University of Zambia Medical Library

HIV/AIDS in Zambia: November - December 1999

"Condom Gap: A Major Health Crisis!"
Times of Zambia, December 28, 1999

The need for condoms is growing as HIV/AIDS and other sexually transmitted infections (STIs) spread. Making condoms more accessible, lowering their cost, promoting them more and helping to overcome social and personal obstacles to their use would save many lives and reduce the enormous consequences and costs of STIs and unintended pregnancies.

The Reuters Health Information Service reports that researchers from the University of Texas Medical Branch as Galveston have found that consistent use of condoms reduces the risk of heterosexual HIV transmission by about 87 percent.

"The meta-analysis of 25 studies on condom efficacy showed that proper condoms use prevents the transmission of HIV with anywhere from 60 per cent to 96 per cent effectiveness in preventing HIV transmission," the report says. The researchers writing in the November/December issue of Family Planning Perspectives add that the incidence of transmission among individuals who always use condoms was 0.9 per 100 person-years, compared to 6.7 per 100- person years for those who never used the prophylactics.

Every sexually active person should always use condoms unless in a mutually monogamous relationship. An estimated 24 billion condoms should be used each year, but actual use is much less, at estimated 6 to 9 billion each year. To avoid AIDS, more and more unmarried people are changing their behaviour. Some are avoiding sex entirely, while others have started using condoms. In surveyed countries, 5 to 33 percent to never married men say they have started using condoms to avoid AIDS. But many others have not adopted safe sexual behaviour. Rates of condoms use are lower within marriage than among the sexually active unmarried. Yet, many married couples need condoms, too, both for family planning and for protection against STI's including HIV.

Narrowing the gap
Narrowing the gap between condom need and use is a major public health challenge. Worldwide, at least 33 million people are living with HIV/AIDS and another 14 million people have died. An estimated 16,000 new infections occur every day. About 6 of every 10 new infections are to women, and many newborns contract the virus from infected mothers. Efforts to increase condom use are a good social, economic and health investment. More condom use would reduce rates of HIV infection and slow the spread of AIDS so that emphasis could shift from dealing with consequences of AIDS to meeting other health needs.

Why don't more people use the condom?
Despite the AIDS epidemic, many people practice risky sexual behaviours - even when they know that condoms prevent infections. It is unlikely that all sexually active people will always use condoms when needed. Powerful social norms encourage men to take sexual risks, such as visiting commercial sex workers and at the same time discourage condom use. Traditional gender roles keep women from talking about sex or asking for condoms. Wives may know that their husbands have sex outside marriage but cannot suggest condoms for fear that their husbands many abuse or reject them. There are other obstacles to condom use. Some people know little about condoms, dislike them, cannot afford them or cannot obtain them easily. Others believe, wrongly, that they face little or no risk of pregnancy or STIs. Unmarried young people are particularly at risk: Many face social pressures to have sex and have difficulty getting condoms.

What programmes can do!
Condoms prevent infections and pregnancy - but only when people use them correctly and consistently. Communication campaigns can help make condom use, not sexual risk-taking, and the social norm. Reproductive health programs also must address the issue of trust, negotiation and communication between partners that are important to condom use and essential to safe sexual relationships. Condoms should be made accessible to all and provided not only through health clinics and retail shops but also in hotels, bars, grocery stores and vending machines. Progammes can reach out to more groups who need condoms, including youth, unmarried men and commercial sex workers. Especially, programmes can offer condoms at subsidised prices in retail outlets through social marketing. In the developing world, social marketing supplied about 900 million condoms in 1997.

Access and promotion go hand in hand. Condom promotion can improve the image of condoms, portraying them as fun, reliable and important. Counselling and the mass media can foster safe sexual behaviour and teach condom-negotiating skills. Particularly because of AIDS, most countries need to do more to encourage condom use. Governments, health programmes, manufactures, donor organisations, retailers and health care providers must work together to assure that condom suppliers, information and services meet the goring need.

If you need more information on this or any health topic, please write to:
The Media Relations Coordinator
ZIHCOMM, P.O Box 37230, LUSAKA

"Youths Advised to Take on HIV/AIDS." By Sheikh Chifuwe
The Post, December 23, 1999

It is a challenge to all the youths to fight HIV/AIDS pandemic as they enter the next millennium, Youth Alive, Zambia (YAZ) schools committee chairperson Kennedy Katongo has said. Katongo, speaking at the official handover of two dormitories and an ablution block in Lusaka by the British High Commissioner to Zambia, Thomas Young said new strategies of implementing intervention programmes would be employed next year.

Katongo said Youth Alive, an international non-governmental organisation aimed at sensitising youths in Africa about HIV/AIDS effects, needed concerted efforts from all stakeholders to curb the pandemic.Young said the British government was committed to assisting Zambia to ensure that the supply of drugs and improvement of other health programmes were fulfilled especially in rural areas. He said the K46 million project would enable YAZ to conduct some of their programmes effectively. He said the scourge was broad based and needed everyone s participation.

Youth Alive has a very strong record since its formation in 1996. The problem of AIDS is not only in Zambia but in the United Kingdom also, Young said.Youth Alive national co-ordinator Luzia Wetzel said next year s theme: Building on good values would emphasise on eradicating child abuse and behaviour change among youths. Our focus will be primary schools, orphaned children and street kids. YAZ wants to be partners with those concerned so that the vision of fighting AIDS is achieved, said Wetzel.

"UN's Children Fund, UNICEF has Cited Zambia as a Country of Hope in Southern Africa in the Battle Against AIDS"
Africa News Online, December 23, 1999

The UN's children fund, UNICEF has cited Zambia as a country of hope in Southern Africa in the battle against AIDS. In its 'State of the World's Children - 2000' report, UNICEF said: "In the grip of this calamity and against sobering odds, some Zambian's have chosen to live hopefully even as many struggle with their own poverty and difficult life circumstances. They brave a stigma by their association with AIDS and often are themselves discriminated against as they work to spare future generations from the ravages of this disease."

