University of Zambia Medical Library

HIV/AIDS in Zambia: July 1999

"Survey Speaks Volumes on STDs."
Times of Zambia, July 30, 1999

A survey has revealed lack of appropriate strategies for effective prevention and control of sexually-transmitted diseases (STDs) which have been identified as a major health problem in Zambia. This is contained in the 1998 health facility survey for Zambia based on an assessment of STD management in health care facilities conducted by project concern international (PCI) and the University Teaching Hospital (UTH).

According to the survey, there had not been an evaluation of the impact of the national AIDS/STD/TB/leprosy programme in terms of quality care provided to patients with STDs in public health facilities. "Such evaluations are crucial to the success of national AIDS/STD programmes. There is need to develop appropriate strategies for effective prevention and control of STDs in the country," the survey said.

This posed a great challenge for local experts who had to contend with decision-makers at various levels and fora. "The major responsibilities may include, but are not limited to, convincing, initiating dialogue and successfully leveraging already scarce resources to implement a meaningful STD management programme," the report said.

The survey sampled around 41 health facilities countrywide involved the observation of 117 and interviews with 43 health care providers and case record reviewing of up to 24 patients at each centre visited. The survey was conducted with the technical support from the measure evaluation project based at the University of North Carolina in the US.

"CSO Director Disputes HIV/AIDS Statistics." By Lubasi Katundu
The Post, July 29, 1999

To say 20 per cent of Zambians are infected with HIV/AIDS is not true, said Central Statistics Office (CSO) director David Diangamo yesterday. Officially opening the Dissemination Seminar for the Zambia Sexual Behaviour Survey, Diangamo, who is Ministry of Finance acting permanent secretary (economic affairs and budget), criticised United Nations AIDS resident representative Bernadette Freers' statement on Monday that 20 per cent of the Zambian population was HIV positive.

"There is no national study in the country which has been taken to measure the extent of HIV/AIDS," Diangamo said. "Such statements are alarming the nation, lets get to realities." (Sic mod.) Diangamo called upon CSO to come up with a well designed, comprehensive, nation-wide representative survey to accurately determine the incidence of HIV/AIDS in Zambia. He said this information should be disaggregated by province, district and sub-district levels. "You will agree with me that the government will be in a better position to take measures to control the epidemic if only sufficient and accurate data is available," he said.

Diangamo said research would greatly assist in developing policy interventions for effective implementation of population and development programmes as well as clear the current confusion on the incidence of HIV/AIDS in Zambia. United States Agency for International Development (USAID) director Walter North, speaking at the same occasion, said the most important topic of discussion in Zambia was the effect of HIV and the damage it had done to the country. "Whether the rate is 20 per cent, 25 per cent or 30 per cent, one death is one death too many," he said. North said he could not understand why a disease which could be prevented was not being prevented and behaviour had not changed enough to reduce the occurrence of the disease. "A sector wide approach is needed. All of us have a role to play in tackling this problem," North said. "It is not just a question of resources, but a question of determination and will." Project Concern International (PCI) country director Masauso Nzima said the problem of HIV/AIDS needed commitment, reliable information and the belief that it could be curbed.

Freers' statistics are, however, contained in a Ministry of Health' report: "Zambia National HIV/AIDS Strategic Plan summary 1999 - 2001". According to this Ministry of Health report which was compiled in May this year, "Zambia has one of the worst HIV-AIDS pandemics in the world, with an estimated 20 per cent of the adult population HIV positive". The document also confirmed Freers' statistics of the AIDS related deaths to peak in the year 2005 including the drop in life expectancy rate from an average 54 years to 37 years.

"AIDS Figures - Editorial Comment."
The Post, July 29, 1999

Central Statistics Office (CSO) director David Diangamo's criticism of UNAIDS country programme advisor (CPA) Bernadette Freers over her statement on Monday that 20 per cent of the Zambian adult population was HIV positive is unjustified. Freers' statistics came from the Government of the Republic of Zambia, the employers of Diangamo. They were obtained from a Ministry of Health report: "Zambia National HIV/AIDS Strategic Plan summary 1999 - 2001".

This Ministry of Health report which was compiled in May this year observes, among other things on page 1, that "Zambia has one of the worst HIV-AIDS pandemics in the world, with an estimated 20 per cent of the adult population HIV positive". This makes us wonder why Diangamo, a professional and not a politician, is so much in a hurry to display his ignorance. Who is he trying to please? This, however, reveals how much little time the CSO director may be spending in his office doing serious government work.

Diangamo accuses Freers of alarming the nation, what should be alarming is not the HIV/AIDS statistics but the increasing number of people who are afflicted by, and are dying from, this horrible disease. We agree with Diangamo that we should get to realities.

The advice given to us by United States Agency for International Development (USAID) director Walter North will get us to the realities of the HIV/AIDS problem in this country. As North advises, the most important topic of discussion in Zambia today is the effect of HIV and the damage it had done, and is doing, to the country, "whether the rate is 20 per cent, 25 per cent or 30 per cent, one death is one death too many".

This, however, is not to say Diangamo's concern for lack of a well designed, comprehensive, nation-wide representative survey to accurately determine the incidence of HIV/AIDS in Zambia is not important. Although statistics alone will not solve the HIV/AIDS problem in Zambia, with sufficient and accurate data we will be in a better position as a nation to take measures to control the epidemic. A similar report from the Zambia Daily Mail, not criticised by editors though. The CSO should perhaps first set up a reliable HIV/AIDS monitoring system before criticising others who HAVE at least done something.

"Data on AIDS Pandemic Inaccurate, Says CSO Chief." By Frank Bwalya
Zambia Daily Mail, July 29, 1999

The dissemination of information on the prevalence of the HIV/AIDS pandemic in Zambia has been inaccurate, unreliable and quite alarming, a senior government official has said. Finance and Economic Development Ministry acting permanent secretary (Economic Affairs and Budget) and Central Statistical Office (CSO) Director, David Diangamo, made the remarks when he officially opened "The 1998 Zambia Sexual Behaviour Dissemination" seminar at Lusaka's Hotel Intercontinental yesterday. Mr Diangamo said it was disheartening that statistics regarding the incidence of HIV/AIDS in Zambia have been exaggerated by some quarters. He singled out UNAIDS country programme advisor in Zambia for misleading the nation that 20 per cent of adults in Zambia are HIV positive.

