University of Zambia Medical Library

HIV/AIDS in Zambia: January -- February 1998

"SDK Searches for Partners."
Times of Zambia: February 26, 1998

SDK Essential Oils of Kitwe has intensified its search for business partners to take over the pharmaceutical development of its medical herbal balm whose properties tackle AIDS-related skin disorders. Project director Sid Kabaso said yesterday that his company was now looking for foreign partners to help it complete the project, in view of the slow response that had been received from local pharmaceutical industries. His company was pleased to have taken the project as far as it did but was now looking to others to take over because of the positive findings that had been made. The company had intensified the search for a foreign partner because of the massive finance involved in the project which his company had no capacity to meet.

He said so far the balm had been used on trial basis and had to be distributed to patients free of charge. This was not possible to continue because of the high cost involved in the production of the balm. However, the costs of producing the balm could go down considerably once the product was made in bulk and make it more affordable to the patients. The balm was used for the treatment of AIDS-related skin disorders but was not a cure for the deadly disease.

"Health Reforms Under Attack."
Times of Zambia: February 25, 1998

Government's health reforms came under heavy attack in Parliament yesterday with some backbenchers warning Minister Katele Kalumba that he would be remembered as the worst leader if he did not make amends. The backbenchers who described the reforms as a disaster also registered disappointment that Zambian medical doctors with AIDS cure were being snubbed.

Contributing to debate on estimates for the Health Ministry, Mangango MP Crispin Shumina (MMD) charged that the reforms had destroyed existing health institutions and people in his area were particularly incensed with a decision to downgrade mission hospitals. He was supported by members for Mwandi Monde Nangumbi (MMD) and Nalikwanda Walusiku Situmbeko (ZDC) who demanded that these mission hospitals be handed back to missionaries. Chimbamilonga MP Samuel Mukupa (MMD) said health personnel were disillusioned because their fate had not been properly explained and warned that the reforms would collapse once donor funding was withdrawn. Kantanshi MP Steven Chilombo (MMD) said mine doctors were also in a quandary and demanded that Government explains the reforms properly.

Itezhi-Tezhi MP Bates Namuyamba (MMD) directly attacked Dr Kalumba under whose leadership he said hospitals and heath centres had deteriorated. Mr Namuyamba wondered why there was a veil of secrecy in the distribution of drugs and other medical supplies while only one province was receiving preferential treatment. "Dr Kalumba should be warned that if he does not make amends, he will go down in history as the worst minister of health," he said.

He also criticised the ministry for snubbing Professor Lukwesa Mulenga manufacturer of the controversial AIDS drug, Hebiron Tisaniferon in preference to Western drugs. Kasempa MP Mr John Muasa (NP) said it was sad that instead of pharmaceutically testing the AIDS drug and furnishing the House with the result, Dr Kalumba was embroiled in a row with Prof Lukwesa. Chipili MP Ntondo Chindoloma (MMD) said Government was demoralising AIDS victims by insisting that there was no cure yet local practitioners were capable of producing a drug that could retard development of the AIDS virus. He said Government should encourage both herbalists and medical practitioners to submit their inventions at an AIDS conference later this year.

But Education Deputy Minister Bertram M'membe said Prof Mulenga had not followed procedure for registration of his herbal cocktail. Mr M'membe who is Malambo MP said unless his drug was tested for side-effects by the Pharmacy and Poisons Board and the World Health Organisation (WHO) his drug would not be accepted. Home Affairs Minister Dr Peter Machungwa said Government was committed to improving health services as evidenced by the K194bn allocated to the ministry.

Winding up debate, Dr Kalumba pleaded with members to support the reforms arguing all measures taken were in line with the MMD manifesto. He said admittedly there were lapses in drug distribution and apologised for the mess but emphasised that Government had the capacity to devise an equitable system.

Legal Affairs Minister Vincent Malambo defended lawyers in his ministry over the loss of the Zero-Option and the Black Mamba cases saying the outcome of the two matters did not reflect incompetence by State advocates. Mr Malambo said Government had some of the best lawyers but sometimes lost cases because they were simply unwinable on the basis of facts or improper investigations. During debate on the ministry of Legal Affairs, nominated member Christopher Chawinga said the loss of the Zero-Option and the Black Mamba cases was a dent on the competence of Government lawyers.

"Find AIDS work cash, says PERMSEC."
Times of Zambia: January 29, 1998

NORTH-Western Province Permanent Secretary, Ronald Mukuma has appealed to the provincial Zambia National AIDS Network (ZNAN) to consider sourcing more funds for HIV/AIDS awareness programmes in the province. In a speech read for him by assistant secretary Silva Funkuta at the official opening of a two-day ZNAN planning seminar for counsellors and care givers in Solwezi on Tuesday, Mr Mukuma noted that workshops and seminars have been held but no follow up of activities and logistical help had been given to enable trained personnel carry out the programmes effectively.

