HIV/AIDS in Zambia: A Three Decade Burden

By Dr. Charles Ngoma

Nearly everyone has now heard about the disease that was first defined in homosexual men in the USA in the early 1980s. The disease ravaged the immune system of its victims and they presented with symptoms similar to those who had some form of lack of immunity. Later on in France a virus was isolated from a Zairean woman who had lumps in the neck. On one side of the Atlantic, the disease became known as GRID (Gay related Immune deficiency), because the subjects were usually homosexual and the presentation was usually with Kaposi’s sarcoma (KS) and Pneumocytosis. For political reasons, the name was changed to the Acquired Immune Deficiency Syndrome (AIDS). A French researcher Luc Montagnier called the virus ‘isolated’ from his patient Lymphadenopathy Associated Virus (LAV); an acronym sounding like ‘love’ It is interesting to note that, at about the same time that GRID appeared on the scene, Robert Gallo was working with Retroviruses and their effects on the T-Lymphocytes that he had cultured in the laboratory. He called the retroviruses Human T-leukaemia or lymphoma viruses (HTLV). A year after Montagnier’s publication, and a month before publication in a Peer-reviewed journal, the U.S. Department of Health and Human Services Secretary announced at a press conference that Robert Gallo, had ‘discovered’ the probable cause of AIDS, and it was named HTLV III. It is interesting to note that a Government official made the announcement! Was the virus of national security interest? Montaignier’s group has been credited with the discovery of the virus by the Nobel committee, but Montaignier was not so certain whether LAV caused AIDS. It is now water passed under the bridge. Within 5 years, it was clear that this viral infection was transmitted through contaminated needles and risky sexual activity.

Thirty years on, one in eight Zambians is now infected with the virus. In the mid 1980s, Professor Anne Bayley, a surgeon at the University Teaching Hospital in Lusaka, published articles about a type of Kaposi’s sarcoma (KS) in Zambian patients that was ‘atypical.’ This cancer of blood vessels was first described by a Hungarian Pathologist in Vienna, Austria in 1872. The disease was indolent and affected elderly men and is now distinguished from AIDS defining KS as ‘Classic KS.’

It was not too long after that, that we saw an exponential rise in hospital admissions with patients complaining of weight loss, unexplained acute and chronic diarrhoeas and fevers of unknown origin. Other diseases like Tuberculosis also made a horrific come back. Cancers such as cervical cancer and lymphoma too became widespread. We now know that all these cancers are associated with viral infections.

The 1980s were also the age of ‘baby boom’ as hundreds, yea thousands of young women and teenagers were coming into hospitals with pregnancies; orthotopic and ectopic, miscarriages and all other burdens of pregnancy in the Tropics, such as malaria and anaemia. The ‘floor bed’ was invented as hospital wards burst to the seams! No new hospitals or wards were built to cope with the influx of in-patients. The burden of disease exacted a terrible toll on the fragile health service and the economy. The IMF and World Bank never put AIDS into the equation when they pursued the Kaunda administration to recover soaring debts! HIV infection makes ‘well looking’ people weak. Morbidity and mortality rates rose. The employees of the ‘goose that laid golden eggs’ the Zambia Consolidated Copper Mines (ZCCM) were not spared. Much of mining and farming work is physical and tasking. Billions of ‘man-hours’ lost through sick leave inevitably led to fall in production. Fall in production led to job losses. Jobless miners had no access to health services and many succumbed to disease and neglect, leaving armies of orphans and ‘street kids’ behind. The cycle was self perpetuating, as unscreened infected blood was infused into un-infected patients, such as the large pool of women of child bearing age and children, to treat anaemia etc infection spread relentlessly. Sickle cell disease patients tend to have frequent blood transfusions. Many could have got infected. Shortage of transfusion blood meant that hospital blood banks went to Police camps, Army barracks and even prisons, to get blood! No one has ever been compensated in Zambia for transfusion HIV infection. Health care staff were also at risk in the course of their duties. A Christian Missionary worker in Zimbabwe is documented to have contracted HIV through ‘needle-stick’ injury.