Mr Diangamo said the CSO was the official and authoritative source of credible data which would help policy makers and it was therefore wrong for some Non-Governmental Organisations (NGOs) to give unsubstantiated data on AIDS/HIV. He said people should desist from giving "narrow measurements of HIV." "We are the official source of information. Our information assists policy makers. That is why we discourage researchers who collect information which is not naturally representative,"
Mr Diangamo said. Mr Diangamo said CSO would appreciate any statistical and timely data on statistical issues that came up provided it could be collaborated so that consensus on the socio-economic development of the country could be enhanced. He called for the stakeholders to come up with a well designed, comprehensive, nation-wide representative survey to determine accurately the incidence of HIV/AIDS in Zambia. "This is the only way that substantive and authoritative statements could be made on this issue. Otherwise all we know about HIV/AIDS in Zambia is just hearsay," he said.

And speaking at the same function, USAID Measure Evaluation Project Representative, Walter North, said people's attitude towards AIDS had not changed much. "Behaviour has not changed enough to reduce the rate of transmission. We know that it is not the health information which is lacking," Mr North said, adding that this called for the involvement of all to combat the disease. "It is not just the availability of resources, it is commitment and will," he said. Mr North could not categorically state the AIDS/HIV rates in the country because he was not the authority on the issue saying "we are hoping the up-coming ICASA (International Conference on AIDS and Sexually Transmitted Diseases in Africa) meeting will be of help."

"What Governments DON'T Do or Say!." By Mannasseh Phiri, M.D.
Health-L, July 28, 1999

J R S Malungo has probably been living outside Zambia for too long. As a result, he is able to perceive in Zambia "tremendous government commitment and will" to fight the HIV/AIDS pandemic that we who live in the country find it difficult to see. In fact, my frustrated view (and that of others) is that political committment to HIV/AIDS in Zambia is highly conspicous by its absence.

Political committment does not mean the occasional remark by leading politicians to the press that AIDS is a big problem for the country, or that AIDS is no longer just a health problem but an economic one as well. Take the example and success of Uganda. There political committment meant that President Museveni took it upon himslef to use every conceivable public occasion to remind his countrymen and women that HIV/AIDS posed a real danger to their lives and to advise them on the ways available to them to protect themselves - including (and especially) the use of condoms.

In Zambia, there is no political committment (nor government will) to promote the use of condoms to fight HIV. To the contrary. Senior political leaders have been quoted as saying that promoting condom use is promoting promiscuity and immmorality. As a result, lesser politicians are reluctant to publicly preach condom use lest they be seen to be promoting immorality. If there was some considerable committment and will, the opportunity presented by our hosting ICASA would not go begging as it is. To date, with ICASA just a few weeks away, every political, civic, business and religious leader, as well as the print/electronic media, should be talking AIDS all the time.

I have always said that if an alien were to land in Zambia from outer space, they would find it difficult to believe that HIV/AIDS is this country's major public health problem. There is no visibility. The ABC (Abstain, Be faithful, Condomise) that Mr Malungo quote are shouted loudly from large billboards in neighbouring Botswana. Not here. The Maximum condoms billboards that dot our country make no direct reference to HIV/AIDS.

Mr Malungo is best advised to contact Dr Moses Sichone ICASA co-ordinator and Country Manager for AIDS/STD Programmes who describes HIV/AIDS in Zambia as a "national disaster" and ask him about the subject of commmittment - political and otherwise.

"Chiluba and AIDS - Editorial Comment."
The Post, July 27, 1999

The disclosure by United Nations AIDS (UNAIDS) country representative Bernadette Freers yesterday that two out of every ten adult Zambians - 20 per cent - are HIV positive may be frightening. But we feel this may even be an underestimation going by the numbers of people who are ill and those we bury everyday. There are very few Zambian families today which have not lost a member through AIDS. The horrible HIV virus has got nearly to every door step in Zambia. And the impact of AIDS is now being felt by all - individuals, corporate entities, the church and the government.

The daily deaths and the cost of looking after those being decimated by AIDS are increasingly becoming too heavy for families, employers and the nation to bear. AIDS, which is spreading at exponential rates in this country, is now starting to threaten the country's prospects for sustainable economic and human resource development as it is taking away our most educated, energetic and productive population at a very fast rate than they can be replaced.

This, coupled with or resulting in, declining life expectancy which has plummeted to an average of 37 years from 54 years should cause serious concern to rulers of this country, taking into account the fact that most of the people who manage our state institutions are over 37 years. Today Zambia has no member of parliament, minister or judge who is 37 years or younger. AIDS threatens this country and our region more than the war raging in the neighbouring Democratic Republic of Congo (DRC) but it has received more attention from our rulers than the HIV problem.

If our government and those of our neighbouring countries can put in even just 20 per cent of the efforts they have legitimately and commendably marshalled to try and end the senseless DRC war - for which there's a political cure - the dangers of AIDS that today, more than anything else, threaten our very existence, and for which there's no cure, will be greatly reduced.

Let's seriously think about the danger of AIDS and what we can do to reduce or avert it as citizens, parents, employers, members of parliament, ministers and church leaders. We accordingly call on our President, Mr. Frederick Chiluba, to tackle the threat of AIDS in Zambia and other African countries with the same tenacity he has exhibited in trying to end the horrors of war in DRC.

"Street Kids Problem Escalating."
Zambia Daily Mail, July 27, 1999

The problem of street kids is escalating. Most of the causes of this problem are well known. As our correspondent DANIEL NYAU reports, its time to pool efforts, address the causes and ignite hope for thousands of Zambian children currently languishing on the streets. As if no effort is being made to bring the street kids problem under control, the shabby and miserable-looking children have continued pouring on the streets. Latest research findings indicate that over 75,000 children in Zambia are roaming the streets. Over 10,000 of them are found in Lusaka alone.

One would wonder whether life is exciting on the streets. The opposite is quite true, because the poor souls rarely show toothy smiles. The abuse of children by some parents forces many of them to run away from home and "seek refuge" on the streets. Many children usually fail to stand the ill-treatment from their "superiors." However, there are many other causes of the children's exodus from homes.

