University of Zambia Medical Library

HIV/AIDS in Zambia: September 17 - 30, 1999

"ICASA Dishonour - Opinion."
Times of Zambia, September 29, 1999

Our traditionally hazardous and accidental way of managing crucial matters will destroy Zambia. There cannot possibly be a reasonable explanation for the ruined state of Lusaka's higher learning institutions, left that way by contractors engaged to refurbish facilities for delegates to the last convocation on AIDS and sexually transmitted diseases (Icasa) in Lusaka. No explanation could make sense in a situation where sufficient financial resources were made available for all renovations. Not in a situation where all aspects of the infrastructure were competently prised open, assessed and tackled. Not where there was massive advanced planning and enormous funding which should have left no part of the work incomplete.

If the contractors were paid, they should be cornered and forced to complete the job. If they were not, the coordinators of the renovation work should be forced to cough the money and pay so that the task is finished. If the coordinators were deprived of money for their assignments, it seeps backwards to Icasa chief Dr Moses Sichone and his deputy Dr Simon Mpuka who should explain what has been going on. If they are too small to do this, Professor Nkandu Luo as Health Minister must openly and fully deal with this issue. At some point, someone must give an account and must be held responsible for the destruction and vandalisation of the three higher learning institutions now laid waste in Lusaka. Excuses cannot be tolerated.

Are the contractors who were engaged competent or incompetent? Were they fairly and honestly selected? If they were forced to abandon their work because of lack of finances, is the money allocated for them as contractors still there? Who was in charge of the money bag? There are thousands of students whose careers have been overturned; nay, it has to be realised that many among these will not be able to return to school after the indefinite closure period. They will have been forced off course to find ways and means of survival. This alone is a severe, unforgettable dishonour on everything that Icasa XI was to Lusaka and to Zambia as a whole.

"College Works Abandoned."
Times of Zambia, September 29, 1999

Contractors engaged to rehabilitate three Government colleges in Lusaka have abandoned the project, delaying the re-opening of the institutions. The affected colleges which were due to open for the third term last week are Evelyn Hone, Natural Resources Development College (NRDC) and Lusaka Trades Training Institute. The contractors hired by the organising committee of the recently held 11th International Conference on AIDS and STDs in Africa (Icasa) abandoned the rehabilitation work to the three institutions due to non payment.

Science, Technology and Vocational Training Permanent Secretary Josephine Mapoma said her ministry was still studying the matter and would soon announce new dates for opening of the institutions. Ms Mapoma was hopeful that the Icasa organising committee would pay the contractors their dues to enable them complete the renovations. She said constructors had assured Government that they would finalise rehabilitation undertakings as soon as they were paid.

In the event of the contractors failing to complete the works at the institutions, Government would make other alternative provisions to facilitate the early opening of the institutions. A visit to the three higher learning institutions yesterday found that dormitories and ablution blocks were in a deplorable state as most fittings had been removed and were to be to be replaced with new ones under the rehabilitation programme. Lecturers and students at the colleges expressed fear that any further delays in opening would affect the end of year examinations. Lusaka Trades Training Institute (LTTI) vice principal Sarah Kalule urged the contractor to immediately come up with a solution to enable the college re-open.

Ms Kalule said her administration was worried about the state of affairs. She said the delay had affected the school calendar as students were expected to commence examinations in November and December. And some lecturers at Evelyn Hone College said there was no official communication on when the college would open. They lamented that it was impossible for the students to complete the syllabus and predicted a high rate of failures as a result of the delay.

Natural Resources Development College students union president Emmanuel Mulenga appealed to President Chiluba to institute disciplinary action against individuals involved in what he described as the Icasa scandal. Mr Mulenga said all the 11 blocks at the institution were still in a deplorable state despite the seven months closure to facilitate repairs.

"Young, Beautiful and the World to Live For."
Times of Zambia, September 28, 1999

Early every study which has been done so far, shows that the spread of HIV among the youth is principally due to unsafe sexual behaviour. Seventy-five per cent of youth are sexually active and most of the sex is unprotected. Only 25 per cent are abstinent. The Society for Family Health (SFH) says 71 per cent of youth did not use a condom last time they had sex and a Care International report for 1997 says 55 per cent of boys and 40 per cent of girls had sex with more than one partner during the previous three months.

Teaching young people about sex and contraception is often thought to encourage early experimentation. However, this has been disproven by the World Health Organisation (WHO). WHO found out that: "Sex and AIDS education often encourages young people to delay sexual activity and to practice safe sex when they are sexually active."

The WHO review of 19 studies showed no evidence of sex education leading to earlier or increased sex in young people. In six studies, it delayed the onset of first sex while in 10 others it showed an increase in adoption of safe sex. There are many reasons why youth engage in such high-risk behaviour. Many young people think they cannot get HIV because their partners are young, sexually inexperienced and look healthy. They believe AIDS is a disease for older people. According to the Demographic Health Survey (DHS) 1996, 64 per cent of girls and 70 per cent of boys do not think they are at risk of contracting HIV. Such misconceptions result in many youths not using condoms when having sex.

"The key to limiting and then reversing the damage done by AIDS among our young people is to get them to change the behaviour which puts them at risk of getting HIV," says Maimbolwa Shula, youth coordinator for the Zambia Integrated Health Programme (ZIHP). She adds that to achieve that goal people must understand how to motivate youth to change their sexual behaviour. "We must understand the youth and the environment in which they are living. We must know the problems and issues they are facing and based on this, design positive messages which will motivate them to avoid the risks they are currently taking," she says.

Shula's views are shared by many people including Sister Leonia of the Mother of Mercy Hospice in Chilanga. Sister Leonia recently told To Your Health that: "We must give value to life. The young people must know that they have something to live for. That they can go to college, get a good job and as adults, start their own families." Shula says it is important that children are taught about sex and the dangers of HIV/AIDS at an early age. According to the 1997 Care report, 17 per cent of youths in urban townships have sex by age of 10. "We must catch them young. This means talking to them at primary school going age. If we leave it until secondary school, it will be more difficult to get through to them," she says.