A blood screening test appeared on the scene by 1986. Thank God that blood is now universally screened for HIV.

The country is truly broken. The Zambian population in the immediate post-independence era was young and many diseases that afflicted the people were short term and primarily related to infections. In the majority of cases, hospital admissions were not necessary, and complete recovery within a week was usual. The scenario now dramatically changed as patients stayed longer in hospital and returned too frequently soon after discharge. In the 1980-90s there was much ignorance and anti-retroviral therapy was not so widely available.

What I have tried to elaborate above is that HIV/AIDS plays a crucial role in the economy of the country. If Zambia is to achieve its Millennium development goals by 2030, there must be a very strong HIV/AIDS policy. Besides this, there are some quiescent infections that are inexorably spreading through the communities which play a very crucial role in worsening the course of HIV infection. I have mentioned Virus induced cancers like cervical cancer, Kaposi’s sarcoma and lymphomas. There are other viruses like Herpes, Varicella, Hepatitis B and C which have never been acknowledged as a public health problem of importance in Zambia. Hepatitis viruses cause Liver cancer and Herpes increases the risk of contracting HIV.

There must be a total re-think of Public health policy in Zambia. We have spent millions of dollars ‘mopping’ the flooded floor while the causative leaking tap is running!

Here are a few suggestions:

  1. HIV/AIDS must be declared a national disaster. I am glad that this was in the Patriotic Front Manifesto (2006). It is more than a partisan issue. We need the help of cooperating partners to deal with this, yes, but also ALL politicians and the highest office of the land must be directly involved. Awareness campaigns must extend beyond highlighting HIV infection alone, but other viral infections as well. This is why the issue of condoms is crucial.
  2. Testing. When there was no treatment available, it was quiet right to be as discreet and confidential as possible while dealing with this pandemic. But now, the life saving drugs that are available, not only prolong life, but also reduce the risk of spread of infection. All gloves are off. Treatment centres can deal with the problem of confidentiality by using numbers alone for identification. These test results must be fed into a central database so that the exact extent of the problem can be known.
  3. Treatment as a form of Prevention. It has been shown mathematically that treating every HIV positive person can lead to no new infections within ten years. If hospital staff were able to test universally, they could be able to commence treatment of patients, and if one million Zambians were on treatment it will go a long way in reversing our fortunes.
  4.  Male circumcision. Circumcision must be offered as a part of the national health strategy.
  5. There must be School health services. A public health nurse must be assigned to every school in the country. Every school going child must have a Health card in which vaccinations received are documented. Measles, Rubella, Meningitis etc should be a priority. Health education and confidential counselling must be part of the education curriculum.
  6. Limiting Co-factors. Whether HIV positive or not, screening must also include other viruses such as Hepatitis as well to begin with. In addition to this, there must be wide dissemination of information on adequate nutrition. Perhaps the ‘milk biscuits’ must make a come back. Assessment of nutrition status is crucial for both preventing infections as well as promoting quick recovery.
  7. A Virology Research Institute must be established in the country. We need to be able to identify any emerging viruses in the country because HIV is not going to be the last. There are many more to come up. We must be ready.
  8. Preservation of woodland and natural habitats, including forests. The rate of deforestation in Zambia is alarming. We are preserving wildlife for the satisfaction of Western eyes, but we are destroying our forests at an alarming rate. We know that certain trees like the Moringa species have nutrition and medicinal value. Herbs may be a source of cheaper drugs in future and there must be established a research institute that will collect, cultivate and collate information on all known herbals and preserve them for posterity.


This disease can be defeated and it will take concerted efforts to do so. We need to take away stigmatisation. Insurance companies must not segregate against sufferers. To minimise risk to the Insurer, the State must be able to under-write Life Insurance policies where the Insured undertakes to be diligent with treatment, follow up and non-risky behaviour. Every Zambian who is in employment and HIV negative must be encouraged to take Medical Insurance. By its own characteristics, the more people subscribe, the cheaper insurance becomes. Employers should contribute to Medical insurance of their employees. This should be enforced by statute law.

