University of Zambia Medical Library

HIV/AIDS in Zambia: February - March 2000

"Newspaper Probes Efficacy Of Chinese HIV Immunity Booster."
PanAfrican News Agency, March 22, 2000

In its response to growing local interest in the Chinese HIV/AIDS 'Tian Immunity Booster', the state-owned Times of Zambia newspaper has launched independent investigations to determine the drug's efficacy. The paper reported Wednesday that it wants to investigate the drug after a Lusaka-based Chinese doctor, Tian Shengxun, claimed recently that the three drugs he prescribed reduced the viral load (number of virus) within the bodies of people living with HIV, which eventually leads to AIDS.

The Times has offered to pay for all medical expenses including various independent medical examinations to be conducted on a Lusaka couple living with HIV, whose name was not revealed. "This is the newspaper's response to Zambian scientists to develop local drugs to combat the disease more cheaply than with drugs from Western countries," the paper wrote.

According to the Times, the couple has undertaken to abide by the prescription to the latter and allow the newspaper to monitor the progress of treatment with the Tian Immunity Booster. The couple is reported to have voluntarily disclosed its HIV status and willingness to undergo treatment with the Tian Immunity Booster. Tian has claimed the Booster increases the defence cells within the body, scientifically known as CD4 cells. Recently, many people living with HIV in Zambia claimed that their health situation improved after taking the Tian Immunity Booster.

"Zambia Launches National AIDS Council and Secretariat."
UNAIDS Secretariat, March 16, 2000

Following a recent cabinet decision to establish a Council and Secretariat on HIV/AIDS/STDs and TB, the Minister of Information and Broadcasting and the Minister of Health made a formal announcement today 16th March 2000, launching the National Council and Secretarait at a ceremony in Lusaka. Present at the function were members of the diplomatic corp., including heads of UN agencies, Minsters, Permanent Secretaries and other dignitaries.

Speaking at the ceremony, the Minister of Information and Broadcasting Services, the Honourable Newstead Zimba said the HIV/AIDS/STD/TB Council and Secretariat is the body that will advocate effective multi-sector approaches towards the prevention of HIV transmission, Care and Social Support, as well as impact mitigation for those infected and affected by HIV/AIDS. There will be a three-trier structure consisting of:

The Committee of Minsters which will supervise all programmes on HIV/AIDS as well as monitor the work of the Council and Secretariat. The HIV/AIDS/STD/TB Council which will be the highest national body with authority to coordinate the national response to HIV/AIDS/STD and TB. It will enjoy autonomy while being supervised by the committee of ministers. It shall comprise of 15 Council members appointed by the Minister of Health. The terms of office will be two years with possibility for reappointment.

The National HIV/STD/TB Secretariat will provide technical guidance and implement council decisions emanating from the mandate of the council. The following Ministers will constitute the Cabinet Committee that will monitor the work of the HIV/STD/TB Council: Ministers of: 1) Mines and Minerals Development 2) Health 3) Education 4) Communications and Transport 5) Presidential Affairs and 6) Information and Broadcasting Services

The Minister of Health, the Honourable Mpamba said the launching of the HIV/AIDS/STD/TB Council and Secretariat was the culmination of a process that started in 1987, marking a significant turning point in Zambia's effort to prevent and control HIV/AIDS. The Council and Secretariat he added, will not be an implementing agency, but will play a facilitatory and catalytic role in the implementation of the new National HIV/AIDS strategic Framework.

Mr. Peter McDermott, chairman of the Expanded Theme Group on HIV/AIDS, presenting a message from the Executive Director of UNAIDS, Dr. Peter Piot, congratulated the government of the Republic of Zambia on the establishment of the Council and Secretariat on HIV/AIDS/STD/TB. Mr. McDermott said that though the Council and Secretariat were long overdue, he assured the government of the Theme Group's full support to the Council and Secretariat. He outlined the three challenges facing the council as; providing leadership; establishing a coordinating mechanism and prioritizing action. He said the impact of HIV/AIDS on the country was overwhelming. Using the example of the more than 600,000 children orphaned by AIDS, he added that the challenge of HIV/AIDS will be with us for a very long time. Mr McDermott was however optimistic, citing the recent evidence of decline in HIV prevalence among the 15-19 year age group, he observed that this was an indication that HIV prevention works if well targeted.

The chairman of the Theme Group highlighted some of the ongoing programmes supported by UNAIDS and its cosponsors and the bilateral agencies, such as the prevention of Mother-to-child transmission of HIV (MTCT) which is starting in three sites, and the Voluntary Counselling and Testing (VCT) which is about to be expanded from a few sites to all districts. Mr. McDermott said the establishment of the Council and Secretariat will break the silence surrounding AIDS, and guaranteed the support of all the cooperating partners.

Also, speaking at the ceremony were the American Ambassador and the British High Commission accredited to Zambia, and the Representative of the World Bank. They all congratulated the government for launching the HIV/AIDS/STD/TB Council and Secretariat, and acknowledged that this will break the silence on AIDS. They pledged the support of their respective governments and organizations to the Council and Secretariat and to the Government of the Republic of Zambia.

"State Launches AIDS Council."
Times of Zambia, March 16, 2000

Government has established the HIV/AIDS/STD/TB Council and Secretariat which would be the highest national authority to co-ordinate Zambia's efforts to tackle the diseases. Meanwhile, the World Bank and Zambia's co-operating partners have welcomed the establishment of the council and secretariat and pledged assistance to ensure the objectives were achieved.