Moreover, Catherine Phiri of Youth Media, publishers of Trendsetters, a reproductive health newspaper says youth must learn that preaching and dictating do not work. Young people make their own choices about sex and their lives. Instead, youths must be shown safer sex options such as abstinence and condom use. They must be given compelling reasons and skills for practicing safer sex options. "We always encounter the argument that everybody was meant to die and no matter how careful you are, death always awaits you at the end of the door. Though this is admissible, we counter it by pointing that you need not to die now. That there is a future out there if you really want it," she says. Young people should be told that it is right to abstain from sex. They can overcome peer pressure by abstaining from sex as this will also help them avoid pregnancies and STDs including HIV. This will eventually give them a chance to grow up and become useful members of society.

"For the sexually active, our message to them is that they must use condoms every time they have sex, even with their regular partners. "Using a condom is a smart and responsible thing to do and will help you avoid getting unwanted pregnancies and STDs including HIV," adds Phiri. She says that girls should be encouraged to overcome cultural norms that make it difficult to suggest or demand for condom use. "No boy or girl friend is worth dying for," emphasises Phiri. "I am young and beautiful. I've got so much to live for. I don't want to waste my future, because I've got power to abstain from sex. No need to compromise. It's not a play, its my life I must protect. So I abstain and keep my dream awake," so say the words of an album to be released soon. It is a message well worth getting your child to learn. And remember to tell them, "Be Proud, Abstinence iliche (abstinence is okay) and ask them, "Just How Cool Are You? Use a Condom Every Time.

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"TB Data Wrong, State Told."
Times of Zambia, September 28, 1999

Government has been urged to devise ways of collecting statistics on various diseases from private medical institutions. Country Travellers Health Care director Anthony Zimba said in Lusaka the statistics being released by Government on ailments such as HIV/AIDS and tuberculosis (TB) were inaccurate because they did not include records from private hospitals and clinics.

Mr Zimba said the Ministry of Health should seek measures to compel private medical institutions submit their monthly returns on various diseases they were treating. He was reacting to reports quoting the Kitwe District Hospital Management Board that over 6,000 TB cases were detected throughout last year in Kitwe out of which more than 600 people died.

"The statistics released by the Government do not reflect the true picture of the problem because the returns are only based on patients visiting Government hospitals but what about all those who come to our private institutions," he said. He said many patients with ailments like TB or HIV/AIDS related symptoms died at private hospitals and clinics and all this data was not asked for.

"TB Data Wrong - Opinion"
Times of Zambia, September 28, 1999

Country Travellers Health Care director, Anthony Zimba, might have hit the nail right on the head. We concur with his appeal to the Government to devise ways and means of collecting statistics on various diseases. Conmen masquerading as experts and researchers have painted Zambia and this continent red. The continent that was once referred to as dark continent - in the manner HIV/AIDS statistics are being churned out- will be completely desolate. And we fear for the children growing up under such dread and trauma. Not knowing whether they will reach the age of their parents or grannies. They have already been charged as carriers.

Even then compelling private clinics and hospitals to release the statistics of HIV/AIDS related diseases is in itself not a solution. No one is interested in mere figures which do not add value to the fight against the dreaded disease. The solution, we feel lies in the Government verifying such statistics, ensuring that any information released is correct. The outrageous figures that have been released to the international community on Zambia do not reflect the reality of the situation on the ground.

We are not saying Zambia should bury her head like the proverbial ostrich. Those who have lived abroad and have seen seas of prostitutes in Paris, London, the Americas, Asia and Far East, will agree that the scourge in Zambia is a mere fraction. But as usual the Western world has better propaganda machinery. The green gold ensures lies are peddled against a continent that is struggling with poverty and backwardness. And many compatriots will lie and falsify figures just to be able to receive an American dollar from the ever generous donors. The truth must be told if such research is to be respected. A picture more real even to those involved will help build the community's confidence in preventive actions, than one that gives blanket guilty.

One such fib was flashed right across the airwaves and papers by some unknown researcher recently. Saying 20 per cent of Zambia's population was infected with the HIV/AIDS was alarming to the extreme. We are pleased and grateful to the Minister of Health Professor Nkandu Luo for her prompt denial. We feel those are the researchers whom the Government must invite to come and substantiate their findings. It gives the impression that Zambians are walking corpses. And in the face of high technology which has brought the world closer, such information reaches the globe in seconds. The name of Zambia is tarnished and any retraction if it comes, will certainly be too late.

The result of such outlandish claims is that Zambians cannot enter a foreign country without going through scurrilous scrutiny, experiments fit for a laboratory mouse. This must be checked. What Zambia needs is funding and improvements to the medical facilities to expedite research. HIV/AIDS wherever, it started has come to stay. Unity in its fight is what is needed now.

"Favourable Changes in the HIV Epidemic in Zambia in the 1990s." By Fylkesnes K, Musonda R M, Sichone M, Ndhlovu Z, Tembo F, Monze, M Kaetano L, Malamba C, Phiri S, Mwakamui C.
Health-L, September 27, 1999