According to Fountain of Hope, a Lusaka-based Non-Governmental Organisation (NGO), social lapses like marriage breakdown have greatly contributed to many children losing trust in their parents and deserting them. The negligence of children by some parents has of late been reported to be one of the most common causes of many children leaving home to try and make ends meet on the streets. Acting Director of the outreach department at Fountain of Hope, Brian Mulenga says there is also alarming statistical data on children roaming the streets after the death of their parents, mainly from the HIV/AIDS pandemic. Mr Mulenga notes that the extended family system is slowly vanishing in Zambia because many 'next of kin' are not ready to look after the orphans.

UNICEF (United Nations Children's Emergency Fund) figures show that in Zambia, more than nine per cent of children are orphaned as a result of the AIDS. UNICEF's strategy is to integrate responses to HIV/AIDS within all elements of the country programme to prevent infection, care for orphans and advocate for more action on HIV/AIDS.

Mr Mulenga told the MAIL that of late many street children, especially those from the Copperbelt, have "migrated" to Lusaka because they believe that is where "easy money" can be accessed. The kids are unaware of the necessity of education. "The education of a child determines the development of the nation, and later the entire world," Mr Mulenga observed.

UNICEF says globally, over 140 million school age girls and boys are not receiving primary education. About 600,000 children do not receive primary education in Zambia. UNICEF noted that many children lack elementary tools such as school books, pencils and other requisites. The UN agency has challenged governments in developing countries to ensure that there should not only be the availability of schools but also the quality teaching aids and materials for children to entice them to remain in school and reduce the temptation of ending up on the streets.

A UNICEF report singles out rural areas as being of great concern. Director of child affairs in the Ministry of Sport, Youth and Child development, John Zulu admitted the street kids problem was not getting any better. "It appears the situation is not improving, but this is not to say that we are doing nothing. We always have to do something about it," said Mr Zulu. Mr Zulu bemoaned the lack of recreational facilities in many areas of the country as one of the causes of the street kids problem. Many children end up getting involved in illicit activities, and subsequently run to the streets because they do not have any pass time activity. He also called for AIDS prevention programmes to reduce the number of orphans. "You will realise that HIV/AIDS is forcing many orphans to go to the streets because of lack of support from their relatives," he said. He said poverty levels were also a contributing factor to many kids opting for streets.

Currently, 70 per cent of Zambians are said to be living in poverty. About 55 per cent of the population are incapable of satisfying their basic nutritional needs. The Child Affairs Department coordinates associations and organs which deal directly with street children. He said any assistance from organisations like UNICEF, meant for the street kids, is channeled through various groups because his ministry mainly deals with policy formulation.

However, Mr Mulenga called for cooperation from stakeholders, the government, media and many others to arrest the street kids problem. He said donors should also acknowledge efforts made by private organisations and come up with a deliberate strategy on how best to push their cause. Mr Mulenga said it was an expensive task to embark on street and home visits to assess the extent of the street kids situation throughout the country. Fountain of Hope, which was launched two years ago, receives about 500 street children daily for outreach activities which include sports and basic training skills.

But Mr Mulenga said Fountain of Hope can only feed about 100 children a day because of financial constraints. The organisation is planning to expand the feeding programme to about 200 children a day. Mr Mulenga was quick to say, "if we don't work hard as Zambians to improve our own economy, the street kids problem will continue deteriorating. We have to pool our efforts." "About 100 children reside at the "Rescue Peace House" in Lusaka's Kamwala compound. A few are from as far as the Democratic Republic of Congo but the bulk of them are from the Copperbelt," Mr Mulenga said adding, "the building is incomplete, but it should be done by next September." Children from the streets are provided with short-term shelter, non-formal education, literacy classes and counselling at the centre.

Fountain of Hope is also raising awareness and creating a lobby among parents and other institutions responsible for the welfare of children to combat the growing problem. Case studies and testimonies on the streets kids problem speak of a trauma so deep that many are unable to return to the normal way of life because they find it difficult to re-integrate.

"What Governments Do and Say-Zambia." By J.R.S. Malungo
Health-L, July 26, 1999

Government s role in mitigating and prevention of the AIDS pandemic can not be over emphasized. This applies not only to the Zambian, but all concerned governments. Since the first AIDS case was diagnosed in 1984 in Zambia, the country has seen tremendous political commitment and will. By the late 1980s the then head of state, K.D.Kaunda, came out in public to alert the nation that any Zambian whose sexual behavioural patterns were immoral (citing his son who allegedly died from AIDS) stood the risk of contracting the epidemic.

The current president, F.T.J Chiluba has on several occasions warned the nation the risks involved if efforts to alleviate and redress the epidemic are thwarted. Even the current minister of health, Professor Nkandu Luo, has, both through her research and policy agendas, highlighted the need to put proper socio-economic and policy frameworks. Such government will has been manifested in consolidation of activities and programmes including, the hosting and partial sponsorship of the coming ICASA, establishment of the National AIDS/STD/TB and Leprosy Programme, among others.

Notwithstanding the above, one clearly observes two legal systems in the country, the general and common laws. These customary and civic laws are not exceptional to Zambia, but prevalent in most developing nations. It is a must that all the stakeholders, therefore, be involved if the efforts aimed at redressing the impact of the epidemic are to be more effective. This includes traditional rulers, the community based organisations, non-governmental organisations and religious leaders.

My recent studies in Zambia (1998) suggest that religious, traditional and CBO/NGO are often apprehensive, skeptical and suspicious of some of the government activities, be they implementation of the 1989 Interstate Succession Act that may be relevant in prevention of HIV contraction through widow inheritance and property grabbing; and integration of both abstinence and barrier methods of HIV prevention.

Although the concept of ABC (A=Abstinence; B=Be faithful to your partner and C=Condom usage if not abstaining) is now coined in Zambia, successful implementation of such needs further consolidation of the existing government-CBO/NGO, traditional and religious consortia. This also means recognizing the two legal systems and paying enough attention in integrating both in programme implementation. This entails streamlining some of the existing legal frameworks in fine-turning these institutional arrangements.