Information Minister who is Chief Government Spokesman, Newstead Zimba, yesterday launched the project at Pamodzi Hotel in Lusaka. Health Minister David Mpamba, Health Permanent Secretary Kashiwa Bulaya, Science and Technology Permanent Secretary Josephine Mapoma, diplomats and UN agencies representatives attended the ceremony. Mr Zimba said Cabinet had approved the establishment of the council and the secretariat after lengthy and extensive consultations.

"The overall goal of the council and secretariat is to provide national leadership, co-ordination, policy guidance and resource mobilisation for a more effective national response to the HIV/AIDS epidemic in Zambia," Mr Zimba said. Although the new body would be the highest national authority to co-ordinate the national response to HIV/AIDS/STD/TB, it would enjoy autonomy with the supervision of a council of ministers. The secretariat would provide technical guidance and implement council decisions arising from the council's mandate.

The body will comprise a committee of ministers to supervise all HIV/AIDS programmes and monitor the work of the council and secretariat. The minister of Health would be empowered to appoint 15 council members on a two year contract renewable on account of performance. A committee of senior Government officials from the Health, Community Development, Labour, Finance, Science and Technology, Youth and Sports had been appointed to liaise with the Zambia National AIDS Network in overseeing an orderly transition to the new council.

The ministerial supervisory committee for the council and secretariat would be Mr Zimba, Mr Mpamba, ministers of Education Godfrey Miyanda, Transport Nkandu Luo and Presidential Affairs Eric Silwamba. The growing number of orphans currently estimated at 600,000 was expected to soar to one million by 2002 as HIV/AIDS continue to overwhelm the health care delivery system.

"This had led to financial pressure on the national treasury due to high cost of drugs. Health expenditure on HIV/AIDS will increase from the estimated $3.4 million in 1989 to $18.3 million in 2004," Mr Zimba said. Mr Mpamba pledged his ministry's commitment to ensure the success of the council and secretariat. US ambassador David Dunn, British high commissioner Thomas Young, UNICEF representative Peter McDermott and World Bank representative Laurence Clark all hailed Government for making what they described as an important step in the fight against HIV.

"Zimba Bemoans Effect of HIV/AIDS in Zambia." By Brighton Phiri and Douglas Hampande
The Post, March 17, 2000

The rapid spread of HIV/AIDS has devastated the country s development gained in the last 30 years, information minister Newstead Zimba observed yesterday. Launching the HIV/AIDS, TB, STDs Council and Secretariat at Lusaka s Pamodzi Hotel, Zimba urged Zambians to avoid lifestyles which were contributing to the spread of the HIV/AIDS.

The most affected is the active age group, thereby causing the loss of continued productivity, Zimba said. He cited increased number of orphans and high medical expenses as some of the burdens caused by AIDS, which his government was facing. According to Zimba, Zambia had spent US $ 3. 5 million on medical drugs for HIV/AIDS related illnesses in 1989 and the figure was expected to increase to US $ 18. 3 million by the year 2002.

Zimba said the HIV/AIDS prevalence in the country was between 25 and 30 per cent in urban areas as compared to 15 and 20 per cent in the rural areas. Zimba said the council and the secretariat would advocate for multi-sectoral approach towards the fight of the disease. He said the council shall consist of 15 members who would be appointed by a committee of ministers of health, community development and social services, labour, finance, science and technology, sports and child development and education.

United States Ambassador to Zambia David Dunn asked the government to establish an AIDS policy which would supplement the existing efforts. Now that you have established the council, we are looking forward to the formulation of an AIDS policy by the health ministry, Ambassador Dunn said. British High Commissioner to Zambia Thomas Young said AIDS had claimed more lives than the war conflicts in the past decade. World Bank country representative Lawrence Clark saluted the Zambian government for launching what he termed a fundamental step towards the fight against HIV/AIDS.

"New AIDS Group Restores Hope to Lusaka." By Dave Chibesa
Times of Zambia, March 16, 2000

At the dawn of the millennium, millions still face the prospect of annihilation by the dreaded AIDS virus. Being the most beaten issue of the day, many are inclined to take the danger for granted, but the scourge persists. On international fora the topic, however, has taken a paradigm shift from a leverage of hopelessness to one victims can live with for life.

In the developing world, modern drugs are making it possible for boosted life spans but at a cost third world patients can barely afford. For instance, a typical dosage may cost K1.3 million per course monthly. "The price for HIV medication is very high because not many in developing countries can afford such medicine," bluntly declares Tinta Chona national coordinator of Hope Worldwide (Zambia) behind a new strategy proving effective in the least developed countries which revolves round the introduction of support groups in selected communities.

This entails the dissemination of information on the prevention of HIV by distributing pamphlets and condoms on a weekly basis including the provision of home-based care. In Lusaka, a community prevention project has been set up in Chainda where counselling is effected to rid patients of stress as well as provide them with clothing and other needs.

The model is based on the Soweto Hope model which has proved effective in South Africa. This model has been developed to provide community-based care and support in resource limited settings. It is sustainable and mobilises community resources through volunteers to provide low cost, high impact multi-level support.

Hope Worldwide is a non-profit charity whose headquarters is in Philadelphia, US. As the name implies, the organisation strives to bring hope to the world's poor plagued by the dreaded virus. Rather than let people bury their heads in the sand, the global concern which began work in 1991 with about three simple programmes now serves 75 countries worldwide. Hope Worldwide is determined to restore hope by educating, developing, training and serving through disease control programmes.