According to the report, one in five Zambian's are HIV positive and that according to local health educators in Zambia, everyone is either affected or infected by HIV/AIDS. "Virtually everyone you meet has lost friends or relatives to AIDS," the report noted. UNICEF said that an estimated 360,000 children had lost at least one parent, most of them to AIDS. Life expectancy at birth, has dropped from 50 to 40 years since 1990, and "child mortality rates are rising to levels not seen since the early 1970's, erasing a quarter-century of progress on children's health and welfare."

In UNICEF's under-five mortality rate ranking, a critical indicator of the well-being of children, Zambia has been listed at number 12 in the world, with Sierra Leone at number one. In sub-Saharan Africa, the report said, children's health continued to be under "severe threat", with an estimated 4.1 million children under the age of five dying last year, compared to 3.3 million in 1980. The report said that in Zambia, the link between disease and poverty was "particularly stark",with the country's dramatic socio-economic decline "providing fertile ground for AIDS to flourish." According to the report, young women are especially vulnerable and many succumb to the temptation of so-called "sugar daddies". It said that despite the fact that Zambia had one of the highest HIV infection rates in the world, resources have been "hamstrung" by its foreign debt. In 1998, debt servicing amounted to US $110 million, more than the government's health and education budgets combined.

In a statement Carol Bellamy, executive director of UNICEF said: "Advances in science and technology have helped us push polio to the brink of eradication and drastically reduced deaths caused by measles. At the same time, a vacuum of leadership has allowed the merciless targeting of children and women in armed conflict, the frightening transformation of AIDS into the number one killer in Africa and a devastating free-fall in development assistance to the poorest nations." Bellamy added: "If we don't seize the start of the new millennium to solve the terrifying plight faced by our children, then we are guilty of contributing to their suffering and to the wholesale abuse of their rights. The choice ours."

The report also noted that of the nine countries with the highest adult HIV prevalence, Botswana, Namibia and Zimbabwe are the most affected. In Botswana, it said that without AIDS life expectancy would have exceeded the age of 69 by 2000-2005, "now life expectancy is predicted instead to plumb to new depths to 41 years in the same period."

This item is delivered by the UN's IRIN Humanitarian Information Unit
e-mail: irin@ocha.unon.org
Web: IRIN Humanitarian Information Unit

"Youth Speak on HIV/AIDS"
Health-L, December 21, 1999

Recently, the Youth Advisory Group (YAG) which is composed of various youth serving organisations, has been airing messages on National Television and Radio to empower Zambia's young people against HIV/AIDS . Today, we share with you some young people's thoughts on this campaign.

I am a Zambian male who would like to thank and congratulate you on your wonderful work regarding the youth adverts that are currently running on ZNBC's Television and radio. I feel your efforts and good work should not pass unnoticed. I heard during Icasa that 19.5 per cent of Zambians are HIV positive and so I am very happy to see that ZNBC has immediately taken interest in addressing this concern by bringing us the abstinence and protection adverts. It is good to know that there are organisations/companies that still believe in us the young people. I only hope more organisations and companies would emulate your involvement and commitment to fighting the HIV scourge . Congratulations and please continue with the splendid work you are doing.
-- Suwi Waluka, Lusaka

"Accept AIDS is a reality, forget the statistics."
I wish to comment on some of the issues that you have covered on the HIV/AIDS scourge recently. I am 18 years old and have watched relative after relative and friend after friend die of AIDS. What I find very distressing is this quarrel about statistics. Surely what is important is not whether it is 15 or 20 per cent of the people who are HIV positive. What is important is to accept the reality that HIV has reached epidemic proportions in this country and we must set our priorities accordingly to fight it. I have no doubt that had this been a war arising from politics politicians would be in the forefront telling us that one more person killed in this fight is one death too many. Well, here is my appeal to politicians. read somewhere that for every person who dies from your fratricidal wars, 10 die of AIDS . That surely qualifies the fight HIV/aids as the single most important item on your agendas. The United Nations says the two countries: Thailand and Uganda , which have succeeded in stopping and then reversing the spread of HIV infections did so manly because their presidents made the fight against HIV/AIDS their number one priority. As I remember my friends and relatives who have died of AIDS, my prayer is that more presidents, including our own, will make the fight against HIV/AIDS their number one priority. If they don't, I fear my generation is doomed .
-- Concerned Youth, Lusaka

"Continue the spirited fight against HIV."
Your television commercials against HIV/AIDS are teaching the nation lessons which our culture has failed to impart to stop the decay of morals. It is because of this decay that people are dying and hence the need for programmes such as yours to continue.
-- Mwiinga Hamoonga, Mazabuka

"On Abstinence-'iLi Che . . ."
The adverts against AIDS encourage us as youths to abstain from sex. They also make us feel proud to be virgins.
-- Clandine Booth, Kabwe

"We can now make informed choices."
Your commercials on AIDS contain a lot of information and are very educative. I especially like the one called "Choices" when the boy says I abstain because I want to keep God's commandments. This very true and at the same time encouraging . That you very much for the adverts.
-- Florence Chileshe, Kasama

"On Condom use-You can't tell by looking!"
I appreciate your AIDS advertisements on TV very much. That one about Ing'utu and her friend tells us to be careful because someone looking healthy might actually be finished by AIDS inside.
-- Kingsley Namakando, Lusaka

"Who is really cool?"
YOur advert called Ice is very educative . It tells us that you cannot tell whether a person has an STD or AIDS just by looking . Love at first sight can lead someone to death.
-- Worried youth, Kasama

"Condom use and tell me more."
I am so proud to learn how to use a condom. I would also like to know more about it. So please send me information.
-- Mubanga Stephen, Kasama

If you need more information on this and any health topic, please write to:
The Media Relations Coordinator
ZIHP
P O Box 37230, Lusaka

"AIDS Day: Why did Youths Run the Show?." By Joseph Banda
Times of Zambia, December 11, 1999

The morning was sunny with a slight nip in the cool breeze blowing gently. A multitude of youths, some as young as nine, gathered at Ndola's Broadway clinic to commemorate the World AIDS Day last week. At exactly 08:30 hours youths accompanied by Ndola mayor, Paul Katema, set-off for a march through Ndola's city centre to the Broadway cinema hall. During the march, the youths displayed banners that expressed their awareness of the existence of HIV/AIDS while the Zambia Police brass band played several and great Christian hymns.

