Op-ed By Kanni Wignaraja and Amaya Gillespie*
Zambia is one of the countries most affected by HIV and AIDS with 14.3% of the population estimated to be living with HIV. We are now approaching almost 30 years of trying to control HIV and AIDS: So what have we learned, and what are we doing differently?
In highly affected countries like those in this region, the risks are high, but it is very clear that women and girls are most affected. More women (16%) than men (12%) are living with HIV in Zambia and it is women of reproductive age (15 – 45) who are most at risk. Women also bear most of the burden of care for sick partners, relatives and sick children; In addition, approximately 690,000 children are left without one or both parents and it is largely women, including grandparents, who take care of them.
HIV/AIDS threatens to reverse the economic and social gains achieved so far. It has the potential to destabilize a peaceful society and rupture human development, already having contributed to reducing life expectancy by 25 years. However, the Government of Zambia, working with local and international partners, has put in place a sound multi-sectoral national response that both reflects the local realities and international commitments made through the United Nations General Assembly Special Session on HIV/AIDS (UNGASS, 2001), Millennium Development Goals and others. And these actions are reaping significant rewards for the people of Zambia.
The UNAIDS Global Report (2010) announced that Zambia is among 56 countries globally which have reduced the rate of new infections. Zambia is estimated to have reduced new infections by 25%, and it is young people who are leading the way. Surveys from 2007 were already showing that young people are waiting longer until they first have sex, are more likely to use a condom, and also they are reducing the number of sex partners. However, we have also come to recognise that the immediate risks of unprotected sex cannot be addressed fully, without addressing the underlying gender inequalities in society and the status of women and girls.
Zambia has drastically reduced deaths related to AIDS as well. The roll out of free Anti-Retroviral Therapy (ART) through public clinics is the single most important factor in achieving this. Government, non government and cooperating partners have made this possible, in an unprecedented concerted approach. Due to the rapid scale-up of HIV care and treatment in Zambia, close to one million HIV-positive Zambians can expect to resume active, and long, productive lives. And for the first time, it possible to consider an HIV-free generation in terms of virtually eliminating transmission of HIV from mother to child through better and earlier treatment.
The new infection rates albeit on the decline, are still far too high. Behind every data point is an individual and a family and a community that suffers, that hopes, that prays, that deals with death and celebrates life. These stories, both of tragedy and of hope, are what make up the tapestry of the HIV/AIDS story across the world, and it is through this sharing of what works, what is possible, and how communities and countries have led the way back, that makes a fuller response possible.
For a response to be effective and successful over time, it has to go beyond immediate care and livelihood needs, to understanding and addressing the underlying causes and consequences of attitudes and behaviors that help such an epidemic to thrive. Issues of gender inequality and disempowerment, economic hardship, practices that encourage sexual and gender-based violence are contexts that enable this virus to flourish. The evidence is clear – in order to stop this epidemic, these factors must be addressed head on, just as much as providing access to ARVs, voluntary testing and counseling.
In the early stages of the response, information was central, and still is necessary, but it is not sufficient to end the epidemic. Changing attitudes and risky behaviour remains a challenge to the average Zambian. While unprotected sex is certainly the most important risk in Zambia, the practice of having more than one partner at the same time, especially if you are married or living together, seems to be fueling higher rates of infection in Zambia (approximately 16%). The limited research available in Zambia suggests that men are much more likely to have multiple concurrent partners than women. At the same time, couples tend to be suspicious of a request to use a condom within a long term relationship or marriage, even though condoms are very acceptable for contraceptive purposes. Up to 20% of Zambian couples are unknowingly living with an HIV partner; because only 16% of Zambian adults aged 15-49 have been tested and know their HIV status. Most people also do not present for testing with their partners. And so, if it is very common to have extra partners, and it is well known that it is difficult for a woman to control decision about sex, how does a woman protect herself from HIV?
Contrary to popular belief, urban, educated adults in their most productive and reproductive years are most at risk in Zambia. These are often professional people who are very mobile and have disposable income. Those living in rural areas (approximately 10% HIV prevalence), where poverty tends to be greater, have about half the risk of the urbanites (approximately 20% HIV prevalence). Therefore, while poverty, per se, does not make you more at risk of becoming infected, it is certainly not helpful and makes coping with HIV once infected, much more difficult.
The World AIDS Day that we just commemorated last Wednesday on 01 December 2010 is a sober reminder that HIV and AIDS is still very much with us, and it requires each of us to work together, and with an intention and intensity that we are yet to see. Some of us will say that the risky behaviours and lack of will is ‘cultural’ or ’traditional’, however, as was said by one of the champions for an HIV-free generation on the recent visit to Zambia: ‘If part of your culture is killing you, you need change.’ This is a world with unprecedented access to knowledge and expertise and resources, leaving us with few excuses for not succeeding. Changed attitudes and behaviours must become the norm and the culture. This cannot be addressed by better project design. It is driven by leadership vision and commitment to achieve such change at all levels, where a people’s courage and determination to do away with this epidemic prevails.
*About the Authors: Kanni Wignaraja is UN Resident Coordinator and UNDP Resident Representative and Dr. Amaya Gillespie is UNAIDS Country Coordinator