He said it was sad for such a vast province with diversity of different ethnic groups to fail so badly in such a serious programme. Mr Mukuma wondered why the home based care unit which was World Health Organisation (WHO) in early 1990, had died a natural death. Very little had been seen to be done by Government and non-governmental organisations in the province to try and control,prevent HIV/AIDS yet Government has spent a lot of money in buying coffins and paying funeral grants for AIDS victims. He said the most industrious, energetic and productive age group of the population of the province was being wiped out slowly by the deadly HIV/AIDS.

Solwezi district health board senior clinical officer, Derrick Nyirenda said the health department in the province was receiving far too little money for HIV/AIDS to enable it carry out HIV/AIDS activities. Mr Nyirenda also told the seminar that sexually transmitted disease (STD) cases were rising significantly in Solwezi, largely due to high influx of people from other provinces coming to trade mostly in cattle. Solwezi is ranked third in HIV/AIDS infection rating in the country and Mukinge AIDS prevention programme (MAPP)coordinator, Kingsley Kuwena attributed this to the increase in STD cases. Other contributing factors highlighted were poverty (people engaging in sex to earn a living), ignorance and women's lack of control on the use of condoms.

The seminar is organised by the Zambia National AIDS Network, North-Western Province branch.ÑZana.

"Happy, Healthy and Safe Book." Family Health Trust
Health-L: January 22, 1998

Do you have a successful model of a training-of-trainers ("training cascade") system? Family Health Trust, a Zambian NGO, has produced a book ("Happy, Healthy and Safe") of 50 participatory learning activities on sexual health, growing up, life-skills etc, designed to be used by young people (not adults) to lead participatory learning activities.

Pre-testing has shown that children as young as 10 can use the book to lead groups, after 5 days' training. However, some help is needed from adults in preparing the activities. 2 days' training for adults was adequate during pre-testing.

Family Health Trust hopes to disseminate the book to 600 Anti-AIDS Clubs throughout Zambia; at least 2 leaders (young people) from each club need to be trained, plus 1 adult (the club patron). Our problem: We do not have the resources to train all these clubs ourselves, so we want to set up a national system, whereby we will train a group of trainers (possibly in each of the 9 provinces) who will then train adult patrons and young leaders.

Has anyone done something similar, that does not cost too much money, does not take too much time and produces good quality training? Your experiences would be greatly appreciated, from the AIDS field or other fields.

P.S. There will also be a southern and eastern African edition, in collaboration with AHRTAG and SANASO.

Andrew Hobbs, Family Health Trust, Lusaka, Zambia
fht@zamnet.zm
Fax: 260 1 222834

"No Simple Solutions To Complex AIDS Issues." Yohane Kamanga
Times of Zambia: January 10, 1998

WHAT would you do when you discover that your partner is HIV? This seemingly hypothetical question was asked on the "AIDS in the city" family life sponsored programme. This writer, in his own naivety, offered the following answers:

• Go for an HIV test immediately and psychologically prepare the mind for the inevitable.
• Out of absolute necessity, seek AIDS counseling
• Introduce protected or safe sex with partner (s) and stop sharing instruments such as razor blades and toothbrush.
• Stop drinking (if possible)
• Eat enough food (if possible)
• If this has occurred in marriage, current relationship with partner, his/her attitude towards our relationship, has truthfully he/she has confessed when he/she thinks that he/she got infected will determine whether to seek divorce or not. Not his/her seropositivity.

The last anecdote to all the lies confessed above was: "The idea here to live with him/her should not be misinterpreted to condone promiscuity or indicate my partner's indispensability. Rather, it must be understood that I am ready to forgive and live with an HIV infected person". Not until after writing this anecdote did I realise that many of us are trapped in the condition that adopts simplistic attitudes and solutions to complex questions.

The answers given above which are similar to those given by the one who won the prize are far too simple to an intricate situation and question. Unfortunately, the anti-AIDS campaign is quite fraught with such simplistic solutions. Answering such an important life and death question is opting for credulous answers because it is tantamount to tackling a serious issues in isolation of factors that brought it about or are directly related to it.

Here, gender, marital status, religion and stereotyped attitudes must come into focus when seeking solutions to such a question. Let's get back to "AIDS in the city", stay there and see what happens. Suppose you are a man and you discover your wife is HIV positive, what question comes to you mind immediately? How and when did she get infected? If you decide- arbitrarily- that she contracted HIV before marriage, the most obvious solution will be good-bye. The same would be the case if you suspect infidelity. No potency of love potion would deter such course of action. This is because matters of life and death invoke a lot of variables and factors to the centre stage.