The group has set out to help Lusaka residents with community-based support and prevention by building partnerships to meet needs of thousands infected and affected by AIDS. According to Hope Worldwide, 22,000,000 Africans are infected with the AIDS virus and need attention. At the moment, the group runs 16 programmes in 12 African countries and intends to expand partnerships which are essential to this development. As part of the local lobby plan, the organisation would like to get to various companies to help sustain volunteers groups to a point where some buildings such as servants' quarters would be converted into offices and counselling points.

"We're looking at the bulk of volunteer groups to help patients gradually," explained Mr Chona. Volunteer groups can also be used as a data collection resource base as has become apparent in the Chainda pilot project where it had been discovered that tuberculosis patients were the closest to HIV manifestation. "On talking to these patients, one major problem which surfaced was medication," Mr Chona pointed out.

This is a radical difference from the situation obtaining in the developed world where film stars and sports legends are able to contain the virus for a very long time unlike Africa where millions are destined to die as the millennium unfolds. It was thus important for the populace at large to realise that HIV does not initially kill but fully blown AIDS does. To this effect, many people may not bother to go for HIV tests to ascertain their health positions but this turns out to be a serious oversight.

One major advantage of having these tests is that patients know right from the start that they need a special diet and appropriate medication. In the light of this development, it is vital to draw up a community-based plan that would work in a situation of scarce resources. For example, in South Africa, Hope Worldwide receives no operational funding but is entirely funded by local grants. These are received from corporations, the health department, churches, international aid agencies and individuals.

Zambia has yet to utilise her vast potential in sourcing corporate help and channeling it to the under class communities. In doing this, companies would be taking a load off the shoulders of the hard pressed Government institutions that will not cope with the magnitude of the problem given limited logistics. The plague may appear inconsequential to healthy persons unaware of how AIDS develops but one day when they become very sick and are unable to walk, realisation then sets in. It should not get to a stage where victims have to contend with the effects of negligence. Prevention is better than cure is a decade's old saying so fitting in the circumstances.

Thus the hapless patients in Kanyama, Chainda, Kabanana, Chazanga, Chawama, Misisi and a myriad of residential settlements countrywide would benefit from a workable plan that brings hope rather than despair and suffering. It is worse for those in rural areas where natural obstacles to travel and access to medication including information seems a remote possibility. In current times, the concept surrounding HIV/AIDS development appears to have shifted focus from despair to hope for longevity and thus needs apt response such as the one provided by Hope Worldwide.

"Norway Pledges to Continue Fight HIV/AIDS."
Times of Zambia, March 10, 2000

The Norwegian government has pledged to continue working with the Zambian Government in its effort to fight the HIV/AIDS pandemic which it says needs immediate attention.

At the signing ceremony of K1.9 billion support programme contract for the year 2000 between the Norwegian government and Society for Family Health (SFH) in Lusaka yesterday, Norwegian ambassador to Zambia John Lomoy said Norway was not going to sit back and ignore the presence of the deadly disease in Zambia looking at the fact that the friendship between Zambia and Norway had come a long way.

He said the Zambian Government should provide political leadership in the struggle against AIDS and must create the overall framework that other partners should work within. "Under a strong Government leadership we want a vibrant partnership involving Zambian non governmental organisations, international non governmental organisations and the private sector including partners like us who are ready to continue with the fight," said Mr Lomoy.

He said the fight for the disease needs a lot of resources and that the Norwegian government recognised the need to assist society for family health which he described as a priority organisation for his government to support. And SFH executive director Elizabeth Mataka said Norway had been a major partner to her society and that it had been largely responsible for the development of the association and that the credit will always be given to Norway for all the success the organisation had scored.

"Incorporate AIDS Subject In Schools Curriculum."
Times of Zambia, March 9, 2000

Lusaka - An HIV/AIDS specialist has suggested that pupils progressing to the university should be those that would have passed in a subject related to the deadly pandemic. Joint United Nations AIDS Programme (UNAIDS) country representative Kenneth Ofosu Barku said this would be one way to enhance AIDS awareness in Zambia.

He said HIV should be the major priority in the curriculum if the nation is to work out effective measures to fight the disease. At a workshop to integrate AIDS in school curriculum organised by Unesco in Lusaka yesterday, Dr Barku said there was need to effect full security in the education sector if the nation was to get rid of the disease.

"HIV/AIDS is the major problem which has led to all the development problems because people could not get the formal education in the first place regarding the disease," he said. And Education Minister Godfrey Miyanda said people should not waste time arguing about the origin of the disease or the figures of infected people but should concentrate on finding a lasting solution to the problem.

"AIDS has come as a challenge and my ministry has an obligation to make sure that the old and the young alike, are given the formal education on the subject," "I would like to see a situation where the education system will involve AIDS related subjects from the start up to the university level," he said. Brigadier General Miyanda said education played an important role such that tackling the AIDS problem through education was the immediate answer which the Government would have to undertake. He said his ministry would soon introduce subjects in schools to which teachers would ensure the curriculum was implemented.

"AIDS Ravages the Work Place." By Mildred Mpundu
Times of Zambia, February 28, 2000

Millions of Kwacha meant to improve workers' skills and welfare are going to waste because of the sweeping impact of HIV/AIDS on various Government departments and private companies. This is hard-earned money going down the drain. The rate at which employees are dying is bewildering Ñ a trend worrying many employers. Organisations are at a loss. How do they help cut down the rate of infection in the workforce? Man hours valued in millions of Kwacha are channelled to employee's health care costs, funeral expenses, death benefits, recruitment, training and replacement of employees.

This scenario has resulted in firms loosing experienced labour force and recording lowproductivity levels. A study by the Ministry of Health says over 40,000 hours were lost at one firm in 1995 alone due to sickness and funerals. The number increased as the AIDS epidemic took its toll. Government which is the country's largest employer has not been spared by the dreaded scourge.