The scene raised eyebrows as mainly children took over the streets in the town centre on this particular day. The day was December 1, declared World AIDS Day and commemorated throughout the world. The Ndola youths really knew what they had gathered for as it was unfolded in the poems, songs and sketches that the young ones performed before the Mayor and other district senior officials.

In his opening remarks the master of ceremony introduced to the gathering that also included civic leaders, health personnel, non-governmental organisations (NGOs), the theme of the last World AIDS Day in millennium: ''Listen, Learn, Live Ñ World AIDS Day campaign with children and young people'' read the theme.

The activities in the hall whipped up emotions as the youths expressed their fear, anxiety and hate for the deadly disease. A 13-year old pupil James Makoka of Twapia basic school nearly moved the house to tears with a poem that tearfully questioned why and who brought AIDS into existence. ''AIDS, yesterday you took my parents, uncle and cousin. Today you attack my friends, sisters and brothers," the boy cried. "AIDS is sweeping the world when God said go and fill the earth," he continued in a poem that triggered a thick silence in the whole house.

Kanini basic school also presented a play that emphasised behavioural change by the youths to avoid the deadly disease. The play promoted abstinence and good behaviour as the only solution to ensure youths were AIDS-free in the coming millennium. ''We are the answer and behavior change is the key'' the girls declared at the close of the play.

HIV/ AIDS has affected the social-economic development of many nations as employees in key sectors have died from the disease and most of them are in the reproductive age group of 15 to 39. Zambia like other nations has not been spared from the effects of the deadly disease. According to the ministry of Health and Central Board of Health statistics Chilanga Works lost 43,370 hours due to HIV/AIDS related sicknesses and funerals in 1993. And the 1997 report revealed that the lost hours increased by three and a quarter times between 1993 and 1995 because of the growing AIDS epidemic. The same report says 1,500 teachers died of AIDS in 1998 alone. At Indeni the costs for medical care, salary compensation and funeral grants more than doubled in the period 1991 to 1993 because of the escalating AIDS pandemic. Military personnel, nurses and other uniformed officers have also not been spared of the alarming high numbers of those that have died or affected with the disease.

The Sub-Saharan Africa accounts for 70 per cent of HIV/AIDS cases in the world. Of the 34-plus million people infected worldwide 22 million are in the Sub-Saharan Africa and the number is in the increase. Women and children have become more vulnerable to food insecurity as the HIV/AIDS continue to rise. Children are mostly affected because they lose parents and then forced to leave school because there is no one to pay school fees. Youths are future leaders who need to enter the new millennium AIDS-free. Time to guide them is now.

"Declare HIV/AIDS a National Disaster, UNICEF Urges Government." By Brighton Phiri
The Post, December 10, 1999

United Nations Children s Fund (UNICEF) representative in Zambia Peter McDermott has advised government to declare HIV/AIDS epidemic a national disaster as the disease is claiming 200 lives daily. McDermott, during the official opening of the national planning workshop on orphans and other vulnerable children at Lusaka s Mulungushi International Conference Centre yesterday, said the country s response was not proportional to the impact of the deadly disease.

It is unfortunate that the impact of AIDS is underestimated in the country despite it being equivalent to that of a physical war, McDermott said. He urged government to come up with a policy and institutional framework which would guide the fight against AIDS. McDermott advised Zambia to emulate other African countries like Kenya and Zimbabwe which have declared AIDS a national disaster and a national emergency respectively. He said there was need to build an alliance against AIDS because no one in Zambia could deny the fact that he or she had lost a close relative as a result of AIDS.

Sport, youth and child development minister Abel Chambeshi admitted that there was a growing number of children rendered destitute and vulnerable by the high level of poverty and rapid spread of HIV/AIDS. My ministry strongly believes that unless there is a collective response to the growing number of fatherless, motherless, vulnerable children, the future of Zambia could be bleak, Chambeshi said. He urged the participants at the workshop not to allow themselves to be caught up into endless rounds of what he termed paper shuffling, academic debates and the establishment of new bureaucratic structures bent more on self-fulfilment or self perpetuation. The three- day workshop is expected to help government draw up a policy and national action plan.

"Zambia Has Second Highest Proportion of AIDS Orphans." By Brighton Phiri
The Post, December 10, 1999

Zambia is the second highest country in the world with proportion of children orphaned by AIDS, a United Nations Children s Fund (UNICEF) report has disclosed. According to the report, many families in Zambia were facing difficulties in coping with increased number of orphans as widespread and extreme poverty had stretched them beyond their capacity.

Mkushi South MMD member of parliament and Sport, Youth, and Child Development minister Abel Chambeshi told parliament yesterday that there were 1 million orphans in the country as result of AIDS. Government is currently facing difficulties in addressing this problem, Chambeshi said. He disclosed that the American and British governments had pledged their financial support towards the fight against increased number of orphans in Zambia.

UNICEF representative in Zambia Peter McDermott disclosed that 64 per cent of the orphans in Zambia had lost their fathers, 22 per cent (mothers) while 14 per cent had lost both parents. Zambia s orphan rate has increased from 13 per cent to 15 per cent per year, McDermott said.