• Objectives:
  Examine trends in the HIV prevalence and links to change in sexual behaviour in Zambia in the 1990s.
• Methods:
  The core national system for epidemiological surveillance and research in Zambia, “Zam Core HIV-EPI”, has two components:
  • the national epidemiological HIV sentinel surveillance system (ESS) amongst antenatal clinic attenders (ANC);
  • population-based HIV surveys (i.e. open cohort) in selected rural and urban sites (PBS).
  The prevalence data stem from EES, whereas the data for assessing links to change in risk factors stem from PBS. In 1998/99 new data from ESS (i.e. 22 sites, n=12000) and PBS (n=5000) were collected and are compared with “Zam Core HIV-EPI” studies from the 1990s.
• Results:
  A marked decline in HIV prevalence in the age-group 15-19 years was revealed in most urban sites and in the majority of rural sites. For example, in the four sites in Lusaka the average decline the last 5 years from 28% to 15%, and in Macha (rural) from 10% to 5%. However, no general sign of change in the overall prevalence was revealed. A consistent finding, restricted to urban areas and to the two youngest age-groups (15-19, 20-24, stratified analyses), was a marked decline in prevalence rates among groups with medium or higher educational background, and more of an increasing trend amongst groups at lower levels. The behavioural data revealed a consistent pattern of declining high-risk behaviour, regardless of sex and age-group, in urban populations, whereas no sign of change appeared in rural populations in this regard.
• Conclusion:
  The data suggest a dominant trend in the HIV prevalence, both in urban and rural populations, that corresponds to a substantial decline in the incidence of HIV attributable to changes in behaviour. In urban areas this was supported by indications on behavioural change and differential trends across social status groups. The declining incidence seems to have been going on since early 1990s, but has not yet resulted in a significant decline in the overall prevalence.

Note: Late breaker abstract XI ICASA

"Blood Transfusions. The Confusion...."
Times of Zambia, September 25, 1999

Safe blood saves life. Unsafe blood destroys it. Doctors are now encouraging patients to avoid blood transfusion as they risk being infected by the HIV/AIDS virus. Ms Judith Goddard, regional blood transfusion training course coordinator based in Uganda says it is the duty of blood banks to reduce transmission by blood transfusion as much as possible.

"The safest blood transfusion is that which is never given," she told delegates to the just-ended 11th International AIDS Conference on STDs in Africa. Because of the problem of HIV infections there is need to test every single unit of blood that goes into another human being even if the donor is known to be healthy. There are other problems to look out for other than just HIV infection. Hepatitis, syphilis, hypertension and other diseases should not be present in blood that is being given to another person. There are problems encountered in ensuring that blood is safe for transfusion.

National debts, weak economies, civil unrest, high cost of living, low salaries, restructured ministries and retrenchment of staff has contributed to growth in the AIDS epidemic. While sexual intercourse is a sure way of spreading and contracting the HIV/AIDS virus, chances are that if one gets a blood transfusion they will get 100 per cent fully blown AIDS. "As blood banks it is our duty to reduce transmission by blood transfusion as much as possible," said Ms Goddard.

Mr Estine Mbayo, a volunteer with the Watch Tower Society, department of hospital services said there was need to integrate into the national policy the use of alternatives to blood transfusion. Alternatives to blood are safe because they are not blood products and are cost effective. Mr Mbayo encourages hospitals to explore transfusion free drugs or use of alternatives like crystalloids, choloids and others which are not expensive but does the work. Doctors, he says, should use less blood.

The HIV/AIDS pandemic has a direct impact on the blood system in two ways that more and more people get infected the less and less people donate blood. "That creates a crisis on the blood system because the more the demand the less the blood and the more people get infected. An example of Uganda was given on laboratory testing, screening and logistics in blood delivery: experiences from existing structures in Uganda. Ms Goddard said that 80 per cent of transfusions in Uganda are for children. One donation is divided into three and saves lives of three children. It is difficult to get blood. There are seasons when the blood bank is dry. In Uganda a 200 hospital bed during the dry season gets 10 - 15 units each month, but 300 safe units are needed a year. It has not been an easy road for Uganda. In 1972 blood bottles were very old or not available at all. there was no stored blood. Even though AIDS was unheard of in those days techniques of collecting and storing blood were laborious.

In 1999 Uganda managed to solve some of her problems, but more came up. Sterile blood bags available now have given the Blood Bank one way forward in blood supply. The problem of HIV/AIDS requires that every single unit of blood was tested. Blood clubs have been introduced where discussion groups have been formed. Planning on blood collection and storage is done six months in advance. Storage is not much of a problem. Domestic refrigerators can be used as long as they are well controlled. The only disadvantage with such fridges is when power goes or when there is load shedding. Gas or kerosene fridges can be used though it is advisable to use solar refrigerators. To help solve problems of blood supply blood bags and elisa test kits should be bought in bulk. A pool of voluntary non remunerated repeating blood donors should be encouraged. There must grouping and compatibility of blood and easy transportation of blood. There must be government commitment and diversion of funds to blood transfusion. "It is expensive but with proper strategies then we know we can stop the transmission of HIV by blood transfusion.

The Uganda experience is a success story because of government commitment and support from the European Union. Government provides 65 per cent of support. Policy makers are informed of the importance of safe blood. Ms Goddard says of Ugandans, "they are willing to volunteer. They are wonderful people who want to save lives." Mr Joseph Mulenga director of Blood Transfusion Service in Zambia said that a lot of organisation was required to achieve safe blood. Strategies should identify areas of recruiting donors and target low risk groups. Investment should be made in blood donor recruitment than in the lab and on appropriate use of drugs. Unsafe blood puts the patient at risk. So should hospitals consider giving alternatives to blood transfusion?

"AIDS in Ndole - Opinion."
Times of Zambia, September 22, 1999

Following the disclosure during the 11th International Conference on AIDS and STDs in Africa (Icasa) in Lusaka that Ndola is among African cities with the highest rate of HIV infection, a clergyman is reported last Sunday to have jokingly said very soon parents in the city will demand AIDS free certificates before marrying off their children. This was at a service at Bethel City International Church in Ndola where it was also reported that the congregation laughed at this.

The AIDS crisis has reached such stages where parents and guardians must by all means find out about the health of those who wish to marry their sons or daughters. There is simply no reason these days to look only at the economic status and reputation of that prospective in-law. Where parents fail to burrow into medical facts about their own child and that child's future spouse, there is a lifetime of misery awaiting. There have been too many cases where soon after the wedding, a few days or weeks or months, or indeed a couple of years on, one of the newly-weds begins to suffer ill-health and that persists until an early death.