We are a very poor country notwithstanding the vast untapped resources. Until we reach our potential, we cannot afford a free to all healthcare service, like we had immediately after independence. The pandemic of HIV/AIDS has shown that we cannot run health services as we did before. Every citizen must take responsibility for their personal and family health but Government must provide the means and incentives to do so. I am not claiming to have the answers, but we should have a real debate about this and if there are any bright ideas out there, let us bring them on the table. Zambia must be saved. Victory is in our hands.

 The Author Dr Charles Ngoma  is Former Zambia Medical Association Vice President, 1998.


  • comment-avatar
    Dr Brazil 7 years

    Additional points to note:
    MC as HIV prevention tool is anchored on Biological studies, interventional studies (RCTs) and Observational studies.

    Circumcising areas Africa have lower HIV prevalence rates. e.g. Southern Africa (15% – 35%), Eastern and central Arica ( 3% – 7%), West Africa (1% – 5%). This hiv prevalence order also explains the traditionally circumcising areas where MC is a traditional tool. In Zambia, the same applies: NWP has lowest HIV and also is traditionalyycircumcising.

    Check Quinn et al NEMJ, 2000 (for data on discordant couples and MC)

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    African 7 years

    A critical thing that needs to be established is to find the origin of HIV/Aids. It’s difficult to figure out the solution if you do not know the origin. Could the theories behind “WHO murdered Africa” right, how come Africa has been the worst hit.What about the Tuskegee experiment. May God deliver us.

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    THE SAINT 7 years

    Dr Brazil
    I agree that there may be some protective effect with circumcision, and that has to do with the langerhan’s cell portal sites in the foreskin. But there are weaknesses with the studies that you have quoted. in the first instance, where the sexual activities correlated between the groups. Soreness after circumcision may have reduced the number of sexual incidents thereby reducing risk. Secondly, I have not seen in the Kenya trial wether there was correalation between religions in the groups involved. Thirdly, only 3 of the studies that you have cited were published in a peer review journal and two of the three in Lancet! The Lancet has an editorial policy that allows mavericks to publish sensational and outrageous research. Remember the MMR debacle?
    There may be protection, yes, but we need more evidence and as the author has commented, we have enough Zambians in the cities with similar life styles and religious profession from whom we can draw insight.

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    THE SAINT 7 years

    There is nothing more stupid than the promotion of abstinence against a native human instinct. I am amazed that a man who could not abstain from alcohol himself (George Bush) was at the fore front promoting sexual abstinence. Alcoholism is not a native instinct and where was his will power when he was binging like a fish? Jesus told the Pharisees never to lay burdens on people that they themselves could not carry. Promiscuity is wrong, but God recognised this in fallen human beings and thus allowed Moses to permit polygamy and divorce. Some people are continent when it comes to sex, but not when it comes to food. Others are continent when it comes to greed but not to verbal diarrhoea and gossip. Yes, HIV is contracted primarily through sexual intercourse. Yes, people must be faithful to their partners. BUT that is not a message that governments should be giving, and not even donors. Where people fail to abstain due to human weakness and frailty (for we are dust), other means of protection from infection should be equally promoted. The Romish Church must discard the hypocrisy about condoms and allow people the choice. If we all could chose to do the right thing, there would be no obesity, lung cancer, alcoholism, road traffic accidents, thefts, murders, strife, war, fist fights etc, indeed, there would be no sin and Jesus would not have died. But ‘all have sinned and fallen short of the glory of God.’ The stigma comes from this condemnation.

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    Dr Brazil 7 years

    Ladies and Gentlemen, all methods of HIV prevention should be promoted. Abash ignorance. Read on….

    Male Circumcision Randomised Controlled Trials and Related Studies

    Three clinical trials conducted in sub-Saharan Africa have shown that medically performed circumcision is safe and can reduce men’s risk of HIV infection during vaginal sex by about 60 percent.