It is in this light that the United Nations Development Programme (UNDP) has gone flat out to support people living with HIV/AIDS to work as volunteers in strategic points including Government ministries. One such UN volunteer (UNV) placement in the Sport, Youth and Child Development Ministry is Augustine Chela. Chela, based at the department of child affairs is there to:

• Provide peer education to the ministry's members of staff;
• To work as part of an outreach team to give HIV/AIDS a human face;
• To advocate the needs and concerns of people living with AIDS into programmes beingplanned by the ministry.
• To participate in HIV-related training and meetings and
• To do any assignments assigned by the ministry.

The aim of Chela's placement like other volunteers is to "promote a deeper understanding of the nature of the HIV epidemic and strengthen national capacity to respond effectively through the involvement of people affected by the epidemic." Chela works with Chola Kangwa, a focal point person on HIV/AIDS and gender who is also a senior planner in the ministry. He has had a two-month orientation with the ministry's departments in Lusaka and other provinces. So far he has provided counselling to trainees, employees and even relatives of employees. He has also helped establish support groups in various communities especially among the youth. Chela is also a resource person in soliciting funds for the support groups. Youths, he observed, have skills but lack funds to build on what they want to do. He provides peer education to HIV positive and negative persons.

The Workplace Employee's Educational Programme (Weep) is one of Chela's initiatives in the ministry whose aim is to help "normalise" the disease in the workplace. It also aims at identifying and strengthening the ministry's staff to break the conspiracy of silence and create an effective response to the HIV/AIDS epidemic. "The environment in the workplace represents an opportunity for educational initiatives, making employee education and training programmes an effective means of countering widely held myths surrounding HIV/AIDS. This also helps reduce the transmission of HIV, by nurturing an informed workforce," says Chela in his two-month Weep work-plan.

Weep implemented this January will be conducted weekly where an extensive HIV/AIDS awareness campaign progress through sharing information and Chela's own personal experience as a person living with HIV. The programme to be implemented in two phases will target senior management officials at workshops or seminars. Senior staff will be educated on how to deal with HIV/AIDS issues in the workplace. The programme will ensure that they have the necessary tools, time and support to endorse the programme with their staff and answer questions that may arise.

Weep will work closely with employers in monitoring employee responses to any programme that will be introduced to ensure that it is appropriate for a particular workforce. Employers would be required to devote sufficient funding to the programme to reinforce messages at a frequency that maintains behaviour change. After the first phase, middle management and general members of staff will be involved. Members of staff that will be trained in HIV/AIDS will have to offer emotional support to other staff "going through trying moments." They will also enlighten fellow employees about the advantage of attending HIV/AIDS educational programmes using personal experience, participate in outreach activities in other ministries which do not have similar programmes. Members of staff will also be expected to provide a conducive workplace environment for sharing experiences and feelings without fear of being stigmatised or discriminated against.

Chela says the advantage and effectiveness of employee-led education programmes is that they go beyond the workplace like employee's families and their friends. The programme will also enable members of staff to be introduced to the concept of voluntary counselling and testing. Workshops for coaches or sports trainers to equip them with psycho-social counselling skills to help them cope with their players problems will also be organised. "Most of the active sportsmen and women are vulnerable people and have multiple problems in their daily lives.

To sustain the programme after the services of the UNV, sports associations will be made to pay participation fees in order to learn psycho-social skills. Chela says the overall objective of a work-plan for the sports department is to create a forum of sports associations responding to their need in HIV/AIDS mitigation. The associations will be encouraged to form a network of sports association against HIV/AIDS whose objectives will be to equip sportsmen and women with the needed facts on HIV/AIDS and train these role models into outreach peer educators of outreach programmes in the sport community. The programme is also aimed at empowering aging sportsmen and women by teaching them survival skills like income-generating activities after retirement. The network is meant to create a revolving fund to assist players in times of need, like quality medical facilities through required medical schemes which many players cannot afford or access.

Chela, a former Zanaco player has also targeted sports activities for orphans and vulnerable children, especially street kids. Using his football playing and coaching experience to heal the pain that the children go through, he says, "I would like to initiate a football coaching project with the orphans and vulnerable children in Mtendere at Mapode and other drop-in-centres like Kamwala's Fountain of Hope." The aim is to train the children into responsible citizens through sport and also teach them survival skills and coping mechanisms to protect them from the HIV/AIDS epidemic ravaging the Zambian society. Chela intends to establish a youth friendly drop-in-centre to cater for the interests of the youth in collaboration with Kara Counselling and the Commonwealth Youth Programme of which he is a member. The idea is to involve and encourage youths to be active partners, rather than passive recipients of programmes designed and run by adults.

The UNV project strategy is to ensure the representation of PLWHA (both infected and affected by the epidemic) in institutions and organisations active in HIV and AIDS by engaging them as volunteers in their own countries. UN volunteers have played a vital role in providing emotional support to those infected and affected by AIDS. This time, employees will no longer plead ignorance. They know, they have heard and have been affected by an HIV death in the home or neighbourhood. There is hope that HIV/AIDS deaths will reduce and hence increase productivity - for the good of the nation.

"We Take an HIV Test, Honey?" By Mumba Mafwenko
Times of Zambia, February 16, 2000

What would you do if you discovered your spouse-to-be is HIV positive, weeks before the wedding? Considering how advanced the wedding preparations have gone, would you still tie the matrimonial knot or would you back off completely?