Society in general and family and friends in particular come into play. Then, there is your ego. Your mind spins as you consider insoluble questions. How will society look at you when it is known your wife is HIV positive and that you're not responsible for her state? How is the woman her self going to regard you if she knows she got infected from illicit sex? And the men who infected her?

Discordance:
These problems would become even more acute if and when by fluke of a chance the husband discovers, after the result that he is miraculously HIV negative. For sometime- especially before family and friends know about the discordance- he might habour notions of living with her. But more problems surface. Suppose he wants to sire HIV negative children! "Naturally" he will seek an HIV negative partner to bear his children. Then, why hang on to a perceived promiscuous woman? To nurse other men's' destruction trail? Many a man would probably find this an ideal situation to confess their belief that condoms are not safe enough. The fact that the husband is HIV negative is evidence enough that the woman was infected by other men.

Female promiscuity in Zambian traditional society is unpardonable. The Bembas in their usual wisdom about things they and do best say that a man's promiscuity does not break marriage. Translation: A woman's infidelity does break marriage.

During a survey in Lusaka, this attitude that it's "normal" or "natural" for men to have mistresses and it's unpardonable for women to engage in illicitly sex pervades almost the whole social strata. Unfortunately, there is now humorous appendage to it; it's "better" that when the virus decides to visit our home, it must be invited by the head of the house- not the tail, ear or shoes.

Sitting ducks:
For some very strange reasons, married women share this absurd notion. Eighty per cent of those interviewed felt it was more scandalous for wives to infect husbands with HIV than the reverse. They even admitted engaging in unprotected sex with their spouses even when they were double certain their men have illicit affairs.

During field work about three years ago, this writer met Dr. Hilda, a physician at the Kara counseling workshop. She is one of those who feel man -woman relationship is loaded in favour of man against women. "Men are quite strange," she said. "Even the most promiscuous will resist condom use at home," she continued. "The question they ask is 'Waona ciani?' (what have you seen?) or (what is happening?). "Women are forced to accept unprotected sex from them. Many because they don't have power to say no. Some because their attitude towards their relationship is different from that of men. Others because of genuine love and understanding," she concluded.

This kind of love and understanding turns a lot of our women folk into sitting ducks of male promiscuity. Very few men, if nay at all would accepts this position.

This brings us to the flipside of the question under discussion: What would most wives do if they discovered their spouse was HIV positive? There are so many options almost of all of which depend on a host of intervening variables. These are:

• Her own HIV status
• Her susceptibility to outside influence
• Her general exposure
• The economic strength and social status of the man
• Her own economic strength emotional, spiritual and material independence
• Available alternatives
• Her current state of health

If a female spouse discovered his husband was seropositive and she also confirms she is HIV positive the average woman would almost always maintain the marriage. Of course she would fuss or pretend too. However, this would depend on the current relationship's stability. But suppose she was negative and decides to live on with her HIV positive husband on condition that she be allowed to bear HIV free children with another man (if they cannot afford insemination) what would most men do? This is quite a hypothetical situation because, very few women would give an emphatic negative to such a proposition. To most men HIV or no such situation is unthinkable. It is a taboo. Yet, AIDS demands that we revisit some of the taboos.

Over my dead body:
The question under discussion is only one of the many complex problems brought about by the AIDS situation. A less hypothetical and more real life one is: What would you do if you discovered that you were HIV positive? Would you tell you partner?

The survey conducted in Lusaka revealed men had a lot of varied options. The deeply religious who know they are faithful to their spouses opted for unconditional divorce- without discussing the issue much. "What would be there to discuss? She already killed me," said one man. The more liberal said they would buy time- mostly because of uncertainty as to who invited the virus home. Only five percent mentioned couple counseling. Women were more hegy. "telling who? My husband? Am I crazy? So that he divorces me and sings about it! Over my dead body," said a 25 year old lady.

Brenda Makombe thought differently. "I would look for evidence in his own promiscuity behaviour as an opportunity to bring up the topic otherwise, I rather let the sleeping dog lie," she said. This attitude was echoed by another woman. "depending on how long we have been married, how much I understand my husband and to what extent I can predict his reaction and when I suspect I was infected, I would choose an ideal moment if he wanted to know about our HIV status", she said. She continued, " one has to handle such delicate situation with a lot of care. Any wrong signal, for example, that you want to test your spouse's awareness of your activities- past or present- will certainly lead to unavoidable disaster".

Another woman who refused to give her name sounded quite callous and discreet, "Look! Sometimes we marry because we are infected. So why the fuss. You must realize this is no scenario a woman can tackle by the horns. The consequences would be dire. This is one situation only time has solution to," she said and left.