Within the confinement of limited resources, also, prioritizing HIV/AIDS on the political agenda means effective communication of programmes and activities aimed at contenting with the epidemic. Although more than 9 out of 10 of all the people in Zambia (see 1992 and 1996 Zambia demographic and Health surveys) have heard of HIV/AIDS, rarely do they hear any radio, radio-drama, nor see tele-or live drama of the impact of AIDS. The problems here include limited sponsorship of expanded radio coverage, inertial in supporting and sustaining of such programmes, that is, general improvement in communication network; improving accessibility to barrier methods, condoms and now female condoms.

Recent research suggests that some rural sexually active youth and adults desire to use them, but do not easily access them, high unmet need. Publication of various pieces of information on AIDS in the country is far from being admirable. Surprisingly, no tangible government measures have being put to redress this. This could be in form of sponsoring or promoting publishing houses, journals and other relevant research material. Quite often, the international agencies have had to take a leading, instead of a supplementing, role. In many cases, therefore, this has resulted in usage of foreign literature when the potential in the country is vast.

There are instances, luckily still few in Zambia, if any, when people after being tested sero-positive would want to spread it to others through unsafe sexual means- they do not want to die alone! Governments have to put in place strict preventive laws aimed at averting such practices. Many traditional rulers revealed that they are willing to co-operate in implementing such a law. While realizing that there is no disease called AIDS , as it is a syndrome, it is also difficult to appreciate that no person has died from Aids Related Complex (ARC) as death records do not reflect this, like malaria, T.B and others.

My recent research instance cases when a number of people were suspected to have died from (ARC), but due to lack of medical certification to that effect, witchcraft was cited. This has caused some family disunity, and the trend might augment denials on the extent of the pandemic in our societies on the pretext that no body dies from ARC. It is plausible to certify ARC deaths under the auspices of a government supported ethical committee? This will be more a campaign strategy against the epidemic than moral.

Jacob R.Shakumenzya Malungo
Researcher, Trainer, Advocator and Counsellor in HIV/AIDS (Zambia and Australia)
The Australian National University Demography Programme
E-mail: Jacob R. Shakumenzya Malungo

"High Rate of AIDS Doesn't Mean Africans Are More Promiscuous." By Kelvin Shimo
The Post, July 23, 1999

The high incidence of HIV/AIDS in the region does not mean Africans are more promiscuous than other continents, said health minister Nkandu Luo yesterday. Luo, officially launching the UNICEF Progress of Nations 1999 Report at Lusaka's Inter Continental Hotel yesterday, said HIV/AIDS in Africa cannot be contained through information dissemination only but alternatives like economic empowerment and vocational training.

"HIV/AIDS Affects Agriculture Sector." By Ellen Chikale and Christeter Macha
The Daily Mail, July 14, 1999

Government says the HIV/AIDS scourge has had a considerable negative impact on the Ministry of Agriculture Food and Fisheries (MAFF) and the agricultural sector in the country. This was disclosed by acting permanent secretary, Peter Sinyangwe, at the official opening of an HIV/AIDS workshop for District Agricultural Extension officers at the Cooperative College in Lusaka on Monday.

Dr Sinyangwe said that the incalculable adverse effects the HIV/AIDS pandemic continues to cause on agricultural production, food security, human resource and agricultural productivity in the country was very alarming. He said the Agriculture ministry, in conjunction with the United Nations Development Programme (UNDP) and Joint United Nations Programme on HIV/AIDS (UNAIDS), saw it imperative to convene and sponsor the workshop. Dr Sinyangwe said the ministry can positively contribute to the concerted national efforts of combating the spread of HIV/AIDS in the country. He said the workshop seeks to train extension officers who are expected to sensitise and educate farmers and colleagues about the hazards of HIV/AIDS. Dr Sinyangwe said the ministry decided to involve the extension officers in the workshop because they were the people who dealt with the rural farming community who made up 80 percent of the rural population.

Meanwhile, representing the chairman of the theme group on AIDS, Bernadette Olowo-Freers said that knowledge and awareness about HIV/AIDS was almost 100 percent in the country, but that behavioral change did not match this. Ms Freers said there was therefore need for all sectors in the country to take part in the fight against HIV/AIDS scourge. She advised the participants to put into practice what they learn from the workshop and immediately implement and share the knowledge with the farmers.

"Government Official Puts Record Straight."
Times of Zambia, July 12, 1999

A government official in Southern Province says the misconception that HIV/Aids was a Ministry of Health problem alone was frustrating efforts to effectively control the rapid spread of the scourge.

Provincial Deputy Permanent Secretary Patrick Banda said in Choma yesterday. Mr Banda said although the Ministry of Health and NGOs had formulated plans to combat the spread of the pandemic, there has been very little results realised. This was because the HIV/Aids was considered a problem only for the Health Ministry.

He regretted that the HIV/Aids pandemic was negatively impacting on agriculture production in the province as many farmers had become victims and died. The deputy permanent secretary was speaking at New Kalundu Motel in Choma when he officially opened a five- day HIV/Aids sensitisation workshop for farmers and Ministry of Agriculture extension staff, The workshop was sponsored by the United Nations Development Programme.

"Survey on Condom Use in Zambia." By Mervyn Syafurko
The Monitor, July 2-8, 1999

The Central Statistics Office (CSO) in conjunction with Society for Family Health (SFH) is conducting a compulsory survey on sexual behaviour and use of condoms and other contraceptives in Zambia.

This has been mainly prompted by the HIV/AIDS epidemic, which is now affecting over 20 percent of the Zambian population from the time it was first reported in the country in the early 80s when the first case was identified. According to a Government Gazette signed this month by CSO Director David Diangamo all the people in which the research will be conducted are by law obliged to comply with the agents that will be doing the study.

"All households residing within the selected Standard Enumeration Areas are obliged by law to furnish the necessary information to the enumeration staff from the Central Statistical office," reads an except of the gazette. However some people interviewed by The Monitor expressed reservation on whether they should be compelled to reveal their sexual behaviour despite it being against their will.

"Why should I tell people whether I use condoms or not with my woman, it's unacceptable that is my private life," said a man who chose to only be called Mbewe.