This is a dilemma faced by many young couples these days as the HIV/AIDS scourge reaches alarming levels. Is this a decision you would make two weeks before your wedding? Would you be in a state to weigh the pros and cons. The question of whether people planning to marry should consider testing for HIV/AIDS is a very touchy one. With stacks of kitchen party presents, wedding dresses and suits already prepared, can a woman forget about marital bliss when told her betrothed is HIV positive? Or a man gives up on his mesmerising wife-to-be on account of an HIV test?

To many the issue of going for an HIV test poses no problem. The tricky part arises when the test results are out and one of the two is HIV positive! What would be the wisest thing to do in such a situation? For starters AIDS is one subject which has been talked about so much while the public is bombarded by many AIDS awareness campaigns on television, radio and newspapers.

The Seventh Day Adventist Church in 1996 raised controversy after conference participants encouraged couples about to marry to undergo HIV tests. The church counsels the couple, but if one is positive and they want to marry the church does not stand in their way. Pastor Kasaji said, "while it's not mandatory that couples should go for the test, we recommend to couples that it's wise to go for the test so as not to get into trouble." He said the church did not impose testing on couples but wanted to ensure that couples are aware of what they are getting themselves into in a bid to protect as well as prevent the spread ofthe disease.

Ndola's Bethel City Church International also supports HIV testing for would-be couples. There are demands that couples should submit AIDS free certificates before marrying to curb the spread of the deadly disease. Pastor Robert Bwalya said some marriages he had presided over had been shattered because couples had manifested full-blown AIDS. "I've witnessed a number of deaths of members shortly after marrying them and as a church we can't just let the situation go on."

But the Permanent Human Rights Commission in Lusaka received with reservations, the call by the church. Judge Lombe Chibesakunda, the PHRC chairperson said the requirement of producing AIDS free certificates by people intending to marry within the church seemed reasonable on the outlook but advised further review of the issue. She said the idea needed further clarification because some aspects, if not well articulated, could easily violate an individual's right of choice, association, privacy and right to marry.

"The practice amounts to discrimination of those with HIV/AIDS," said Justice Chibesakunda. The commission would like to receive more details on the guidelines from the church officials to take a firm position on the issue. There was no law in Zambia which said people intending to marry should undergo an HIV test. There are people who have said that the question of human rights should be ruled out in case of AIDS because there was no turning back and the situation could not be reversed, once one tested positive.

Tony Phiri says, "If I found out that my fiancee is HIV positive I would still go ahead and marry her, because all along I've been proclaiming my love for her and I will just be proving it." He says if a person is positive it did not mean that the person will die there and then. For some it could even take 10 to 15 years especially if they are living positively. Another said he would go ahead with the marriage as long they agreed on not having children because the virus could be passed on to the child and decide to use condoms throughout married life. "If your partner has been your friend and you love them genuinely you can't possibly disappoint them in time of trouble," one Lusaka man said. Another one said, "If your partner was involved in an accident and became disabled as a result, you would still marry them. So why should it be any different when it comes to AIDS?"

Others do not agree. "This is putting your life at risk. And it's not helping the situation at all, if anything you are contributing to the spread of the disease," one woman said. She believes there is a certain stage when you would not tolerate the sickness of a partner. "There's a stage when your partner is sick, on and off. There's no way you can be married for five to 10 years and use condoms all that time!"

Another man observed "Going ahead with such an arrangement is like digging your grave, it's different if you go into a marriage without knowing her HIV status but when you do, it's suicidal."

One may argue that the marriage should go ahead and safe sex should be practised although condoms are not 100 per cent safe. Faced with such a dilemma, one has to look beyond the plush wedding day and consider the burden on the extended family, should one fall sick. Of course a couple could be pressured into marrying with a positive HIV result hanging over their heads. And what about people who indulge in sex before marriage, do they give up when they discover they are HIV positive?

Kara counselling offers free counselling to people and HIV tests at K500 to Zambians and K5,000 to non-Zambians. Hope House programmes manager Stanley Chama said: "We get about 500 to 600 people per month testing for HIV throughout our five centres." Mr Chama said demands for HIV testing have risen because more and more people want to know their status before having children or getting married. Kara offers pre-test counselling which includes basic facts about HIV to prepare couples should they have different results. Couples are left with the final decision. If positive, they are helped to make appropriate decisions and face consequences of such a marriage.

AIDS is spreading like wild fire and it is real. Whichever way one looks at it, taking an AIDS test could just be the wisest step a would-be husband or wife ever take, in the age we are living in.

"Church Takes Bold Stand on HIV/AIDS." By Mildred Mpundu
Times of Zambia, February 16, 2000

Finally, the Church is taking an open and bold stand on the issue of HIV/AIDS. AIDS has reared its ugly head everywhere...in homes, work places, communities and churches.

In the past there were snide remarks, cruelty, bitterness and intolerance towards people living with HIV/AIDS, says pastor Alex Phiri of the Gospel Outreach Centre Ministries. A recent debate on "The role of religion/church in the fight against HIV/AIDS" organised by the Network for Zambian People Living with HIV/AIDS (NZP+) in Lusaka recently, pastor Phiri said people have had to leave the church because it was judgmental about people with AIDS.

Initially the church was apprehensive and scornful about HIV/AIDS. Anyone with HIV/AIDS was seen as having disobeyed God's commandments. Over the years since the discovery of the first AIDS case questions have arisen as to whether HIV/AIDS is a curse from God or God's wrath on the people for their misconduct or disobedience to His law. The question still remains unanswered: "Is AIDS, God's punishment on man for being promiscuous?"