Parents and guardians have the right to make painstaking and extreme enquiries lest a chaste and upright boy ties the wedding knot with a wayward girl who brings with her a whole train of diseases. If parents or guardians know that their own child is of questionable health, they should deal sincerely with their future in-laws. Anything selfish and dishonestly protective will lead to death for two instead of one. These are miserable but inevitable facts.

Concerning condoms, take this:

• Firstly, two people getting to know each other for the first time and entering into a sexual relationship will use that condom for a short while. As soon as they think they know each other, they drop the condom and the one who has always carried the HIV all along infects the partner.
• Secondly, condoms do not work for at least 15 per cent of the time - that is scientific. What it means is that if an HIV carrier faithfully meets one HIV-free partner 10 imes with a condom, infection will still happen in that half-chance.
• Thirdly, when a man armed with condoms goes gallivanting in one of the country's brothels for only one week, he will surely find himself in that 15 per cent danger zone.
• Fourthly, there is a fallacious but widespread belief that before you marry, play around as much as you like. When you are in your late 20s or 30s, marry.

Many people live and think like this, but the problem is that when is time to settle down and honourably start a family, diseases from those forgotten days emerge. There is therefore no such thing as safe sex - not even safe marriage where there is dishonesty.

"Ten Reasons Why Many are at Risk of AIDS." By Priscilla Chela
Times of Zambia, September 22, 1999

AIDS, what a pandemic! Matter-of-fact, many are at risk. The only refuge is to be under God's wings as many clerics have repeatedly said. President Chiluba must seriously consider calling a national day of prayer and fasting against the plague of AIDS in our nation. Let it happen, as a matter of sacrifice, during the week and may all bars be closed. Only churches should open for all-day times of prayer and fasting to plead with God to have mercy on Zambia and stop the plague. It is ravaging this nation. Only God is the answer as just about everyone is affected or knows someone or a relative who is affected. A cleric or not, one lady, on Radio Christian Voice pointed out the risks of AIDS facing all.

Apparently, there are 10 points why many could be at risk of AIDS. It's frightening. If your answer is 'yes' to the questions below then you are at risk of AIDS.

• Have you had an extra marital affair or just fornication, sex with anyone, during the past 10 years? Sex with anyone puts you at risk. Even worse, when one sleeps with another person apart from their spouse. It puts them at risk of contracting the deadly HIV/AIDS.Arguably, some people might say 10 years is a long time for one to be diagonised with HIV virus now. However, the diagnosis is possible because you don't know how many sexual partners the person you had sex with had. In some cases, a person with HIV infection has the disease in his body but remains strong and healthy for years. Such a person is called a 'carrier. A carrier, though not sick can pass the HIV infection to others.
• Have you had a blood transfusion in the past 10 years? Let us go back to the 1980s for instance. It was unknown then for medical personnel to test blood before undertaking a blood transfusion. The blood in the blood bank was rarely screened and many patients were just transfused according to their blood type. Any potential donor was free to donate blood, whether he was sexually active or sexually promiscuous.
• Did you have an affair with a widow or widower whose spouse or girlfriend died and you don't know what they died of? It is true that not every deceased person died of AIDS but it is vital to find out how your lover's spouse died. It would be of great importance as well to find out what symptoms that person had before he or she died. Partners of HIV infected persons or suspected infected should be informed as soon as possible about their partner' positions and be made aware of their own risks as well. For instance, if ritual cleansing through sexual intercourse occurs, the widowed spouse may pass the infection to another member of the deceased spouse's family; or if the widowed spouse remarries he or she would infect the new spouse.
• Have you assisted in a bleeding case without gloves? If you had been involved in an emergency incident like an accident and while you were attending to a victim in a pool of blood, you had an open wound which you overlooked, you are at risk of AIDS.
• Have you been involved in delivery (babies) without gloves? In the delivery room, there is a lot of blood and if one is assisting in the delivery of a baby, they is need for such a person to put on gloves. If that person does not wear loves, there is a big possibility that he/she might get the HIV virus especially if he cuts himself during delivery or if he/she has an open wound.
• Have you kissed anyone mouth-to mouth? You never know. Don't be in the habit of kissing. Your friend may have bleeding sores in the mouth and if there is an exchange of saliva and blood with such a person, who knows, you might just get the virus.
• Have you been an intravenous drug user, using contaminated and unsterilised syringes even once in the last 10 years? It is a fact that many people only started a strict use of sterilised syringes at our hospitals, school, college and university clinics in the 90s. So, everyone who went for an injection at our clinics before strict sterilisation was adhered-to is at risk. Then there is also the issue of drugs. According to the UNAIDS Report, drug use can entail considerable societal damage and health risks to the individual, including HIV infection. For those who do inject or otherwise use drugs, complementary strategies are needed to prevent them from becoming infected with HIV and passing on the virus to their sex partners and babies. Because drug use is disapproved of as almost always illegal, drug injectors-often young people at a vulnerable stage in their lives-are driven underground and do not come forward for help or information, even where it is available. To maximise the chances of success for HIV prevention, it is important to reach drug injectors on the street on the street and in the places where they congregate, to use former drug users as peer educators, and to win the cooperation of law-enforcement officials so that harm-reduction strategies are tolerated," the report said. A person with HIV infection should not donate blood nor share needles, razor blades or other skin-piercing instruments with others. If an HIV patient goes to see a traditional healer, he should make sure that any skin piercing instruments being used has been sterilised.
• Have you had sex with a woman during her menstrual period? This is the most risky of them all. Not only that, it is an unacceptable act in the eyes of God. LEVITICUS 18:19 states, you shall not approach a woman to uncover her nakedness as long as she is in her customary impurity.
• Have you been molested or raped in the last 10 years? One of the most unfair ways of getting an HIV infection. Anyone who has been raped in the last 10 years and didn't go for an HIV test, you are at risk and you could possibly be a carrier without even knowing it.
• Have you had oral sex or a homosexual union in the last 10 years? The National AIDS STDs Tuberculosis/Leprosy Programme (NASTLP) states: Although oral sex is said to be less dangerous, it is one way of getting infected with HIV/AIDS. Oral sex with a woman's genitals should be avoided while menstruating. A woman should not allow a man to put semen into her mouth. It is better not to have oral sex when sores are present in the mouth or on the genitals. These same precautions are advised for men having sex with men (homosexuals), or women having sex with women (lesbians).