On the other hand CSO enumeration officers doing the exercise in all the nine provinces have been receiving cooperation from people they have interviewed so far since the survey started last week. According to SFH Research Coordinator Diane Emanuel, the exercise is going on well and people are giving necessary information to the officers conducting the study.

"Zambia Has Highest Number of Orphans." By Deborah Hastings
CNN-AP Interactive, July 11, 1999

More than half the children in Zambia have lost at least one parent to HIV/AIDS, giving the country of 9.5 million the world's highest concentration of AIDS orphans, the Associated Press reports. An estimated 600,000 Zambian children have lost one or both parents to the epidemic.

"One of the world's poorest countries and one of the hardest hit by AIDS," Zambia has a 20% HIV/AIDS infection rate. The life expectancy in Zambia has dropped from 56 to 37 years. If this rate of infection continues, international aid groups say the number of orphans will increase for the next 20 years.

Most of the orphaned children flock to the urban center of Lusaka, where they "quickly learn to survive on charity, thievery and prostitution." Malnutrition plagues the children and many are likely infected with HIV themselves. But the children are not tested for HIV, "because it would do no good. There is no treatment here. Even AZT, the most basic of AIDS drugs, is unaffordable in a country where $50 a month is considered good pay."

The "impoverished Zambian government can spend next to nothing on AIDS or its orphans. It counts on international relief agencies to carry an impossible load." With all of the country's orphanages filled, grassroots relief agencies are often the children's only salvation, though they too are severely limited.

Louis Mwewa of Children in Need, an umbrella network of orphans groups, said, "We have to do something. But even the few of us who do something, we are reduced to beggars. I have to run up and down to get money, and all of us, we're going to the same places."

"Victimisation, Stigmatisation Haunting AIDS Victims." By Mildred Mpundu
Times of Zambia, Julye 8, 1999

Are women to blame for the high rate of HIV/Aids in matrimonial homes? It seems this is the widely held view that society has about women who find themselves in a situation where both husband and wife, or in some cases one of the partners is diagonised HIV positive.

There still is ignorance, stigmatisation and discrimination to some level in most African communities when it comes to HIV/Aids. People tend to receive and perceive the disease differently. As a result denial, fear and violence creep into their lives.

Mrs Elizabeth Mataka, Family Health Trust director says that women are the ones who are subjected more to violence. If a woman is diagonised first, they risk being thrown away by their husbands. This usually happens when one partner is negative and the other positive. Men most often think they are virus proof and cannot get it. Some women in Africa are still financially dependent on their husbands and therefore fear standing up to their men for fear of being left destitute.

In Lusaka's Makeni area, Samson Kondwelani (not real name) could not take the news that his expectant wife who was not in good health had been diagonised HIV positive. "I was pregnant and didn't feel well. I went to the clinic and a blood test was done. I was told to go back to the clinic together with my husband. At the health centre the news that I was HIV positive was broken. My husband said that it was all lies and told me we were just all right," said Samson's wife.

It did not take long Samson got ill too. His wife is also sick although they have been living a positive life since 1993. The couple has only revealed their status to their 20-year-old son, close relatives and community based workers from Family Health Trust.

Does the community around them know about their status? "I don't know may be they just guess. Some people will talk behind your back others will be supportive. But looking at peoples behaviour I can't come out in the open. I fear that if I open up people will talk too much," she said.

In Uganda, 30-year-old Sarah Wakabu is HIV positive. She learnt of her status after her husband died of Aids in 1993. When he first fell sick, Sarah made the bold suggestion that they both go for HIV testing. Not surprisingly, her husband refused. She waited until after her husband died to go for testing.

Sarah's experience is quoted from a UNAids booklet "Aids education through Imams: A spiritually motivated community effort in Uganda" for the Islamic Medical Association of Uganda (IMAU). Sarah is living positively with Aids. She is a Day Centre Supervisor at The Aids support Organisation (TASO) in Jinja, Uganda one of the organisations where IMAU refers their community members.

"Sarah is pleased to work for the organisation that rescued her with counselling and food assistance when she first received the news that she was HIV positive. Her job is important because she is responsible for her two sons, as well as several orphans left behind when three of her sisters and one of her brothers died of Aids." She has finished building their house and has started putting something away for her children's future. Sarah and her two sons are healthy and she takes pleasure in sharing her experience of living positively with Aids with the many HIV positive men and women who come to TASO.

"I let my Muslim brothers and sisters know the importance of HIV testing before marriage. Not just with the first wife, but with every wife. And the importance of being faithful, says Sarah who has overcome denial and fear. Mrs Elizabeth Mataka says: "Being HIV positive is considered deviant in African Society. There is a general state of helplessness surrounding HIV/Aids. People know that there is no cure." "People tend to deny their situation at a personal level especially that the disease is wrongly seen as bordering on a persons moral character," Mrs Mataka said.

Initially there is an anger- why me? Then the negotiation to be given another chance and the despair of having no cure. All these result into violence. Mrs Mataka said it is important to counsel before testing to avert violence.

However, having observed the epidemic in the last 10 year, Mrs Mataka notes a normalisation of the disease. Stigmatisation was high a decade ago, but with education and as the disease grew, a realisation that the epidemic affected everyone dawned. "It is no longer a mysterious obscure kind of illness. Everyone's life has been touched by Aids. Everyone has seen the face of Aids," she says.

Now, people are forced into situations where they need other peoples help. In other words, Mrs Mataka is of the view that if stigmatisation really existed, Community Based Care programmes would not exist. She believes that Home Based Care programmes, visiting the sick and attending their funerals are indications of peoples support. Even at most work places, the HIV status of a person seeking employment is irrelevant.

Family Health Trust believes people living with HIV/Aids are entitled to work as long as they can. "Employers must make adjustments to work contents of the employee and make available counselling services or transfer to organisations doing counselling." A person living with HIV/Aids should be encouraged to train and develop their career. Seeking appropriate medical intervention at the right time without delay, changing personal behaviour like eating, drinking habits, exercise, and sexual lifestyles can contribute to the delay of the onset of Aids.