    In each trial, uncircumcised men were randomly assigned to one of two groups. Participants in one group were offered immediate circumcision (the treatment group), while those in the other group (the control group) were offered circumcision at the end of the trial. During regular follow-up visits, each participant received HIV testing and counselling, condoms and safer sex counselling.

    All three trials were halted early because the evidence of a protective effect was so strong that it was considered unethical to ask the study participants in the control group to continue waiting to be circumcised.

    The results revealed a much lower rate of new HIV infections among men in the circumcised groups compared to the men assigned to remain uncircumcised during the trials:

    In South Africa, a trial in Orange Farm enrolled 3,000 men ages 18 to 24. The circumcised men were approximately 60 percent less likely to acquire HIV than the uncircumcised men (1).
    In Uganda’s Rakai District, in a study among 4,996 men ages 15 to 49, circumcision reduced the risk of HIV infection by approximately 51 percent (2).
    In Kenya, 2,784 men ages 18 to 24 joined a study in Kisumu. HIV risk was reduced by approximately 59 percent among those who were circumcised (3). An ongoing follow-up study found that this protective effect was sustained over 42 months, reducing men’s chances of becoming infected with HIV by 64 percent (4).

    Further analyses of the data from these studies suggest an even greater protective effective against HIV. Some participants assigned to be circumcised did not undergo the procedure, while some in the comparison groups went to other providers to get circumcised before their trial participation had ended. When data on these men were excluded from the analysis, the average reduction in risk of HIV across trials was approximately 65 percent.

    The only randomised controlled trial to date to investigate whether male circumcision protects women was conducted in Rakai, Uganda. The study was closed early because it was not going to be able to answer the question with sufficient statistical power. The interim results of this clinical trial suggest that if a couple does not abstain from sex until the surgical wound from the man’s circumcision has completely healed, the woman may be at increased risk of acquiring HIV if her partner is HIV positive (5).


    Auvert B, Taljaard D, Lagarde E, et al. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: The ANRS 1265 trial. PLoS Medicine 2005;2(11):e298.
    Gray, RH, Kigozi G, Serwadda D, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. The Lancet 2007;369:657-666.
    Bailey RC, Moses S, Parker CB, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. The Lancet 2007;369:643-656.
    Bailey RC, Moses S, Parker CB, et al. (Abstract only) The protective effect of male circumcision is sustained for at least 42 months: results from the Kisumu, Kenya trial. XVII International AIDS Conference, Mexico City, August 3-8, 2008.
    Wawer M, Kigozi G, Serwadda D, et al. Trial of Male Circumcision in HIV+ Men, Rakai, Uganda: Effects in HIV+ Men and in Women Partners. 15th Conference on Retroviruses and Opportunistic Infections, Boston, MA, USA, February 3-6, 2008.

  • comment-avatar
    Dr Charles Ngoma 7 years

    and all bloggers.
    I must thank you for your reasoned arguments on this topic. Indeed that was the very aim I had in mind when I brought up the topic. It is high time that the Zambian people themselves got hold of the bull by the horns and started sorting out our ‘health problems.’ We cannot let such an important area of national security rest in the hands of donors and foreign benefactors. Cuba and Brazil recognised this long ago. Zambians must know that there are ‘nasty people’ out there who hate Africans in general and black people in particular. Just because there is a half black man in Washington White House does not mean that racial prejudices have disappeared. The Government MUST take this case very seriously. There are serious questions to be answered about the origins of this pandemic. Promiscuity is a human phenomenon and not limited to black people. But we all know that some genetic constitutions do offer some resistance to HIV infection. Whether HIV came about intentionally or by accident, we have been warned, and to be fore-warned is to be fore-armed.
    As for circumcision, you are right. The evidence is anecdotal, but we cannot take chances. We can conduct our own research because we have Zambians who practice circumcision in their culture and that is not a problem. I just suggested that ‘Circumcision must be offered as a part of the national health strategy.’ A national health strategy means that more evidence is needed and not as isolated practices here and there, if it is proven to work.

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    If an adult man wants to undergo for whatever reason, because he believes he will not get AIDS, because he wishes to “become a man,” or simply just because, it is his business.