UNICEF report indicates that families failure to adapt to increased number of orphans has forced many children on the street. In 1991 in Lusaka, some 35, 000 children were living on the streets. Today that number has doubled to around 75, 000. Half of this number are orphans, read part of the report. The report further indicates that Zambia s primary health care system used to be considered one of the best administered and most decentralised among African countries had broken down due to increased cases of AIDS, household poverty and external debt obligation. According to the report, HIV/AIDS illness accounted for about 30 per cent of hospital beds and 43 per cent of in-patient.

"AIDS Loosens its Grip in Zambia"
Africa Analysis, December 10, 1999

Zambia is poised to become the third African country to demonstrate that significant inroads can be made into sub-Saharan Africa's devastating HIV/AIDS pandemic, with encouraging news that there has been a slowdown in infection rates among the most vulnerable sector of the population, teenage girls.

Preliminary findings from the latest government national survey of HIV prevalence suggest that the infection rates in 15-19-year-old girls in a number of locations, including Lusaka, have fallen between 1994 and 1998. This so-called HIV sentinel surveillance was conducted last year. Actual figures, verified by independent assessments, have not yet been published but they are thought to be noticeable.

Any decline - however minor - in such a high-risk group is significant, given the biological and social vulnerability of young girls to the HIV virus. Their high-risk status has been clearly documented for the first time this year: girls in the 15-19 age-range are five to six times more likely to be HIV-positive than their male peers and 55% of 23.3m infected adults in the sub-Saharan region are women, according to latest estimates by UNAIDS. This is partly because the likelihood of viral transmission from male to female is greater and because there has been a disturbing rise in the incidence of older, infected men having coerced sex with girls.

Further studies are needed to pinpoint the exact reasons for the drop in infection rates for girls in Zambia - which may also contribute to a reduction in the 19.9% overall prevalance. But a turnaround suggests that people's knowledge about HIV/AIDS has increased, condoms are being more widely used, people are limiting the number of sexual partners and there is a real fear about the consequences of HIV infection. If so, health workers see this as a clear signal that changing behaviour is a necessary first step in any prevention rogramme.

The promising news from Zambia is rare, but not unique. Senegal is bucking the trend of spiralling infection rates, keeping rates under 2% - partly because the strain in west Africa is less virulent than in southern Africa, but also because of sustained early prevention programmes. In Uganda, one of Africa's first AIDS hot-spots, the number of 20-25-year-old pregnant women infected with HIV inurban areas has fallen from 30% to under 10% over the past six years (AfricaAnalysis, no 311).

Africa's political leadership still needs to be bludgeoned into taking HIV/AIDS seriously. The past 18 months have seen more openness. There have also been important technological breakthroughs, with the discovery earlier this year that the cheap drug Nevirapine, costing $4 a dose, can reduce by up to 50% mother-to-child transmission (Africa Analysis, no. 327). Coupled with behaviour changes suggested by the Zambian experience, these advances could help dissipate the cloud of fatalism which hangs over African people, who so far have seen no respite from what they see as the inevitable onslaught of AIDS.

But it is still very early days. Health systems are crumbling and HIV/AIDS remain hidden, both because of the social stigma and ignorance. Up to 95% of people are unaware of their HIV status and access to testing and counselling is non-existent in many countries. Life expectancy has dropped and the number of orphans continues to rise.

Nigeria is still a big unknown; the military régimes which ruled before President Olusegun Obasanjo came to power this year did not even track the epidemic. The first comprehensive report published on 1 December warns the epidemic in Africa's most populous country has reached explosive proportions.

"Just What Happened to the Condom on AIDS Day?" By Elizabeth Serlemitsos
Times of Zambia, December 7, 1999

Zambia's World AIDS day campaign commemoration was exceptional and memorable. Unfortunately, what was most memorable about the event was the conspicuous absence of the condom. Not one person who spoke mentioned the condom, even among the banners, besides one of the three banners my organisation displayed which had a condom message, there was only one lone individual who had a placard reading "No condom, no sex". Every other message at the event (and especially at the candlelight ceremony the night before) was about abstinence.

In a country with statistics such as:

• nearly one in five youth is HIV positive (17 per cent according to Central Board of Health, 1997);
• by the age of 19, 59 per cent of girls have had their first child (ZDHS,1996);
• 71 per cent of sexually active youth did not use a condom the last time they had sex (SFH 1997); and
• about 68 per cent of sexually active youth do not think they are at risk of getting HIV (ZDHS, 1996).

We are killing the youth of this country by not talking about condoms - out loud and everyday. Finance Minister Katele Kalumba made an interesting point in his speech during the candlelight service. It was that in the past there has been a lot of support for "other forms of prevention", but not as much for abstinence. He was stressing that it is time for more support to abstinence. Dr Kalumba, we have heard you. Our most recent and on-going campaign is balanced between messages encouraging the delay of sex or cessation of sex, but for those who are sexually active, to encourage them to use a condom everytime they have sex.

I fully support the notion that parents need to be communicating with their children and I hope every parent is or will be equipped to share their values, beliefs and spirituality with their children. By sharing this, the child will feel more self-worth and should be better equipped to make healthier decisions, but the bottom line is that the child will be alone when they need to make those decisions. If the parent has also said to his/her child, "whatever you do, be safe. If after all I have said, you still think you are ready to have sex, you need to know how to use a condom... and to use it. Insist on it. Because your life is the most important thing-don't waste it," then that child will be better equipped, when making what should be one of life's serious decisions.

As we are diversifying our messages to young people, I hope those who have been known to only preach abstinence (and even to criticise the condom), will begin to see the light - it is not an either or people need choices and the power to make their own decisions. If we do not inform people about all their options, we are doing more harm than good. I hope all those present at the World AIDS campaign events heard my concern and plea. As Nkandu Luo, now Communications minister, recently said, "we don't have the time." We will continue to inform young people about all their options. I hope my colleagues will join me in this balanced approach.

