pores, one US study done by the National Institute of Health, found no pores when condoms were magnified 2, 000 times! A second study magnified the condoms 30, 000 times (a magnification at which HIV-size particles can be observed) reported that no pores were evident, even when they were stretched.

Another major concern is condom breakage. However condom breakage is not a very serious problem. Consumer surveys in the US have revealed breakage rates for good quality condoms ranging between one to five per cent. The reasons for breakage are many, including: misuse, reuse, duration and vigour of the sex act, inadequate space in condom tip, air trapped in the tip, unrolling condom before putting it on, damage caused by fingernails, poor quality condoms, and expired, exposed to sunlight, crashed .

A point to note in the studies is that most breakages occur when the condoms are being put on or taken off. Naturally, most people will say why bother with the condom. A sure way to avoid contracting STDs and HIV is to avoid sex altogether or being faithful to an uninfected partner. These two concepts need to be promoted among all age groups as primary and totally effective preventive measures. However, it must be acknowledged that abstinence and lifelong fidelity to one uninfected partner are not the experience of many people. Sex is a very private affair and realistically speaking, it is not that easy to actually get people to change their sexual behaviour, much less to find out with 100 per cent certainly if the change has actually taken place. Consequently, measures to slow the spread of the disease must include the promotion and provision of effective protection and education.

Having said this, it is worth pointing out that certain facts about the HIV/AIDS problem in Zambia require pragmatic measures. A clear picture of the situation before us emerges when one looks at the following facts:

• There is an extremely high prevalence and incidence of sexually transmitted diseases in Zambia. (The dangers of repeated STD infections increases the risk of HIV transmission).
• STDs are the third commonest reported cause of hospital attendance in adults. (STD control is one of the most effective ways of preventing the increase of HIV infection).
• The link between poverty and HIV through lack of access to health, poor nutrition, lack of education and commercial sex is well documented. The urbanised nature of Zambia's population exacerbates this.
• A significant portion of the Zambian population are mobile. Further, trucking routes from south to Zaire, Malawi and Tanzania pass though the country; this has been acknowledged to be one of the major ways in which HIV/AIDS is transmitted.
• It is known that at least 50 per cent of Zambian girls have their sexual activity by the age of 16. The girls increase their chances of HIV infection by having sex with sugar daddies (for money, gifts) and then passing on the infection to their own age group.
• The high mobility of some professions or jobs is an issue that cannot be ignored in the transmission of HIV.

With these sobering reminders, is it not time that Zambians became more frank, courageous and realistic about condoms? The only sure way to avoid the risk of sexual exposure to HIV is to have sex in a monogamous relationship with an infected partner or to abstain. Sex with an infected partner or one of unknown HIV status is unsafe. If one engages in these highly unsafe practices, an effective way to reduce risk of exposure to HIV is to use a latex condom, consistently and correctly!

The article is a product of the public relations committee of ZAMCAM, grouping of contracting agencies and US non-governmental organisations carrying out supplementary work on behalf of the Health Ministry, in reproductive health, HIV/AIDS and child survival.

"Government Determined to Fight AIDS". by Cecilia Banda
Zambia Today, Electronic news From Zambia: April 28, 1997

GOVERNMENT has reiterated its commitment to fight the spread of the dreaded HIV/AIDS disease, Health Deputy Minister Professor Nkandu Luo said today. Professor Luo said her ministry has put in place very good policies but lack of implementation and support has hindered effective responce from the public. Launching the Media Health Promotion Agency at Garden Hotel today, Professor Luo said the agency is critical to the health reforms it encompasses all health related issues that affect the community. Professor Luo said the MHPA will help the government re-define health issues by disseminating information to remote places through the different channels of communication adding that journalists should take this as a challenge to their profession.

She regretted that the HIV/AIDS disease has had an adverse impact on the Zambian society where the journalists have failed to capture the effects ever since the first AIDS case in 1986 was reported. Speaking earlier MHPA chairman, Keagan Mumba appealed for support to the agency whose establishment is still in its infancy. Meanwhile Professor Luo has been nominated matron of the agency whose membership includes journalists from both government and private media.

"Zambian Women Oppose Polygamy."
Xinhua New Agency: April 26, 1997

The Southern Province Tonga Traditional Association is calling on women to avoid married men. The chairman of the southern Zambian group, Dickson Namanza, reportedly said, "We want to promote the 'one man one women' motto in our country as we believe that this will go a long way towards helping to reduce the numbers of HIV and AIDS cases as it will encourage the development of a monogamous society." The effort has the support of both traditional leaders, as well as women's rights activists in Zambia.

Last updated February 13, 1998

UNIVERSITY OF ZAMBIA Med Guide      Index    Zamnet    UNIVERSITY OF ZAMBIA    UNIVERSITY OF ZAMBIA Library 

CONTACTING SCHOOL OF MEDICINE     OTHER INSTITUTIONS   BACK TO SOM HOME PAGE     DEPARTMENTS    Central Board of Health 

Send comments and/or suggestions to: Stan chewe 
Copyright © 1996-2001, The University of Zambia Medical Library and Stan Chewe
Guide to Medical Resources WWW site: http://www.medguide.org.zm/