    But taking a young child and forcefully doing it to him is genital mutilation. It is a violation of his basic human rights.

    At the AIDS conference in Vienna, “rights here, right now” was the slogan. Michel Sidibe talked about “giving a voice to the voiceless.” Where is human rights in circumcising a healthy, non-consenting child who is at zero risk for HIV transmission? Where is the “voice of the voiceless?”

    WHY do people from the West demand you cut you and your children? WHY isn’t there research going into anything other than circumcision? Does it not strike anyone else as odd that they’re asking you to cut your penis for “prevention”? Do you really believe that? Ask yourselves. How many circumcised men did you know that died of HIV/AIDS? Why didn’t circumcision “protect” them?

    Only ABC and condoms work. Circumcision is superfluous. For all intents and purposes, it is a needless mutilation. The “protective effect” is dubious at best. A circumcised man would still need to were a condom. USE YOUR BRAINS! If you have to wear a condom even after being circumcised, what is the whole point?

    Challenge your leaders. Demand they tell the WHO that no, they will NOT take up genital mutilation for “protection.” This is MADNESS. DEMAND that they do research in methods that do not require you mutilate yourself or your children. Don’t let them fool you.

    Medical research usually tries to DISPLACE surgery. It tries to PREVENT the excision of organs, or the loss of a limb. You must ask yourselves, WHY is all this “research” going into trying to necessitate surgical practice? WHY is there no research at all in trying to find ways to AVOID this?

    Question it, people of Africa. I know that you are not as stupid as people at the WHO think you are. Don’t let them push this needless mutilation on you!!!

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    Africans need to beware lies and deception. You have been taken advantage of before, you would be fools to be taken advantage of again.

    Please stand up and question your authorities when they tell you that circumcision does anything to protect you, because even if “studies” are correct, it does not. Even if “studies” are correct, men still have to wear condoms, and men are already saying that they don’t have to use condoms because they are circumcised.

    In America, 80% of men are already circumcised from birth. The rates of infant circumcision are dropping, but at large, the population remains circumcised. These rates are at their highest in the East Coast, where cities such as Philadelphia and Washington DC rival HIV hotspots in South Africa. In the 1980s, when the AIDS epidemic first hit, the rate of circumcised men in America was at 90%. One needs to question how something that never worked here in our own country is suddenly going to start working wonders in Africa.

    In other countries, the “protection” remains to be seen as well. AIDS is a rising problem in Israel, where the majority of the male population is already circumcised. On Wednesday, July 7th, two weeks ago, Malaysian AIDS Council vice-president Datuk Zaman Khan announced that than 70% of the 87,710 HIV/AIDS sufferers in the country are Muslims (in other words CIRCUMCISED). The Muslim, circumcised population accounts for 70% of the incidence of HIV, but only 60% of the population, which would mean that the circumcised population is getting HIV at a much higher rate than the non-circumcised population.

    Circumcision is a dangerous distraction in the fight against AIDS. It does NOTHING for a man. He would eventually still get HIV if he didn’t use condoms, so what is the point in getting circumcised when the answer is in ABC?

    Circumcision is a waste of money that could be used in more effective methods of prevention. There are people that need treatment. Mothers need to have drugs for mother-to-child transmission prevention.

    Africans, the WHO would never promote female genital mutilation, not even if “studies showed” that it prevented HIV transmission 100% of the time. You need to question an authority that dare say you should mutilate yourselves and your children in the name of “prevention.” Demand they “research” other forms of prevention that don’t involve genital mutilation. I’m sure there are many a circumcised man around you. How many of these men have HIV? Ask yourselves that.

    Africans, RESIST this madness. Your leaders are delivering you into the hands of disgusting mad scientists. Circumcision is not going to help anyone. Only ABC and condoms work. Wise up. Don’t be fooled. Circumcision is mutilation, it is nothing but barbaric ritual, and it is a shame that it passes for “science.”