THE author is the chief of party, for the Zambia Integrated Health Programme in Lusaka.

"Street Kids Swell."
Times of Zambia, December 8, 1999

The number of street kids in Zambia is expected to reach one million by the year 2000. Sport, Youth and Child Development Permanent Secretary Helen Matanda said this in Lusaka yesterday. Mrs Matanda was speaking at the United Nations Children's Fund (UNICEF) Press conference on the situation analysis of orphans in Zambia in 1999. She said these children fell prey to drug and substance abuse while others were raped.

The HIV/AIDS virus had reached alarming levels hence the need to commend the organisers of the two day planning workshop set for tomorrow. Mrs Matanda said poverty had contributed to the increase in HIV/AIDS. UNICEF country representative Peter McDermott said the problem of street kids and orphans in Zambia was immense.

The Childcare and Adoption Society in Lusaka has been keeping a lost child aged about five years who was picked from the town centre over a month ago. The society has appealed to the public who have lost a child answering to the name "Moze" to contact the Chilenje Transit Home which has offered him sanctuary. Society spokeswoman Lucille Mudenda said in Lusaka yesterday all efforts to trace the parents or relatives of the boy had failed. "The only thing he tells us is that he is Moze, his father who is a minibus driver is also Moze and that his mother sells beer. He also tells us that his home is near a place where pigs are slaughtered but we have visited many such places in townships without success," Ms Mudenda said.

"Support Anti-AIDS Clubs."
Times of Zambia, December 9, 1999

A widow living with HIV/AIDS has called on Government to increase support towards youth anti-AIDS clubs to curb the spread of the deadly disease. Mrs Idah Mporokoso, 37, whose husband died of AIDS in 1996 made the call during the world AIDS Day celebrations in Mungwi. Mrs Mporokoso said there was need for Government to support youth anti-AIDS clubs to attract more youths to take part in the activities of these clubs.

Mrs Mporokoso who has been living positively since the death of her husband in 1996 said the spread of AIDS can only be checked when many youths were involved in anti-AIDS activities as they would not have time to engage in promiscuity. She also challenged other women with the HIV virus to go public if they were to get any support. Mrs Mporokoso, a mother of four, said she had been receiving a lot of help ranging from free medication to counselling from the time she went public in 1996.

Acting Mungwi district health director Cheleka Kaziya expressed concern on the high number of youths being infected with the HIV virus. Ms Cheleka said it was saddening to note that the majority of the youths living with HIV/AIDS were young women. She called for community support and care for persons with HIV/AIDS to help them live positively.

"Zambia has 40,000 TB Cases Every Year." By Wilson Silungwe
The Post, December 7, 1999

Over 40, 000 cases of tuberculosis (TB) are recorded in Zambia every year. According to University Teaching Hospital (UTH) head of the virology department Dr Francis Kasolo, 70 per cent of the diagnosed TB cases were HIV/AIDS related. Dr Kasolo disclosed this during an orientation tour of his department by the visiting members of the royal Japanese family Their Imperial Highnesses Prince and Princess Takamado yesterday. He said the department has this year recorded a reduction in the rates of HIV/AIDS infection especially among the young people below the age of 19 years.

There has been a reduction from about 14 per cent to about five per cent infection rate among teenagers below the age of 19. This is a positive sign because we know that in the near future as we get into the new millennium, these figures are going to reduce further, Dr Kasolo said. He observed that over use of drugs by TB patients has led to non-response to medication resulting to the bacteria becoming more resistant to the drugs. The Prince and Princess were on a tour of the UTH where they visited the paediatrics and the infectious disease control departments.

"CAFOD spends K780m on HIV programmes." By Kelvin Shimo
The Post, December 3, 1999

The Catholic Fund for Oversees Development (CAFOD) this year pumped in K780 million into HIV/AIDS programmes in Zambia, disclosed CAFOD regional representative Richard Miller yesterday. Miller, at a Catholic Secretariat organised workshop in Lusaka for Catholic dioceses departments dealing with the scourge at the University of Zambia Christian Chapel, said the same amount was released for HIV/AIDS activities last year. He said CAFOD had put in place programmes aimed at looking at orphans and cushioning the social economic impact resulting from the deaths of guardians.

The workshop aims at building capacity of the Catholic Church and how it has to respond to HIV/AIDS. Miller said the workshop will also share experiences by various members in their areas of operation and strategise on how to work with communities. He said CAFOD whose headquarters are in London was committed to helping the countries in the region cope with the social-economic effects of HIV/AIDS through sensitisation and many other programmes.

"Zambia to Have one Million AIDS Orphans by 2000."
Xinhua News Agency, November 29, 1999

Zambia will have over one million orphans as a result of the HIV/AIDS pandemic, Zambian Education Minister Godfrey Miyanda warned here on Monday. Addressing a gathering in the capital Lusaka on the HIV/AIDS issue, the minister urged Zambians to use the World AIDS Day, which falls on December 1, as a time of reflecting on key issues regarding the killer disease.

He said the latest statistics indicate a rise in the cases of AIDS globally, and it is estimated that by the year 2000, Zambia will have over one million AIDS orphans. He challenged parents to educate their children on the dangers of AIDS and other sexually transmitted diseases so that they can protect themselves.

The Zambian government had in the past week intensified its AIDS campaign in an effort to join the rest of the world in commemorating the United Nations World AIDS Day. Statistics by the U.N. show that about 6,000 people world-wide are getting infected by the deadly killer disease every day.