It is possible to enjoy quality life with HIV/Aids. To encourage this support groups have been formed in Zambia's towships. Lusaka's Bauleni Self-Help Women's Support Group was formed in 1998 to enable women living with HIV/Aids share experiences and give each other emotional and financial support. Catherine Nyirenda, chairperson of the group says at the moment people are are afraid of coming out in the open. They do not know what sociey will think of them. People can discuss within the family but not outside.

"I initially had problems because the women thought I wanted them to go public the way I have done. They wanted to understand the idea of coming together. So they were closed up until after intensive counselling," Catherine said.

Martin Chisulo, Programme Coordinator for people living with HIV/Aids on the Copperbelt, working with the Health Education Project (CHEP) has five support groups. He does sensitisation to remove stigmatisation. Initially his members were discriminated but this has reduced. About 70 per cent of people on the Copperbelt are knowledgeable about Aids. Thirty (30) per cent are still doubtful about whether Aids is real because of the healthy appearance of PLWA's.

The Chawama Interfaith Community Home Based Care Project was launched on July 2, 1999 to help those affected with Aids and other diseases. It will among other things promote and strengthen health education in churches and other religious organisations and provide counselling. It is through the formation of such groups that ignorance, denial, fear, stigmatisation and discrimination can be a thing of the past.

"Design New Sexual Policies - PPAZ."
Times of Zambia, July 7, 1999

Planned Parenthood Association of Zambia (PPAZ) yesterday said there is need to design new sexual and reproductive health policies and programmes to suit the needs of the public.

PPAZ vice-national chairperson Joel Moyo said in Mansa that this would empower the people with quality information and services to allow them make informed reproductive health choices. Mr Moyo who was speaking at PPAZ regional conference in Mansa said it was wrong to impose reproductive health policies of other countries on Zambia because of cultural differences. He called for more collaboratory efforts to improve the health care system and the socio-economic status of women. Mr Moyo said his organisation was currently facing financial problems following major cuts of donor support. He said most PPAZ projects had collapsed or had been suspended due to lack of funds.

He urged PPAZ members throughout the country to put in place measures which would sustain PPAZ projects and programmes. Mr Moyo refuted claims by other organisations, especially the church that by encouraging people to use condoms, PPAZ was promoting promiscuity. He said the promotion of condoms was meant to reduce the risk of contracting STDs and HIV/Aids and also for use in family planning purposes. Meanwhile, Government has commended PPAZ for many productive health and family planning achievements. Luapula Province Minister Alex Chama said the organisation was playing a leading role in changing society's attitudes towards family planning.

Mr Chama however said in a speech read for him by Luapula Province deputy Permanent Secretary Martin Kaoma at the 8th PPAZ regional conference in Mansa that HIV/Aids was threatening the foundation of African societies. He observed that HIV/Aids awareness campaign for one reason or another had not generated the required behavioural change because many children were getting infected during pregnancy, at birth and through breast milk. Mr Chama urged PPAZ to focus its attention on addressing the HIV/Aids epidemic.

"Orphaned by AIDS, living on the street -- a part of Africa's lost generation." By Deborah Hastings
Associated Press, July 6, 1999

The younger ones sit cross-legged,quietly waiting, like schoolchildren expecting the story hour. The teen-agers, two feet away, are stone drunk from guzzling buckets of 100-proof, homemade beer called kachasu, and sniffing jekem fermented human feces scraped from sewer pipes. They stab at each other with screwdrivers and swing lengths of metal pipe.

It is dark and cold and about 40 filthy, barefoot street children gather on the dirt and concrete strip that divides this capital's main thoroughfare, waiting for Rodgers Mwewa and his promise of food. The wait is long and a melee has erupted over a stolen pair of shoes.

Into the middle of this mess wades Mwewa, a 28-year-old Zambian relief worker with more heart than common sense. Heedless of the danger, he has assembled these children in the wide center of two-lane Cairo Road, which teems with speeding minibuses. The sidewalks are worked by pickpockets, some the very ones Mwewa has come to feed.

Some 90,000 children live on the streets of Zambia. Many are the sole survivors of families destroyed by HIV. This Southern African country of 9.5 million is home to the world's highest concentration of AIDS orphans, according to the United Nations. More than half of all Zambian children an estimated 600,000 have lost at least one parent, most to the epidemic. The country's future is an abandoned, lost generation.

On this recent night, they fight each other for Mwewa's pots of stewed meat and nshima, a bread-like staple made from cornmeal that has the consistency of wallpaper paste. It fills hungry stomachs but provides little nutrition.

Zambia, a British colony until 1964, is one of the world's poorest countries and one of the hardest hit by AIDS. Death is so common, coffins are sold out of brightly colored vans parked on roadsides. Downtown Lusaka is a ragtag collection of plywood market stalls selling everything from bananas to hand-woven cloth. Its main drag is punctuated by an occasional high-rise, meagerly stocked department stores and a string of pizza and chicken joints. Their greasy fumes mix with the smells of diesel and dirt.

Foreigners are a rarity on Lusaka streets and are viewed by these desperate children as walking bags of cash. The presence of a foreign reporter and a woman from the Dutch embassy escalates the nighttime frenzy on Cairo Road

"Please madame, please madame, give me money,'' they cry, with imploring looks that are sometimes practiced, sometimes predatory, but always pitiable.The teen-agers sniff petrol, aerosol cans, anything to remain numb.Their feet are calloused to rawhide. Their clothes hang from bodies stunted by malnutrition.

Steven Chipili is 13 but looks 8. He is scooping meat and nsima with his fingers. He wears only a dirt-encrusted sweater stretching to his knees. Something is definitely wrong with him. He wallows on the median strip, laughing demonically, as if possessed, at images only he sees. According to Mwewa, Steven was perfectly normal before he ran from police who tried to shake him down for a pocketful of panhandled money. He was beaten, kicked and left in the street. Mwewa found him the next day and took him to the hospital. That was a few months ago. "The boy has not been right since,'' Mwewa says.

Last year, in the northern Copperbelt, where the mines are giving out and thousands are jobless, Steven's parents died of AIDS within four months of each other. He had no one else. So he hopped a freight train to Lusaka.