The UNAIDS Report adds: "One significant source of HIV transmission is sex between men. This type of transmission is frequently difficult to address because, in many countries, men who have sex with men do not view themselves as non-heterosexual and, because of social stigmatisation, may not want to be identified to others as such." If the answer is YES to all or some of these questions, then you are at risk of getting AIDS. Abstinence is the surest way of preventing sexual transmission of HIV/AIDS infection. We have tried everything else and have failed, why not trust God this time and see if he won't come through for us. With God, there is no despair of "Oh, AIDS what a pandemic!" With God nothing is too hard. Nothing is impossible.

"New Drug to Reduce Mother to Child HIV Infection."
Times of Zambia, September 21, 1999

According to the World Health Organisation (WHO), the AIDS epidemic is eroding advances made over the past 50 years in child health and survival. Mother -to -child transmission (MTCT) of HIV infection has been proved to be a major cause of this reversal. The WHO says the average rate of MTCT in the world is about 25 per cent. But the rates differ significantly between developed and developing countries varying from less than 15 per cent in Europe to 45 per cent in sub-Saharan Africa.

In Zambia, it is estimated that 35 per cent of the 80,000 pregnant women who are HIV positive will pass on the infection to their babies. But there is now hope that half of the 28,000 babies at risk may be saved from getting HIV, thanks to a new affordable drug called NIVERAPINE. "Tests in Uganda have shown that Niverapine can reduce mother to child transmission of HIV by up to 50 per cent. This is great news," says the University Teaching Hospital's Dr Chewe Luo, a leading researcher in MTCT.

Dr Luo points out that one of the leading setbacks in the fight against MTCT has been the high cost of drugs such as AZT. The developing countries have been able to reduce MTCT to single digits because they are able to afford the $800 to $1000 that it costs to administer AZT to an HIV positive woman from 14 weeks of pregnancy until birth. In cash-strapped Zambia's case, this would mean spending $80 million per annum to reduce MTCT to the levels obtaining in the developed countries.

"Compare this with Niverapine which costs $4 for a single dose for both mother and child. We would only need $320,000 for all the 80,000 mothers. This drug gives us hope, there is light at the end of the tunnel," Dr. Luo says. She adds that the Niverapine therapy compares favourably with the Thai regimen, a short term therapy using AZT which it is hoped will cut MTCT in the developing world by 50 per cent. The Thai regimen, which is undergoing studies in 10 African countries, including Zambia, involves the administration of AZT to HIV positive women from 36 months. It will cost $50 per person. "You can see that Niverapine is still more cost-effective when compared to the short term regimen. It costs far less but with similar results," Dr. Luo points out.

Another advantage is the administration of the drug. Dr. Luo says Niverapine is given in single doses to the mother at the onset of the pregnancy and to the infant, two days after birth. As a result, a mother is able to administer the drug to the baby even if she was unable to give birth at a health centre. "Compare this with AZT which the woman has to take twice daily from the 36th week of pregnancy. And during labour, AZT must be given every three hours. Niverapine is clearly the easier to administer and makes it possible for us to reach a lot more people," Dr Luo says. Niverapine is manufactured by the German company Boeringer. Dr Luo and many other researchers feel that there is no need for further tests and that the drug should be made widely available as soon as practical.

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"Clergyman Makes Plea."
Times of Zambia, September 21, 1999

A clergyman has appealed to Ndola residents to turn to God to effectively fight AIDS which is ravaging the town. Pastor Willie Singoyi made the appeal to Bethel City International members on Sunday. He said the fight against AIDS would be futile without God. Pastor Singoyi said he was alarmed recently when he read that Ndola was one of the African cities with the highest AIDS infection.

"It is shocking that even our men who use condoms are not spared by this disease and 34 per cent of them are infected in Ndola." He said the solution to the AIDS pandemic did not lie in condoms or in AIDS conferences but in God. A Christian was supposed to make radical decisions to stay clear of the killer disease. There was laughter in church when he jokingly said very soon parents in Ndola will be demanding AIDS free certificates before marrying off their children. "When you take your dowry to the family of the woman they will now start asking for an AIDS free certificate just to ensure that you are fine," he said.

Meanwhile, the Zambia Alliance for Progress (ZAP) said AIDS awareness campaign in Ndola must be stepped up in the wake of latest statistics about the pandemic in the city. Copperbelt secretary Cosmas Musonda said mere rhetoric would not help but Government and non-governmental organisations must double their efforts in the fight against the killer disease. He said the released figures should not alarm anyone but should pose a challenge to the residents to tackle the matter aggressively. At the just ended XI Icasa conference it was revealed that Ndola was one of the African cities with the highest HIV/AIDS infection.

"Samfya Residents Form Anti-AIDS Club."
Times of Zambia, September 21, 1999

Samfya residents have formed a new anti-AIDS club aimed at reducing the prevalence of the killer disease. The formation of the club, with the blessing of the Samfya district health information office, comes in the wake of the 11th International Conference on AIDS and STDs in Africa (Icasa) hosted by Zambia last week.

Club patron Julius Mpundu told Zana in Mansa that the club has been launched in response to the high prevalence of AIDS in Samfya, which he attributed chiefly to lack of adequate information about the disease and its transmission. The club, known as Lupili anti-AIDS club will target places where high risk behaviour was rampant and densely populated areas in the district. These include market places, schools, villagers and fishing camps said Mr Mpundu. The club, he said, would also conduct vigorous health education campaigns through lectures and drama performances. The club was appealing to well-wishers for donations.