"AIDS: Listen, Learn and Live." By Mpundu Mwanza
Times of Zambia, November 30, 1999

Tomorrow is World AIDS Day, observed world-wide. Initially, when it was observed for the first time on December 1, 1988, the aim was to raise public awareness and to generate the desired response to the growing pandemic of HIV/AIDS. Of which we feel a good job has been done by all stake-holders in this fight against HIV/AIDS. Now we are talking about the HIV/AIDS awareness level in Zambia being 98 percent and universal. For this year, the theme is: "Listen, Learn, Live: World AIDS campaign with children and young people." With the theme being interpreted as follows:

• Listen: listen to children and young people, hear their views and concerns, and understand what is important in their lives.
• Learn: learn from one another about respect, participation, support, and ways to prevent HIV infection.
• Live: live in a world where the rights of children and young people are protected and where those living with HIV/AIDS are cared for and do not suffer from discrimination.

According to UNAIDS, of the 33.4 million people living with HIV or AIDS at the end of 1998, about a third are young people, aged between 15 and 24. The Central Board of Health also says there has been a higher HIV prevalence in young women than men in selected urban communities in the 15 to 19 age group. And according to estimates, this prevalence was 24 per cent among women in selected urban communities in Zambia as against six per cent among males in during 1994-97. Lack of negotiating skills for safer sex among women; their biological factor, and the cultural factor are some of the reasons the HIV prevalence rate is higher in women than in men. But the fact is that, we know the youth account for a much higher percentage of the total population infected or who become infected after infancy. Besides preaching abstinence, monogamous relationships, pre-marital sex, is there anything else we can give to this generation in case all fails? Sure, for complete protection from sexually transmitted disease the only effective measure is abstinence. This strategy needs to be widely and consistently promoted. Yet abstinence and lifelong fidelity to one uninfected partner are not the experience of millions of people. Therefore, promoting more widespread understanding of condom efficacy and advocating their consistent use by those who choose to be sexually active is crucial to protecting people from HIV and other sexually transmitted diseases.

During a meeting Lusaka based medical general practitioners, it was revealed that there has been a drop in the number of STD cases in their clinics. They attributed this to an increase in the use of condoms. In a country with a rapidly increasing HIV rate, correct information about prevention methods is vital in battling this deadly disease. In light of the fact that it is not possible to tell whether one is a carrier or not, sexually active Zambians must take action and protect themselves through abstinence or consistent and correct use condoms.

Bishop Desmond Tutu, in one of his speeches on Rubber Revolution, a South African television programme advocating condom use, said: "Our wonderful country is in a major crisis, HIV/AIDS is spreading so fast. We in the Church believe that sex should take place only within marriage. However, I want to urge all those who choose to have sex outside marriage to take the right precautions and practice safer sex." Talking about choice, for those who choose to use condoms, the most important fact about condoms is that they protect against HIV/AIDS and thus save lives. In fact, they will also protect you from infections you may not know you have. When used consistently and correctly, condoms are an effective method. Despite the facts that scientific research from various sources prove that condoms are an effective barrier to HIV and other STDs when used consistently and correctly. Unfortunately, there still seems to be quite a lot of misinformation and questions surrounding condoms their use. For the next few weeks, this column will dedicate itself to addressing the different myths. Now, condoms must be used consistently and correctly to be effectively. Consistent use means always using a new condom with each act of sex from beginning to the end. A study carried out in Europe found out that those who use condoms consistently can prevent HIV transmission. The study was conducted with couples where one partner was infected with HIV and the other was not. And among 123 couples who always used condoms, none of the uninfected partners became infected with the virus. In contrast, among 122 couples who used condoms inconsistently, 12 of the uninfected partners became infected.

A similar 1993 study showed that using condoms every time prevented HIV transmission for all but two of the 171 women who had male partners with HIV. However, eight out of 10 women whose partners did not use condoms every time became infected. It is also very important for the public to know that condom failure is mostly due to incorrect usage rather than poor condom quality. Tests show that condoms are about 95-98 per cent effective in protecting against HIV/AIDS and other STDs. The reason that the tests do not show that condoms are 100 per cent safe is mostly due to user failure. This is why it is important for people to use condoms correctly. Correct use will mean following instructions inside the condom package and avoiding the use of expired condoms.

Before questioning either the safety of condoms or the contribution to the public health made by condom promotion, we should get the facts right. Otherwise, we might end up giving the wrong messages to young people. In the context of HIV, this means putting their lives at risk. So, I hope we will listen, learn, live. We need to rededicate, commit ourselves to the fight against HIV/AIDS and protect our loved ones. We all know what is suitable for ourselves when we have the information and options.

"Poverty Exposes Women to STDS and AIDS."
The Post, November 22, 1999

High poverty and unemployment levels in the country have increasingly compelled women not to say no to sex or demand for safe sex for fear of losing an important source of financial support. According to a Planned Parenthood Association of Zambia (PPAZ) report presented at the just ended Parliamentarian Adolescent Reproductive Health workshop, some women were exchanging sex for food, housing and cash for their survival. PPAZ director of programmes Clement Sakala told members of parliament that many unemployed young women were prone to the high risk of sexual behaviour as they struggled to cope with the economic pressures, thereby increasing potential risk of contracting Sexually Transmitted Diseases (STDs) and AIDS. "Studies have further observed that as economic options shrink men are forced into migration and marriage is postponed. The postponement of marriage places them at considerable risk of STDs including HIV infection," Sakala said. Sakala said Zambia's economic changes had a direct impact on the sexual and reproductive behaviour of the local people. He said the burden had heavily fallen on female adolescent and poor women who faced serious problems of economic self-support.

"Maternal Mortality Rate Called 'Alarming.'" By Joel Chipungu
Panafrican News Agency, November 4, 1999

ZAMBIA: According to a study on maternal mortality, 18% of Zambian women between the ages of 12 and 50 died last year from complications related to childbearing. The study found that the maternal death rate was highest in the Eastern Province of Zambia, where it reached 56%. Discussed at a workshop in Lusaka last month, the study indicated towns which are "flash points" of maternal deaths.