More children arrive each day and quickly learn to survive on charity, thievery and prostitution. Girls and boys who should be in grade school sell their small bodies in order to eat. Winter is approaching in the Southern Hemisphere, and on Cairo Road, the night gets later and chillier. The teen-agers and the younger ones are now a swarming mob. They dart in and out of traffic, then grab Mwewa and surround the embassy worker's car. "Just go!'' screams one of Mwewa's volunteers. Mwewa is stubborn and stays. He fruitlessly tries to calm children who are screaming and tugging at the car doors.

Tyson, a 16-year-old boy nicknamed for the power of his punch, flails and cries in pain. His jaw is swollen to the size of a lemon and he wants a dentist. Now. "Tomorrow,'' Mwewa says, trying to reason with a violent drunk. "Tomorrow I will take you to the dentist.'' Days later, Tyson is dead. The TV news reports that a security guard unleashed his dog on the boy while he was begging in front of a chicken restaurant. Tyson ran onto Cairo Road and into the path of a minibus.

Mwewa spends 1.4 million kwacha on the funeral, about $600. Most of it comes from a Canadian relief organization donation. Wouldn't that money better serve the living? "What am I supposed to do?'' he says. "It is our culture to give a good funeral.'' Mwewa directs Fountain of Hope, a grassroots relief agency that barely lives up to its name. If current infection rates continue, the numbers of dead mothers and fathers will increase for at least 20 years, say international aid groups.

Average life expectancy here has plummeted from 56 to 37 years, according to the U.S. Census Bureau. About 20 percent of the population an estimated one in five adults is infected. The American rate is 0.57 percent. Mwewa has a geology degree and used to work in the copper mines, once the backbone of the economy. "The chemicals were making me sick,'' he says, and so he quit. He turned to this work, compelled by what he saw on the streets. The impoverished government can spend next to nothing on AIDS or its orphans. It counts on foreign relief agencies to carry an impossible load. Fountain of Hope exists on piecemeal funding from such groups.

It is similar in neighboring Botswana, Namibia and Zimbabwe. Their struggling governments can't cope with the epidemic's merciless march across southern Africa, where the number of victims is highest. There are exceptions. In Uganda, a government-funded education program is credited with decreasing infection rates.

Twelve years ago, Zambia's then-president, Kenneth Kaunda, tried to inspire a national campaign against AIDS by disclosing that his own 30-year-old son had died from the disease. It had little effect. The disease is predominantly spread by heterosexuals and birth control is not embraced here. A family's social standing increases with the number of its children.

Zambia is steeped in tribal taboos and born-again Christianity. Few speak openly of sex or say the virus' name. In the shantytowns, it is called "the slimming disease.'' In the villages, it is "this thing that has come.'' No one knows how many orphans carry the virus. No one tests them because it would do no good. There is no treatment here. Even AZT, the most basic of AIDS drugs, is unaffordable in a country where $50 a month is considered good pay.

Zambia's few orphanages are full. In the villages, children who have lost their parents and most other relatives are bundled aboard buses to Lusaka. Effectively disowned, they are told to find help in the big city. "I put this kid on the bus and I say `Go find your uncle.' But where are they going to find this uncle? They don't. He doesn't exist,'' says Louis Mwewa.

Louis Mwewa, no relation to Rodgers, heads Children in Need, an umbrella network representing the few orphan groups such as Fountain of Hope. "We have to do something. But even the few of us who do something, we are reduced to beggars. I have to run up and down to get money, and all of us, we're going to the same places,'' he said.

The government closed Fountain of Hope's drop-in center because of a cholera outbreak. So the group moved into the Kamwala shantytown, where a new school is being built. Rodgers Mwewa needs about $25,000 to finish the building and doesn't have it. So far, only the foundation has been poured. Classes are held outdoors, on wobbling benches that tip every five minutes, dumping their occupants into giggling heaps. Orphans are taught English and rudimentary math on blackboards propped against jacaranda trees. One day, it is hoped, these children will pass the entrance exam for Lusaka schools. But it will take them years, and Zambian schools are not free. Costs range from $10 a year for the younger ones to about $30 for the oldest.

Fountain of Hope also tries, diplomatically, to teach children about safe sex. Instructors use soda bottles to demonstrate how to use a condom. But, said teacher Brian Mulenga, the lectures don't go far with 8-year-old boy prostitutes. "Why don't they make condoms for children?'' the youngsters inquire. "They are too big and they fall off.'' Mulenga laughs, then snaps into seriousness. "They really asked this,'' he said.

Catherine Phiri, 8, has lost both parents to AIDS. She lives in Kamwala with a charity woman who takes in orphans. She has no brothers or sisters. She doesn't even remember how she got here. For days, she wears the same filthy blue sweater. She trudges to school on a dirt path, her bare feet sending up small clouds of dust. Always, she must pass the whitewashed concrete hut where a radio blasts South African music and leering men without jobs drink the day away.

At the school grounds, Rodgers Mwewa translates Catherine's mumbled answers in Nyanga, one of Zambia's prevailing tribal tongues. It is difficult to pull an answer or a smile from this girl. Her tiny face is hard as flint. What does she want to be when she grows up? She hangs her head and plucks weeds from the ground. Mwewa asks again. Finally, in a voice barely audible, she answers. Mwewa's face is clouded by defeat. "She wants to be a cleaning woman,'' he says.

Just outside Lusaka, in the slums of Matero, local women banded together in 1991 to help an ever-increasing number of orphans. They named themselves Kwasha Mukwenu, which means "help your friend.'' They have registered more than 2,000 orphans, but can only feed about 100 a day. The women also clothe and send some of these children to school with money badgered from relief agencies and raised by selling baked goods and batik cloth.

Under the leadership of Elizabeth Ngoma, a large woman with an infectious laugh, Kwasha Mukwenu tries to find homes for the orphans, either with distant relatives or families willing to take in strays. In some houses, grandmothers care for as many as 17 children. For most of these children, the meal eaten here is their only one of the day. As in every shantytown, the people of Matero walk. Cars are unaffordable. So the arrival of a truck draws a crowd.