"Remove Wizard Stigma to Healers."
Times of Zambia, September 20, 1999

Traditional healers who attended the just ended X1th International Conference on AIDS and STDs (Icasa) have appealed to governments in Africa to help remove the wizard stigma associated with traditional healers. And traditional chiefs have urged political leaders to take a leading role in making sure that resolutions from the X1 Icasa were implemented. Traditional Healers Association of Zambia president Rodwell Vongo said governments in Africa had an obligation to help overcome the stigma associated with traditional healers in the fight against HIV/AIDS and STDs.

'Dr' Vongo said: "The fact that Zambia was declared a Christian nation does not mean all traditional healers are wizards. This myth must be overcome if we are to achieve something." In the presence of Margrethe Pallesen, a Danish government sponsored traditional medicine researcher, 'Dr' Vongo said traditional healers were ready to work with the Ministry of Health and researchers involved in combating the epidemic. 'Dr' Vongo also revealed that 20 traditional healers attended the conference. He said Cameroun, Senegal, Nigeria and Togo were among countries that had traditional healers at the conference. Others were DR Congo, Tanzania and the host country Zambia which had 11 healers in attendance.

'Dr' Vongo also appealed for funding from Government and donors if the association was to contribute positively to the fight against HIV/AIDS and STDs. 'Dr' Vongo who described the conference as an eye opener for traditional healers, praised Health Minister Nkandu Luo and her organising committee for making the conference a success.

Chieftainess Nkomeshya of the Soli people said the resolutions of the conference should be implemented if the continent was to enter the new millennium with hope. Chieftainess Nkomeshya also called for an end to some traditional norms that exposed citizens to HIV/ AIDS and STDs infection. "Civic education among the communities is needed. People must be told that cleansing must stop because it is a danger to human life," she said.

Meanwhile, THPAZ members have predicted the discovery early in the next millennium of an indigenous drug that would cure AIDS. THPAZ research director Stains Ziba said this at the Icasa which ended last week in Lusaka. 'Dr' Ziba said THPAZ members were greatly encouraged by Government's all embracing approach where herbalists were also given chance to present their findings on HIV/AIDS and other STDs. "I believe with our colleagues in medical science we shall soon find a cure for AIDS since so far we are able to cure almost all the AIDS related complexes andopportunistic diseases," he said. The herbs used on STDs and HIV/AIDS related diseases were segmented into three phases starting with the cure of the ordinary infection, treatment of resistance to the first medicine and blood purification as well as boosting of restoration. "The first thing to be done before treatment begins is advising the patient to go for medical examination which include laboratory tests to determine the type and degree of infection," said 'Dr' Ziba.

He said patients were in the first phase subjected to interval tests to determine their response to treatment and which diseases were resistant while looking out for side effects of the drugs. After that the patient would then be recommended to go on to the next stage of treatment leading to the completion of the whole course. 'Dr' Ziba said the patient would then be subjected to another test which once proved negative would render that person to be subjected to an observatory period of between one to three months. "When this still proves negative then the hospital now certifies him or her fit and it makes the end of the whole process," the researcher explained.

"ICASA's Sins of Omission, Commissions." By Mildfred Mpundu
Times of Zambia, September 18, 1999

"By the next Icasa conference I may not be around because I would have died from AIDS. No more conferences without me. No more making decisions without me...," these were some sentiments expressed in a poem by Elias Magunje, a Person Living with HIV/AIDS (PLWHA) in Zimbabwe at the just ended conference. He observed in his poem that PLWHAs, the people for whom conferences such as Icasa were held were nowhere fully involved in the discussions.

Researchers and AIDS activists are making money in the name of AIDS. At the end of the conference it was resolved that there should be a comprehensive or holistic care. Medical and psychosocial prevention cannot be provided without the involvement in planning and implementation of programmes. Out of the total number of delegates, only 340 were PLWHA.

They talk about the serious problems of HIV/AIDS among youths and yet they sit in conference rooms to talk about solutions for the youth. "Where are the youth among you professionals in this conference room?" asked Emma Tauhepa , a young Namibian PLWHA during her presentation. Young people have specific care needs that are not being met by care providers. Now that the eleventh International Conference on AIDS and STDs in Africa (X1 Icasa) held in Lusaka is over what strategies or initiatives have been laid out for the future to find a solution the HIV/AIDS problem? For some, it may have been an opportunity to make money, while for others it was a time to see what Zambia looked like and simply take a holiday.

Over 6,000 delegates from 77 countries all over the world attended the five day conference. Four hundred and twelve journalists - 248 from the print media and 159 from the broadcast media were all on site to give coverage and report on the conference deliberations. Five electronic forums, among them AF-AIDS took participants all over the world who where unable to travel to Lusaka right into the session rooms. "Looking into the future: Setting priorities for HIV/AIDS in Africa" was the theme of the conference.

But what was discussed during those plenary and oral sessions, round tables and symposia both in conference and committee rooms and in the village? During the five day conference, many issues were raised concerning the pandemic, but still other important matters remained undealt with. Some may not be included here. It was observed that Africa has really not done much to fight the scourge. A lot of emphasis was placed on need for government commitment at highest levels to the problem of HIV/AIDS, but little explanation as to why that commitment was needed was not there.

There were many calls too for national response and funding. A call by donors to make AIDS a development strategy and giving funds according to political commitment of a country. Governments were urged to take a lead in funding in a multi-sectoral way. There should be a reduction in military expenditure. The uncertainty of not knowing what to do with the youths needs to be cleared. Mass media campaigns should be stepped up and involve the youth in all programmes. Ethical and legal issues were always being written down, but were they implemented? The gender and cultural aspect addressed the issue giving more support for women. It was insisted that condom use be encouraged especially to protect women who were in a vulnerable position. Issues such as interventions that really work in the fight against HIV/AIDS, the need for community action and community control over projects were raised. Anti-retroviral treatment, access to drugs and right of patients to treatment, testing of vaccines suitable for the African continent It was noted too that Africa remained a threatened continent. The issue of men taking participation and responsibility, mother to child transmission, improving care for providers and providing advocacy in traditional marriages.