Perhaps she was right. Perhaps she was wrong.

"Science & Health Bulletin: Information Package." Musengwa Kayaya
PANA Wire Service: January 8, 1998

Zambia has become the first African country to adopt a health package based upon the World Health Organization Regional Office for Africa's AFROPAC information service. The country has created an information package called ZAMPAC, which offers data on many common diseases, including tuberculosis, pneumonia, measles, tetanus, diphtheria, whooping cough, cholera, and poliomyelitis. The document contains information on the causes, symptoms, treatment, and prevention of these illnesses. ZAMPAC also discusses HIV and AIDS, which is said to account for some 30 percent of deaths among sexually active adults in Zambia. Find AIDS work cash, says permsec

"Alternative for married men who shun condoms." By Austin Kaluba
Times of Zambia: January 5, 1998

If there is one contraceptive shunned by men in marriage, it is the condom. Men dismiss the condom as a nuisance which reduces sexual enjoyment. And culturally many married African men think a wife is the last person they can use a condom on. While the campaign to conscientise people to use condoms has been extremely successful even among married men, many married men find using a condom for the prevention of pregnancy, even AIDS, in marriage to be cumbersome.

It is with this knowledge that the Family Planning Service Project a season ago launched a contraceptive called Prolact. This was launched after Safe Plan. This vaginal foaming tablet is ideal for mothers of breast-feeding babies under six months. Though the product has been on the market for some time the non-governmental organisation wants to popularise the product nationally.

The contraceptive has been on the market under the name Conceptrol. The project wants to enable women to use it at certain times when they have forgotten to take family planning pills. Prolact, unlike the condom, is widely favoured among married men "meeting" their wives who are still breast feeding. The contraceptive, which contains an active ingredient of Nonoxynol-9 (100 mg), can enable the couple to "meet " safely without fear of the woman getting pregnant. It offers considerable protection against unwanted pregnancies as compared to unprotected sexual intercourse. Though on its own Prolact is effective, its efficacy can be improved with the use of another barrier method like a condom or diaphragms.

The spermicide is packaged in a foil strip which is ripped and the pill inserted in the female organ. The couple has to wait for 10 minutes after insertion to ensure proper contraceptive protection. As Prolact dissolves it produces a foam and it is naturally formulated to lubricate the woman.

The Society for Family Health (SFH) Promotions and Education Coordinator Mpundu Mwanza says the wetness together with the vaginal secretions helps to lessen the chances of HIV infections. "But people should not be misled to believe that the contraceptive is a protection against HIV," she warns. The SFH Marketing Manager Chilufya Mwaba says the Ministry of Health has tried its best to market the contraceptive but is hampered by the lack of structures and ideal facilities. She says it is for this reason that the project has embarked on an ambitious programme entitled "operation REACH" which aims to market the products throughout the country. The programme is utilizing the large volunteer network of community health workers and traditional birth attendants who are attached to rural health centres to distribute the product.

Miss Mwaba says though at first there were a few problems in rural areas, the program was slowly bearing fruits the country. She says the response in urban areas is overwhelming. The manager says some Zambian women have wrong notions about contraceptives. Myths about contraceptives include beliefs that they cause side effects like infertility, obesity and other ailments. To erase these myths the project is conducting classes educating mothers about the advantages of contraceptives. Says Miss Mwanza: "With the knowledge that is being disseminated, a number of women are knowledgeable about contraceptives." She says there are many myths associated to contraception in Africa. Miss Mwanza says it is important for women to open up culturally since Zambia is a multi-cultural society.

The project is doing well in marketing contraceptives. She claims the project, which had planned to sell 100,000 cycles of Safe Plan pills per year, achieved the target in only seven months. "It is for this reason that we feel we can successfully market Prolact to all parts of the country," she says.

The launching of the product has been divided into five phases. It has already been launched in Lusaka and on the Copperbelt. The contraceptive was set to be launched in Southern, Central and other provinces last August. Like all contraceptives, Prolact has some side effects among women. These can include abdominal pains, chest pains,headaches, eye problems and swellings. However with proper consultation of a doctor this can be avoided. Problem may differ from woman to woman and has more to do with allergies to types of contraceptives. Thus it is important for a mother to find a contraceptive that suits her.

The SFH is funded by the USAID and in works collaboration with the National AIDS, STD and Leprosy Programme and the Family Planning Unit of the Ministry of Health. The programme's goal is to supply and create the demand for essential health products in Zambia. The Zambian population, currently at 9.2m is expected to grow to 9.7m this year. With contraceptives like Safe Plan and Prolact the numbers can be kept low. Even married men who shun using condoms in marriage now have an alternative to "meet" their wives "live".

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Last updated March 2, 1998

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