Inside the Catholic church, some 60 children sit quietly on straw mats, balancing green plastic plates laden with nshima by the women of Kwasha Mukwenu. The youngsters smile and shyly wave, but never stop chewing. Emanuel Daka, 14, lives in a nearby house with his mother, brother and sister. His father is dead of AIDS. His mother is dying of tuberculosis, one of Africa's most common opportunistic infections from HIV. He is in sixth grade. English is his favorite subject, though he cannot speak it yet. He dreams of being a priest. "I want to preach and tell the people the truth about these people who are dying of AIDS,'' he says through an interpreter. He is asked how he lives with the knowledge that his mother will soon die. He stares at the floor. Minutes pass. "I feel very bad,'' he answers flatly. "I am going to be left alone.''

He is surrounded by the Kwasha Mukwenu women, who nod and continue talking and laughing. Death is nothing new. The women produce receipts for medicine to document their work. They need more money, they say. They cannot help every child. Suddenly, one of them gasps. "Oh,'' she cries. "Look at him.'' Tears are streaming down Emanuel's face. The thought of his mother's death has overwhelmed him.

Mulenga Kapwebwe sees children like Emanuel every day. She is the daughter of Zambia's first vice president and a worker with California-based Project Concern International. It teaches Fountain of Hope the Byzantine skills of writing grant applications and soliciting donors. In her world, 5-year-olds have sexually transmitted diseases. If a man will pay more for sex without a condom, so be it. The child must eat today. Tomorrow has not arrived. "There is no age of innocence anymore,'' she says. "You have to get used to certain things.''

Three days later, on a beautiful evening just before sunset, Rodgers Mwewa walks into a backyard party attended by international relief workers. There is a buffet, an open bar, soft music and polite conversation. Mwewa has come straight from Fountain of Hope, where his long, depressing day ended with the arrival of a raped little girl.

Falling apart over each injustice does no good. Mwewa can do nothing more for the girl until tomorrow. To do this work requires not only compassion, but also the ability to turn it off. He looks toward the bar and covets the numbing effect of a stiff drink. The 8-year-old orphan stumbled into Fountain of Hope as he was leaving. She was attacked in daylight while walking alone in Kamwala. Mwewa and his volunteers cleaned her up. She was taken to the hospital. Now he struggles to shake her image. One detail refuses to budge. "She had blood running down her leg,'' he says in a soft voice that is swallowed up by party chatter.

"Youths and HIV/AIDS." By Mapundu Mwanza
Times of Zambia, July 6, 1999

When you talk about HIV/AIDs statistics in Zambia often dissociate themselves from figures even when they know what these figures entail. Giving an overview of the pandemic in Zambia, we know that the number of new HIV infections is still climbing, especially in the rural areas. Statistics also show that AIDS death rates are also escalating, and they are expected to peak around 2005. With this in mind, Zambia's life expectancy is rapidly declining, and also historic gains in child survival are threatened.

Unquestionably, it is reported that there will be approximately 1,000,000 AIDS orphans in Zambia by the year 2000, representing 10 per cent of Zambia's population. Also approximately 25 per cent of Zambian children under 15 years of age expected to single or double parent orphans.

A significant body of research - including national surveys and qualitative studies was reviewed to identify sex behaviors and to pinpoint the determinants of behaviours. According to a research done by UNICEF, the majority of youths are sexuallyactive by the age of 19. Many have sex by the age of 14, i.e 71 per cent of boys and 34 per cent of girls. A research done by CARE International also indicates that 17 per cent have sex by age 10 in urban compounds of Lusaka. Also revealed in the same study is the fact that many youths have multiple partners of which 55 per cent of males and 40 per cent of females report more than one partner in past three months.

Currently, there is a lot of controversy as to whether use of condoms by the youths should be advocated for. When you look at the statistics, just the fact that only 25 per cent of the Zambian youth are abstaining from sex, strikes you with terror. The abstinence situation has been the same from the period 1992 to 1996. For the rest of the larger percentage of those who are sexually active, the majority have either unprotected sex and risky, and for those who try to have protected sex, condom use isinconsistent. In fact, 71 per cent of sexually active youth reported not to have used a condom during their last sex act while 7 percent reported always using a condom. But the fact is that many youths have never even tried a condom.

We are talking about 70 per cent of girls and 49 per cent of boys who never had protected sex. However, boys and girls have their reasons as to why they engage in sex. According to Focus Group Discussions (FGDs) recently carried out in Lusaka by Society For Family Health (SFH) boys clearly said that they do engage in sex because "it's pleasurable, a sign of manhood, fun and a form of entertainment or recreation." And talking about the girls, their reasons are that they engage in sex for exchange for money, gifts or favors. It is reported too, that it is a way of proving their love to their boyfriends and also to try and keep their boyfriends from leaving. The issue of avoiding coercion was a matter of concern too. That is, girls being forced to have sex by their boyfriends.

Nevertheless, overall levels of sexual activity and age debut remain virtually unchanged. The vast majority of sex continues to be unprotected leaving youth vulnerable to HIV despite all this information. Why the youth have not changed their behaviour There are a number of factors affecting sexual behaviour among this group. Some of the key factors are:

• The vast majority do not believe they are at risk because their partners are young, sexually inexperienced, and look healthy.
• The majority do not believe they are at risk because they have reduced their number of partners. They have selected the "B" from the ABC's (Abstain, Be faithful and Condoms) and reached the false conclusion that partner reduction is enough to prevent HIV.
• Boys think they can tell if a girl is infected by looking (subjective physical characteristics) or by the girls reputation. We are talking about kaponyas who just by looking at a woman they would tell if she is makey ya ku mortuary (keys to the morgue).

Despite this information that are a health hazard concerning the youth, their only health concern are unwanted pregnancy, particularly for girls, followed by STDs and AIDS. It is with this overview that an HIV/AIDS Mass Media campaign for the youth in Zambia will be launched soon. The campaign will incorporate behaviour change strategies that will advocate youth between the ages of 15 to 19 years to abstain from sex, or to use condoms consistently to prevent the transmission of HIV. The success of campaign will depend largely on the support from parents, other adults and opinion leaders to help encourage youth to change their attitudes and behaviours that put them at risk for contracting the disease. We will talk more about the youth campaign and what messages will be developed after next week's issue.

Write to: To Your Health, Central Board of Health

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