What also came out strongly during the conference was the need to integrate traditional healers who had solutions to some extent into HIV/AIDS and STDs programmes. Traditional healers should be seen as professional colleagues as they are part and parcel of an effective care and social support responses. Emphasised was the need to look at care for orphans and the gap between the magnitude of the problem and the capacity to respond to it. Community based orphanages were said to be a better solution. Fifteen years later, stigmatisation remains a problem because of lack of proper counselling. Stigmatisation was said to be a hindrance to access for PLWHA. Nutrition using locally provided food is as important as medical guidance. Micro-projects are an important aspect of community intervention and it was decided that credit was important for women. Property grabbing is an issue that still needs to be addressed. Womens rights to property should be protected. AIDS in the military and prisons is a big issue that was under reported.

There are "fatalistic attitudes" enhancing risky behaviour. Delegates noted too that there was a lack of time, warmth, team approach and empathy required for HIV care and wondered why this is so. A strong point that came out was that new initiatives had come up. Communities are increasingly taking ownership of community based programmes and ensuring sustainability. Community based care is more effective and cheaper. The village programme of the conference brought out issues of counselling for PLWHA and orphans, networking among CBO, NGOs, donors, government and communication between all. Spirituality too came up strongly.

The different HIV sub-types were reported to have created a problem in the search for a vaccine. There was insufficient work on sub-types in Africa. No effective vaccine has been found yet but trials of candidates were just beginning. So far only two trials which addresses the issue of opportunistic infection. There was tension surrounding the provision of drugs which were effective but not a cure and required a lot of support and supervision.

African scientists have the responsibility to develop new effective treatment. Despite all these efforts Africa has not done enough in terms of finding a solution to the problem of HIV/AIDS. The continent still lags behind. She needs resources. The fact that the World Bank has put in place a strategic plan for HIV/AIDS is a good sign. AIDS must be made a priority if we have to see meaningful development on the African continent.

"Tembo Explains Chiluba's Absence from ICASA." By Goodson Machona
The Post, September 17, 1999

President Frederick Chiluba¹s absence during the opening and closing ceremonies of the just ended International Conference on AIDS and STDs (ICASA) in Lusaka was due to circumstance ³superior² to the Zambian government¹s control, said Vice- President Christon Tembo yesterday. Reacting to complaints by the World Health Organisation (WHO) regional representative Dr Ibrahim Samba and UNAIDS executive director Dr Peter Piot over President Chiluba¹s no-show, Vice-President Tembo said President Chiluba was nevertheless briefed about the deliberations on a daily basis.

³I am aware that many delegates and international agencies learnt with great consternation and even indignation that my Head of State and his counterparts were not coming to this conference. One can understand that, given the proportion and magnitude of this conference,² Vice -President Tembo said. ³However due to circumstances superior to our control he was unable to come. I can, however, assure you that he was briefed in detail every day and that he was certainly here with us in spirit.²

He also dismissed accusations by some delegates that African leaders were concentrating their efforts more on political conflicts such as the war in the Democratic Republic of Congo (DRC) than on the fight against the HIV/AIDS pandemic. ³This is a chicken and egg situation,² Vice-President Tembo said. ³Whereas I entirely agree that such conflicts take up more of our leaders¹ time, however, even the noble fight against AIDS cannot be executed and won in the absence of political peace.² He announced that the Zambian government would soon launch a new HIV/AIDS Council and secretariat to facilitate the implementation of a revolutionary strategic plan for the period 2000 to 2003. ³This plan recognises the centrality of communities and families in the response to the HIV/AIDS epidemic and seeks to scale up geographic and vulnerable group coverage through catalytic projects in public, private and NGO (non-governmental organisations) sectors,² Vice -President Tembo said. ³It became imperative for us in Zambia to reform our health care system to make it more responsive to the demands of the growing population, emerging epidemics, poverty, scarcity or resources and ecological failures such as drought and floods.²

Vice -President Tembo said he hoped the deliberations had been fruitful and would lead to the improvement of the quality of life for people living with HIV/AIDS. ³Their lives depend on what each one of us, in our own small way, can contribute to the fight against HIV/AIDS,² said Vice -President Tembo. Earlier, various speakers gave syntheses of the five tracks which fell under the scientific programmes, namely HIV/AIDS/STDs and the community, the socio-economic consequences and the determinants of the spread of HIV and STDs and prevention interventions. The other tracks related to care and support of people living with HIV/AIDS and basic science and clinical care.

Other speakers addressed the issues raised by NGO, youth and People Living With HIV/AIDS (PLHA) village programme, the community forum and the cultural programme. President of the African Union Against AIDS and STDs, Ibrahim Ndoyi, said he was disappointed the issue of STDs had been ignored in most presentations. Ndoyi, however, said he hoped the commitments made in Lusaka would be implemented and urged pharmaceutical companies to reduce the price of HIV vaccines so that it is available to more people. President of the Society for AIDS Against Women, Dr. Eka Esu Williams, said there was need to meet women where they are when implementing intervention strategies and remove the stigma about AIDS. She also called for gender equality and partnership between men and women in the fight against HIV/AIDS. Representative for the Network for People Living With HIV/AIDS (PLWHA), Michael Anganga, implored governments not to underestimate the role PLWHA can play in the fight against the disease. ³How many of you include us when formulating HIV policies? How many of you hire us as experts? We have the capacity to know how you can most appropriately work with us in a real and honest way,² Anganga said. ³Don¹t underestimate our contribution . Don¹t over estimate your capacity to offer us support without our leadership.²