In the mid 1980s people were given medical advice that AIDS was spread through anal sex, and that if one was heterosexual they could not get HIV/AIDS. Today, it is well known that people can be innocently infected at birth, through cuts and syringes, blood transfusion or through sexual intercourse with a promiscuous infected partner. Another question the church is asking is whether God can be so unfair as to punish small babies infected by their mothers at birth.

Reverend Reuben Mwape of Hope for Africa Centre that brings inter-denominational Christian leaders from different African countries together to fight AIDS argued that AIDS is in the church and as long as church ministers remain "holier than thou" and do not discuss AIDS, the problem will persist. "As long as Zambia remains a Christian nation, and as believers living in a world of AIDS we can't continue pretending all is well." "By pretending we shall be held accountable to God. There've been many sex scandals involving church ministers, but people still want to pretend that AIDS is not there," said Rev. Mwape. He argued that AIDS was mostly transmitted through sex and if sex was "God's idea who are you to pretend AIDS is not there and not talk about sex." He said it was time to discard what he termed "too holy" attitudes and support others.

However, church ministers now admit they are beginning to get involved in the fight against HIV/AIDS. Pastor Phiri said that Go-Centre has an AIDS wing within the church where they talk about AIDS, invite Kara counselling experts for AIDS talks and train counsellors. He said the mandate of the church in the fight against HIV/AIDS is to first get educated and understand that AIDS is not a result of God's judgment. Even in the church the past resurfaces. There are all kinds of possibilities of Christians being HIV positive or living with AIDS. People who look healthy could be living with HIV and die fast because they are not open about their situation. Openness must be encouraged as this brings a release. After all "a problem shared is a problem almost solved."

It's time the church laid itself bare and invite speakers regularly to talk about AIDS in churches. The church, pastor Phiri said had realised the need to help, especially people caring for those living with HIV/AIDS. Christians should stop shunning those that have AIDS or refuse to shake hands with them because they fear to contract the disease. It should be realised that people living with HIV/AIDS are human beings like anyone else. They should not labelled as promiscuous. An HIV person's life can be restored. The church is guilty of stigmatising attitudes because of being uneducated and ignorant. There is need to maintain friendship among brethren whether one is positive or negative.

Hope for Africa which is made up of different church organisations is also involved in training church ministers in HIV/AIDS issues. The ministers come together with a view to see what they could do for Africa in the fight against the scourge. "If we love our brothers we need to share something with them. They may be lacking love from the church or community which may result in them losing the will to live due to lack of support." From the Christian point of view, the importance of conventional medicine, but Jesus Christ is the answer. To quote pastor Phiri, "God is a God of second chance. One can start again. God's love is greater than his wrath. His mercy triumphs over his anger." Contrary to the Christian view, Adam Phiri from the Islamic community believes AIDS is not the problem. He said it was widely believed that the role of the church was to take care of the sick and pray for the dying. "Is this the role - to wait for people to die. Does the church have to wait for parents to die to look after orphans?" Phiri said. He believes the worst is yet to come as more and more people get infected and die, adding to the growing number of orphans.

The church needs to reconsider its role in dealing with root causes of the HIV/AIDS orphan problem rather than the end result. "If we have to fight AIDS, we must fight the root causes such as illicit sex, prostitution, alcohol consumption, homosexuality and lesbianism." The church was doing nothing in the fight against HIV/AIDS. He said it was important to know how something does not work if one has to know how it works. Policy makers, he advised, should play a role in church if AIDS is to be conquered.

The role of church leaders and those in decision-making, he said, is to also lobby government support. The church should look at the consumption rate of alcohol and fight the short time rest houses that have sprung up in the city. It was easier to get one packet of Shake Shake (Local beer) than to get a glass of water in Zambia, and added that it was easier to get sex than a bag of mealie meal, he added. Phiri observes that people living with HIV/AIDS were not getting support from churches. He has never heard of pastors or church leaders who have openly talked about their HIV status.

Participants noted the following:

• Need to break the silence on HIV/AIDS issues
• Training of church ministers
• Need for restoration of people living with HIV/AIDS
• Need for counselling on HIV/AIDS in the church
• Support for those living withe HIV/AIDS
• Need for the church to do beyond what they are doing and are not doing.
• Need to look at the causes in order to fight the scourge
• Need for the church to seriously lobby government support
• Need for the church to deal seriously with members lives

Churches should not just be involved in spiritual support but also be involved in medical care and see where the community's pain is. It was unanimously felt that the church should reconsider its stand on HIV/AIDS and get involved fully in the fight. The role of the church is crucial. Until it bravely takes up the challenge, the fight against HIV/AIDS will remain a nightmare congregations will continue whispering about from the pew. Time to talk is long gone. It's time to act.

"Double Speak on Reproductive Health Triumph of Politics Over Science?" By Mildred Mpundu
ID21 online research service, February 14, 2000

Coping with the AIDS pandemic calls for a unified strategic response from health managers and policy makers. A central tenet of the International Conference on Population and Development was that reproductive health services (family planning, maternal health and sexually transmitted disease prevention) should henceforth be integrated. This approach was expected to improve efficiency and provide better all-round care for women. The Mwanza trial results in 1995 seemed to fit well withthis approach and were absorbed by global policy agendas despite the lack of empirical evidence that it was feasible or effective to integrate previously separate services such as family planning and STDs. Integration became the lynchpin of reform. But did politics rather than science motivate this policy shift?