The study, headed by University of Zambia demographer Buleti Nsemukila, said some of the common causes of pregnancy-related deaths were hemorrhage (13%), sepsis (13%), HIV/AIDS (10%) and obstructed labour (18%). Some traditional medicines and practices were also believed to be harmful to the health of both mother and child, the survey said. In comparison, the study noted that the maternal mortality rate in Malawi is 24%; in Namibia, 19%; and in Zimbabwe, 17%. The age group considered at greatest risk of maternal death is 25 to 29 year olds. "Women attempting to have their first child had the highest risk of dying from maternal causes," the study noted. "The risk of dying from maternal complications was reduced with increasing age of the woman, which is the reverse of what is expected," it said. The study also highlighted a relationship between education and the maternal death rate. Women with secondary school education were said to be less likely to suffer maternal deaths.

"How is AIDS Related to Debt Burden?" By Dr. Peter Henriot
Times of Zambia, November 2, 1999

The two greatest blocks to human development in Africa today are the burden of external debt and the pandemic of HIV/AIDS. Are these two problems related? Are solutions to these two related? What practical responses are possible as we work to deal with both of these mega-problems?

And what does this mean specifically in Zambia?
During the Icasa meeting in September 1999 in Lusaka, I was asked to comment on a proposal made by the Government of the Republic of Zambia (GRZ) for a proposal that would make available for HIV/AIDS programmes some resources freed up by debt relief programmes that could be arranged with bilateral donors. I made the comments not representing specific HIV/AIDS programmes, though as a pastoral worker and development consultant resident in Zambia for over a decade, I am deeply concerned with the problem of the destruction of life in this country because of HIV/AIDS.

Rather I presented a position coming from the movement in civil society that is attempting to deal with the other great destroyer of life, the external debt owed by Zambia and regularly serviced at the expense of such vital life programmes as health care, education, and other social services. Debt cancellation for Zambia

In his paper presenting the GRZ proposal at the Icasa meeting, the Minister of Finance and Economic Development powerfully analysed both the extent and consequences of HIV/AIDS in Zambia and the depth and impact of our huge external debt. A debt stock of over US$ 6.5 billion for a population of around 10 million comes to US$ 650 for every Zambian woman, man and child, over twice the GDP per capita. The debt is clearly unsustainable and Zambia is obviously a Heavily Indebted Poor Country."

In terms of human suffering, we know well the consequences of the Government's commitment to regular debt servicing that now exceeds spending on health, education and other welfare services combined. Sufficient money is not found in the national budget for meeting basic social needs such as books for schools and drugs for clinics, but is found for servicing the national debt. Yet no nation can develop without educated and healthy citizens, no matter how faithfully it may meet debt servicing requirements. One-third of school-age children in Zambia (ages 7-13) (the majority of whom are girls) are not enrolled in schools. Many of those who are in school face untrained teachers, sit on the floor, do not have books or other educational materials, and are in classrooms for only a few hours a day. Health services are a national disaster, as represented in the shocking figures of infant and under-five mortality, maternal mortality, declining life expectancy, and general morbidity conditions.

Keen analysis of Zambia's debt situation and sharp critique of the economic reform package known as SAP or ESAF have revealed the links between these factors and the human suffering so widely experienced and shockingly growing in Zambia today. That is why Zambian, civil society churches, NGOs, trade unions, student groups, women's groups, professional societies, concerned individuals, have come together to join the international campaign calling for a cancellation of the debts we endure. Jubilee 2000 is the name, immediate action for equitable and effective debt relief is the programme. More than three hundred thousand signatures (45 per cent from rural areas in this country) were taken from Zambia to the G-8 meeting in Cologne in June, joining the 17 million signatures gathered from around the world in the Jubilee 2000 campaign.

The argument behind this campaign was well summarised in a joint pastoral letter issued in August 1998 by the three major church bodies, representing Protestants, Catholics and evangelicals. The pastoral letter stated adamantly that Zambia's debt is clearly unpayable. Zambia cannot pay back because the debt burden is economically exhausting. It blocks future development. Zambia will not pay back because the debt burden is politically destabilising. It threatens social harmony. Zambia should not pay back because the debt burden is ethically unacceptable. It hurts the poorest i our midst."

The call of our debt campaign is for cancellation, not for half-way, totally inadequate measures of a reformed HIPC or a human-faced ESAF. The Lusaka Declaration," coming from a meeting of fourteen African nations last May, stated unequivocally: "We reject HIPC and the other current debt relief processes" that are tied to imposed reform programmes that are deepening economic, social and ecological hardships for the vast majority of people" in Africa.

Who does debt relief benefit?
It is very clear that Zambia is deserving of debt relief, but the key question is: Is Zambia credible with what it would do with debt relief? Any debt relief must be put to the cause of poverty eradication Ñ not simply poverty alleviation such as welfare safety nets or emergency food relief. Productivity, employment, small capital availability, agricultural enhancement, physical infrastructure such as feeder roads in rural areas, women's empowerment, environmental protection: these and many more areas are where debt relief must be designated to move toward effective poverty eradication.

But many persons in donor countries and many more citizens in Zambia are asking today a very sharp and pertinent question: What guarantee do we have that resources freed up through debt cancellation will in fact go to poverty eradication and not to causes such as new Mercedes Benz for ministers, new uniforms for the military, new bank accounts for key politicians?

This question is not politically motivated but realistically formed. And it must be realistically answered, lest Zambia, no matter how deserving we may be of debt relief, will not be credible enough to receive it. That is why our CCJP/JCTR Debt Project (jointly sponsored by the Catholic Commission for Justice and Peace and the Jesuit Centre for Theological Reflection) is currently devoting efforts to establish effective debt mechanisms that involve civil society in setting conditions for how debt relief is to be spent. These are what we call conditionalities from below," not the conditionalities from above" imposed only by outside donors and international institutions.