Later Zambia¹s health minister Nkandu Luo, who had been the chairperson of the conference, handed over the chair to Burkina Faso health minister Professor Robert Soudre. She also handed him various documents on the 11th ICASA and seed money worth US $10, 000. Prof. Soudre, in accepting the chair, said Burkina Faso was honoured to be the hosts of the 12th ICASA. He said the next ICASA would be held in Burkina Faso capital Ouagadougou, from December 9 to 13, 2001. ³Burkina Faso will make sure that the event is a success,² he promised. Burkina Faso deputy health minister, Dr. Karfo Kapoune, read out a message from Burkina Faso President Blaise Compaore. President Compaire said the ICASA provided an important stepping stone in the fight against HIV/AIDS. He also disclosed that the HIV/AIDS pandemic was one of the most vexing problems in his country and was worsening and his government had since set up a foundation to assist HIV/AIDS widows and orphans. President Compaire, however, said prevention, information, education and communication remained the only tools for combating the disease. There was also a message from Cuban President Dr Fidel Castro Ruz to the 11th ICASA read on his behalf by a Cuban minister in Spanish. The English interpretation was not audible.

"People with HIV Should Behave Themselves." By Sam Mujunda
The Post, September 17, 1999

People living with HIV should learn to conduct themselves properly otherwise the community can rise against them, advised Global Network of People Living with HIV/AIDS in Africa board member Milly Katana yesterday. Presenting a lesson on Basic Communication Skills and Personal Development at the International Conference on AIDS and STDS in Africa (ICASA), Katana said the behaviour of someone would make the community have a negative attitude against people living with HIV. ³If people living with it start running around with people¹s children and wives, the danger is that people will rise against all the people living with HIV,² Katana said.

During the same session, some HIV counsellors observed that language, locality and culture have been some of the barriers in disseminating information about HIV/AIDS. Katana observed that most times recipients of the message have had a negative attitude to the people living with HIV no matter how good the message may be. She advised counsellors to be vibrant in disseminating information by coming up with new approaches to the HIV epidemic.

"AIDS Is a Threat to Development." By Joe Kaunda
The Post, September 17, 1999

Unless we can decrease and eventually eliminate the spread of HIV/AIDS, our national human development goals as well as sustainable development are unobtainable, said Zambia¹s finance minister Katele Kalumba yesterday. Finance deputy minister Godfrey Simasiku presenting a paper entitled Breaking the back of HIV/AIDS: Scaling up an expanded approach through a multi-donor debt for development arrangement at the just ended Eleventh International Conference on AIDS and STDs in Africa (ICASA) in Lusaka on behalf of Kalumba highlighted the pandemic as a threat to development. He said in a country where 19 per cent of the population aged 15 to 49 years was estimated to be HIV positive, there was need for concerted efforts from both government and non-governmental partners to make the issue a priority. He said the Zambian government felt that the debt relief campaign, through debt for development arrangement, could help to invest more resources into a wider array of social concerns. He said the cancellation of debt or a significant reduction in debt servicing would help free up resources for investment into activities that will control the spread of HIV/AIDS and respond to its impact.

³Zambia is committed to honouring its international obligations and has been doing so at a great cost to its people, but, clearly the debt burden is a major constraint to our ability to invest adequately in social programmes,² Kalumba said. He said the government had since proposed a multi-lateral and bilateral debt for development arrangement to generate resources for HIV/AIDS prevention and control. Kalumba said under the programme, the national resources presently being used for debt servicing would be set aside under commonly agreed upon terms with creditor nations or institutions and to be used by civil, private and public sector institutions for the epidemic prevention and control. He said this was being done in line with the just formulated HIV/AIDS Strategic Plan for 1999 to 2000 by all stakeholders in the country. The plan, according to Kalumba, involves mobilising a multi sectorial approach, promotion of behaviour change, increased and improved Sexual Transmitted Disease prevention and control. Other aspects involve reduced mother to child transmission including community support for orphans and vulnerable children.

"Tembo Closes ICASA."
Times of Zambia, September 17, 1999

The 11th International Conference on AIDS and STDs in Africa (XI Icasa) closed in Lusaka yesterday with Vice-President Christon Tembo defending African leaders' concentration on conflict resolution saying the HIV/AIDS pandemic cannot be fought in the absence of peace. Lieutenant-General Tembo said there was need to stop the wars to facilitate the fight against HIV/AIDS.

"It is a chicken and egg situation. I agree that such conflicts take up more of our time but the AIDS fight cannot be won in the absence of political peace, we have to have our priorities right," he said. Gen Tembo's remarks followed several contributions by conference speakers who felt African leaders were directing more efforts to conflicts on the continent when issues like HIV/AIDS needed attention. He explained that President Chiluba did not attend the conference as planned because of circumstances beyond his control but was briefed on a daily basis on the important deliberations.

"He was here in spirit. In fact my presence indicates his presence here and I am sure the same applies to my other colleagues from other countries," he said. Gen Tembo said Zambia would soon launch an HIV/AIDS and STD council for the years 2000 to 2003 which would target vulnerable groups with special emphasis on the centrality of communities and families. He stressed the need to reform the welfare system to make it suit new challenges and realities like the HIV/AIDS pandemic. He said to be meaningful, external resources should be channelled through home-grown initiatives and strategies.

Eleventh Icasa chairperson Prof Nkandu Luo officially handed over the mantle to Dr Robert Soudre of Burkina Faso for the next conference scheduled for Ouagadougou in 2001. And United Nations Children's Fund (Unicef) executive director Carol Bellamy has hailed Government for successfully hosting the conference. Briefing the Press in Lusaka yesterday, Ms Bellamy who described the conference as highly successful however called on African governments to undertake measures to control the AIDS epidemic. Ms Bellamy said the AIDS related diseases currently raging havoc on the continent would only be effectively tackled if governments channelled resources into combating it.

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