Politics and science played a role in promoting integrated reproductive health to the fore of the international agenda. The 1994 International Conference on Population and Development advocated a radical shift towards holistic care for women in response to strong political pressure from women's groups. The following year, the Mwanza trial results provided dramatic evidence that offering STD treatment within primary health care, instead of separately, could help prevent the spread of AIDS. Internationally, the promotion of 'integrated reproductive health' followed, with donors eager to support such policies in low income countries. Little is known, however, about whether or not this approach can be translated into practice, especially where STD/HIV services have traditionally been provided separately.

Examining practicalities in Ghana, Kenya and Zambia, researchers asked how donors and governments interact. Findings suggest there are three major challenges to a successfully-integrated reproductive health service. Health service delivery is split down international agenda lines for family planning, maternal health care, STDs and HIV. Financial and administrative arrangements are often separate and supported separately by government and donors. USAID and UNFPA, for example, support family planning in Ghana, while UNICEF backs Safe Motherhood in Ghana and Zambia.

Despite their international rhetoric, donor insistence on programme accountability and rapid attainment of measurable results further encourages separate management. Even at local levels donors shy away from partnership with government, preferring to separate priority activities from the mainstream. For example, in Ghana and Zambia, USAID and UNFPA support delivery of contraceptives through their own supply systems. Likewise, the World Bank in Kenya created a separate tier of HIV/STD officers in district administrations to ensure programme success.

A very real fear exists that political and economic instability undermine the accountability sought by donors. Donors thus opt for small, self-contained projects that governments need hold no stake in. A UNICEF project saw a drop in syphilis among pregnant women in Zambia but because procurement of drugs and test-kits was undertaken by UNICEF, activities could not be sustained or scaled up once its funding ceased.
The politics of the women's movement played a lesser role at a national level in determining policy outcome than it did internationally. Rather, a different set of national politics, including health management systems and the relationships between governments and donors, hindered integration. Despite strong scientific evidence for integration little progress was made. More careful analysis of how research findings are fed into policy is thus essential. The rapid shift in the international health agenda combined with the challenges of political and economic instability make early appraisal difficult.

Contributor(s): Susannah Mayhew and Lousiana Lush

Source(s):
Integrating reproductive health: myth and ideology. L. Lush, et al
Bulletin of the World Health Organisation, 1999: 77(9) 771-777 l
Prevention first: a three-pronged strategy to integrate family planning program efforts against HIV and sexuallytransmitted infections. Shelton, JD
International Family Planning Perspectives, 1999: 25(3) 147-152

Further information:
Susannah Mayhew
International Division, Nuffield Institute for Health
University of Leeds, 71-75 Clarendon Road
Leeds, LS2 9PL,
UK Tel: +44 (0)113 233 6358 or 6956
Fax: +44 (0)113 233 6997
Email: S. H. Mayhew

Louisiana Lush
London School of Hygiene and Tropical Medicine
Keppel Street
London, WC1E 7HT, UK
Tel: +44 (0)171 299 4671
Fax: +44 (0)171 436 4230
Email: L. Lush

ID21 Research Highlights are part of the ID21 online research service, showcasing the latest in development research from UK sources.
Email: ID 21
URL: ID 21

"Go Rural, NGOs Prodded."
Times of Zambia, February 17, 2000

Government has challenged the non-governmental organisation (NGOs) in Zambia to expand their activities in home based care to rural areas as people in these setting are equally affected by the HIV pandemic. Health Minister, David Mpamba (above) in Lusaka yesterday noted that people infected with HIV are taken care of in their rural homes by only relatives hence the need to reach out to them.

Mr Mpamba said that rural people needed expert support so that they could adequately cope with the demands of the HIV/AIDS pandemic. The minister was speaking when he opened the Zambia Red Cross Society (ZRCS) HIV/AIDS workshop at hotel Inter-continental. "I am confident that ZRCS can expand such services to these rural places and other areas that have high incidence rates of infections," he said. He said that HIV/AIDS situation was threatening in the region as it was decimating the active age group who were required for economic growth in the countries.

Mr Mpamba quoting the United Nations joint programme on the HIV/AIDS in the sub-Saharan Africa, said that one tenth on the worlds population was home to two thirds of the world's HIV positive population. He said that since Africa had 10 per cent of the world's resources, HIV/AIDS was a disaster and called for emergency action to fight the pandemic in the sub-Sahara Africa region.

The minister said Government has developed a five-year HIV/AIDS strategic plan for the period 2000-2004, which was aimed at prevention of further transmission of HIV and reduction of its social economic impact. The plan, Mr Mpamba said, would be implemented in partnership with the private sector communities and concerned NGOs such as Zambia Red Cross Society. He further commended ZRCS for the support it was giving to the vulnerable people in the country and giving basic support to thousands of refugees.

And speaking at the same function ZRCS programme coordinator Abraham Eddo said the levels of the disease in the region was worrying as effects had a direct bearing on the already weak economies. Mr Eddo however, said through concerted efforts and identifying priorities the organisation would maintain and maximise the complementary role to fight the spread of the deadly HIV/AIDS. He said the participants should not concentrate on academic and research to fight the virus but should reach out to the grassroots to increase awareness campaign.

Meanwhile, Unicef has counselled Government to form an institutional mechanism for the coordination and management of HIV/AIDS and STD programme. Unicef country representative Peter McDermott yesterday said the international community and donor community were ready to assist the Government of Zambia in its fight against HIV/AIDS and the efforts being made especially the strengthening of adolescent reproductive health programmes. "The single action that Government should undertake immediately which would have a dramatic impact on both HIV/AIDS and the reproductive health of adolescents in Zambia is to put in place a necessary institution mechanism for the coordination and management of the epidermic," he said.