We are suggesting four such mechanisms:

• Independent tripartite management commission, composed of representatives of civil society, parliament and relevant ministries, to oversee debt negotiations and transparent utilisation of a poverty eradication fund (Uganda already has such a mechanism in place)
• Social audit of the budget, to assure active participation of civil society for input and evaluation of the national budget (such a mechanism has been operating in an initial form here in Zambia for three years, conducted by the CCJP)
• Bilateral counterpart funds, to provide designation of resources for specific projects, for example, through debt swaps (e.g., for environmental programmes)
• International debt arbitration, to move negotiations out of asymmetrical and unfair relationships between rich creditors and poor debtors into a neutral forum such as in a United Nations court.

Central to all these proposals is the involvement of civil society and the effort to guarantee a credible use of resources freed up by debt relief. The proposal put forth by the Zambian Government is an example of the third type of mechanism, designed to guarantee that debt relief does indeed involve civil society in assuring conditionalities from below." How can we evaluate this Zambian proposal for a multi-donor Debt for Development" arrangement?

Criteria for debt for development
As the Minister of Finance and Economic Development explained in his Icasa presentation, the proposal aims to scale up an expanded response to breaking the back of HIV/AIDS in Zambia." In order to generate new resources for HIV/AIDS prevention and control, scarce national resources, presently used to service debt, would be set aside under commonly agreed-upon terms.

Civil, private and public sector institutions would be enabled to implement programmes in a combined response that would be part of the overall National HIV/AIDS Strategy. As details of the Strategy are worked out, there is a very strong concern of the civil society engaged in the debt campaign here in Zambia, a concern about the orientation, organisation and operation of this Debt for Development" arrangement. Recognising that this proposed arrangement would be the first large-scale initiative to channel debt relief resources into poverty eradication, we want to be assured that it sets a precedent that meets these three criteria:-

• Clear financial and programmatic accountability
• A wide public participation
• Effective poverty eradication.

First, accountability and transparency must be there as foreign donors and Zambian citizens alike demand this. The programme will not be accepted by donors nor owned by citizens if there is not honest and open accounting at every moment of the arrangements. This will not be easy in the current Zambian political and administrative climate. A government that finds it difficult to be transparent with both members of Parliament and ordinary citizens about the whereabouts of the millions of US dollars gathered during the privatisation process must work very hard to be transparent about the millions of US dollars that might be gathered through debt relief arrangements. The debt campaign of civil society says very clearly: no to any debt arrangement, no matter how attractive it might be, that is not scrupulously accountable to the citizens of Zambia as well as to donors.

Second, wide public participation means that the arrangements are open to the involvement of the many sectors of civil society that will be affected by these arrangements. This includes NGOs involved in HIV/AIDS work and also NGOs involved in debt work. The light of publicity, the fire of debate, the sense of sharing, the structures of partnership: all these must be guaranteed in the arrangements for debt relief. No behind doors" decisions, no exclusion of key partners, no "token" representatives, no un-owned resolutions, etc.

Finally, the arrangements must be aimed at poverty eradication and not simply poverty alleviation. It is a matter of development, not welfare, a question of empowerment, not dependency. Clearly, this requires a fresher and wider vision than is frequently exercised in government and NGO bureaucracies. For instance, debt relief money must not go only into social sectors like health and education. Sometimes money put into road construction between a village and a clinic, or electricity for rural schools, or employment of agricultural extension workers can be much more effective in poverty eradication than simply sectoral monies spent in narrowly defined health and education" projects.

Evaluation of HIV/AIDS proposal
Given these three criteria, how can we evaluate the proposed multi-donor. Debt for Development" arrangement? Obviously, more study needs to be made of the GRZ proposal. But the Minister's Icasa presentation does seem to move significantly in the direction of meeting in its vision and strategy the demands for accountability, participation and poverty eradication.

First, the principles of financial and programmatic accountability are made explicit in the proposal and a clear commitment is made to independent management of the debt relief funds. Prior agreement by all parties to mechanisms for collecting and reporting information about the progress of the programmes must be reached before any funding is released. And structures for an open process are required to be set in place.

Second, a Debt Relief Steering Committee will assure that the debt programme is not a Government-controlled effort but a partnership involving civil, private and public sectors. The exact character, composition and charter of the Committee remains to be designed, but at least the proposal speaks of it in a way appears satisfactory.

Finally, the multi-sectoral approach to HIV/AIDS can be shaped to poverty eradication by implementing truly cross-cutting strategies in the activities of ministries and civil society. For example, education of the girl child should not only be in prevention of HIV but in literacy that enhances dignity and empowers choices. Promotion of behaviour change requires more than seminars, but also job opportunities and recreational facilities. Youth programmes should not simply offer more condoms but also more education in traditional cultural values. Such approaches are not short-term poverty alleviation or welfare, but long-term poverty eradication or development.

• The national Zambian debt campaign, comprising Jubilee 2000-Zambia, the CCJP/JCTR Debt Project and many other groups, reiterates its call for full cancellation of Zambia's debt. We reject the half-way measures like reformed designs of HIPC and ESAF.
• Second, we call for the implementation of debt mechanisms that assure that any freed resources go to poverty eradication and we insist on the participation of civil society in monitoring negotiations and deciding priorities. These are the conditionalities from below" that we promote.
• Third, in speaking approvingly of the GRZ proposal for a Debt for Development" arrangement aimed at HIV/AIDS programmes, we express appreciation for inclusion of the principles of accountability, participation and poverty eradication. However, we do not endorse the proposal unreservedly, since we need to see more details about its actual structure and about the Government's real commitment.
• Fourth, we do not say that HIV/AIDS prevention, control and treatment is the only poverty eradication priority and thus we do not endorse any proposal that would make HIV/AIDS programmes the sole recipient of debt relief resources

But we do see the proposal laid on the table at the Icasa meeting as giant step forward in the design and implementation of debt relief that can effectively benefit the poor.

The author is Director at the Jesuit Centre for Theological Reflection in Lusaka.

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