He was speaking during a sub region group consultative meeting on adolescent reproductive health organised by Africare at Mulungushi International Conference Centre in Lusaka. The meeting was attended by Deputy Minister of Youth, Sport and Child Development Christopher Chawinga and several NGOs and community based organisations.

"US Government to Increase HIV/AIDS Funding World-wide" By Cheryl Mumbati
The Post, February 15, 2000

The United States government will next year increase its world-wide funding for combating the dreaded HIV/AIDS by US$100 million, Vice-President Al Gore announced recently. According to an American Embassy publication in Lusaka The Washington Line, Gore said the money would be used to reduce mother to child transmission as well as the stigma that accompanies the acquisition of the pandemic.

Last year s US world-wide funding stood at US $225 million. It will also support care for AIDS victims and children orphaned by the disease and build health infrastructure, he said. Gore said AIDS was now a security issue as evidenced by the talks held by the Security Council on the pandemic. The publication stated that during the January meeting the council held six open debates on some of Africa s most pressing problems, with one session having Gore presiding over it.

Other discussions centred on the Democratic Republic of Congo (DRC) conflict...

"98% of TB Patients in Zambia are HIV Positive." By Douglas Hampande "
The Post, February 15, 2000

According to a Danish Association for International Co-operation 1999 country programme review, urban areas are more affected by the TB problem which has been caused by a high HIV/AIDS rate. It adds that HIV/AIDS had not, however, spared the rural setting which had an 11-14 per cent range. This range, it states, was still higher than the 10 per cent HIV country prevalence levels recommended by the World Bank. It stated that the pandemic was affecting the nation s economy as it comprised the most active human resource base of the productive sector.

HIV prevalence is over 28 per cent in urban centres and 13.6 per cent in the countryside. The high rate of HIV infection in the urban areas is particularly important because of Zambia s large urban population, stated the review. An estimated 19.7 per cent of the entire adult population is currently infected with the HIV virus.

It stated that Lusaka and Copperbelt Provinces had the highest prevalence rates with one in every four adults in the 15-49 year old category being HIV infected. Quoting the Central Statistics Office (CSO), the review added that more than 1.5 million Zambians were estimated to die of HIV/AIDS by the next 15 years.

"Zambian Judge Advises Wives to Insist on Condoms."
Reuters, February 11, 2000

"" Zambian High Court judge Ireen Mundia has advised women to make their husbands wear condoms during sex if they suspect or know that he is having intercourse with other women. Mundia, who made her comments when presiding over a case in which a woman sued her husband for cruelty and denial of sex, said the man should honor his marital obligations but that the wife should also insist on protection during intercourse. An estimated 20 percent of Zambians between the ages of 19 and 49 have HIV or AIDS.

"Study on Zambia's High Maternal Deaths Concluded." By Lewis Mwanangombe
PANA, February 2, 2000

To curb high maternal deaths among teenage mothers, Zambia is planning to step up the ongoing campaign to reduce pregnancies among girls and young women. Health authorities say the country has one of the highest number of teenage mothers dying from maternal causes in sub-Saharan Africa. A recent study by the health ministry, with the help of the UN Population Fund and the University of Zambia, shows that about 24 percent of all Zambian women dying from maternal implications were attempting to have their first child.

To reverse the high maternal mortality rate, the Zambian Safe Motherhood Initiative has embarked on a programme to provide antenatal care, clean and safe delivery, integrated postnatal and family planning services. The programme has also identified the provision of essential obstetric care and management of complications of abortion as priorities.

Although the Zambian legal age for marriage is 18 years for women and 21 years for men, youths are widely known to engage in illicit sex long before they attain the stipulated age. A study conducted by the Zambian government in 1996 found that the median age at first sexual intercourse was around 16 years for both boys and girls. It discovered that 60 percent of Zambian girls were either pregnant or were already mothers by the age of 19. Reasons for Zambia's higher prevalence of youth sexuality than elsewhere in Africa included lack of traditional teaching.

Some respondents blamed youths for being 'naughty' while others cited pressure from peer groups or parents in economic difficulties pushing teenage girls to engage in commercial sex. While boys engaged in sex for pleasure, girls did so for money or exciting gifts. Some young women erroneously considered early sex as a very positive factor because "practice makes perfect."

However, the study found out that most communities now discourage early sexuality because of the prevalence of HIV/AIDS/STDs and unwanted pregnancies. Most young men and women recognised that early sex was not good because the girls were not yet physically mature enough for pregnancy and delivery. Pregnancy and delivery becomes difficult and risky among young girls because hey have weak bones and small birth canals.

According to the study, 18 percent of women in the reproductive age group of 12-50 die annually from maternal related complications. This high maternal death rate is only surpassed by Malawi at 24 percent and 19 percent in Namibia. Zimbabwe's maternal death is placed lower at 17 percent. The 1996 Zambia Demographic and Health Survey gives the figure of 649 maternal deaths per 100,000 live births. The current study found that there was a significant association between socio-economic factors and women dying from maternal causes. Women with no formal education were nearly twice at risk of dying from maternal causes than their colleagues with at least secondary education. The risk of dying from maternal complications was found to be going down with increased age of the woman.

On the basis of these findings, President Frederick Chiluba's government is now being asked to encourage girls to stay longer in schools as a strategy to increase age at first marriage and pregnancy. Maternal health campaigners are also pressing for increased reproductive health services to prevent the spread of sexually transmitted diseases, including the incurable HV/AIDS, as well as unwanted pregnancies. "These efforts must be complemented with family health education in schools. For those out-of-school youths, institutions must be identified that are suitable for reaching them," the study concludes.

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Last updated March 23, 2000

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