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    theRenegade 7 years

    This male circumcision theory is evidence of the HIV-AIDS medical community clutching at straws. No extensive or conclusive study has been done on the effect of male circumcision on HIV infection rates. Secondly why is it that the HIV-AIDS medical community promotes which ever prevention method is in fashion without doing any real research.When George Bush declared that funds will only be provided to NGOs that promote abstinence, all Zambian NGOs promptly changed tune. When Obama declared that support would be given to the promotion of condoms again they promptly changed course. . . the paymasters decree and our medical fraternity dances to their tune, however ridiculous it may be.

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    Maestro Hhehhehhehhe for 2011 would-b President of Zambia HH 7 years

    On “Within 5 years, it was clear that this viral infection was transmitted through contaminated needles and risky sexual activity.[..] Thirty years on, one in eight Zambians is now infected with the virus… Every citizen must take responsibility for their personal and family health but Government must provide the means and incentives to do so” this information must be treated seriously by all Zambians.

    As for “A year after Montagnier’s publication, and a month before publication in a Peer-reviewed journal, the U.S. Department of Health and Human Services Secretary announced at a press conference that Robert Gallo, had ‘discovered’ the probable cause of AIDS, and it was named HTLV III” this suspicious statement is interesting; and must open the eyes of all Zambia Citizens especially the politicians who can help develop policies that can assist serious research to be conducted in Zambia as the article puts it.

    It is annoying that there are about 2.5 million HIV-AIDS infected persons out of the about 11.5 million population of Zambia right now. A change in attitude and behaviour is therefore required of every Zambia citizen.

    Have a blessed day all.
    Matt 6:33

  • comment-avatar
    Jack 7 years

    it could but would it, would the govenment do that. isay probaly not thats how low it is

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    Jack 7 years

    it could but would it, will it do such a thing, probaly not thats how low the government is

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    Robbo 7 years

    the government is very powerfull but stupid because it could help a lot of people of corse

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    Jack 7 years

    they probly do but don’t whant to spend the money on that any way

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    Robbo 7 years

    doesn’t the government have the money and the power

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    Jack 7 years

    thats a good idea but who’s going to help them, besides we’ll need a lot of money and manpower to do so

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    Robbo 7 years

    well why not help the people who have little hope

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    Jack 7 years

    thats very true GENERAL DAVID PATREAS very true

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    Robbo 7 years

    are you shure

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    its terrible, i know so bcoz i see HIV/AIDS patients everyday and everyone around is dying.its bcoming sad and sad everyday….seems thez little hope, very little.

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    Jack 7 years

    yes a survey has be done so theres the anwser

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    THE SAINT 7 years

    It is time this debate left the Expert conferences and went to the man in the street. I would add:
    1. Curbing ‘Gender-based’ violence as well. The Zambian laws against gender-based vilonce are ok, but the enforcement by the Police service leaves much to be desired. It is also very expensive for the abused spouse to engage lawyers before they can leave the matrimonial home, and once they leave, the abuse finds an opportunity to bring in a third party. This ‘kabiye kuli banoko’ should stop. The abuse MUST leave the house, and not the victim.
    2. Spouses should not coerce their late night partying or carousing partners to sleep with them when they have come home, just to prove that he or she (but usually he) did not do anything naughty while away. Cross-infection risk is highest then and ‘protection’ must be insisted upon until after 6 months testing negative.
    3. Local court Presidents must be trained at law and there must be an express way to appeal to a Magistrate’s court. Most people do not have the will nor the wherewithal to appeal to a Magistrate’s court after the humiliation in a Local Court. Is it any wonder that the juiciest court gossip in our media is from Local courts?

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    I think they should just resolve there prolems Mr Hakahida should not think that he can win on his on he should always know that he is a tonga man and people dont trust Tonga and Lozi’s because they are tribalist me i prefer to vote for Sata, my second option is Rupia Banda, because if i vote for MMD am asured of a peacefull Zambia but that of uneployment,But for a change the pact would do let Sata be president then hakahinda can flow dont be blided UPND or the both of you will not see plot one.

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    Very good and useful information.

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    Justice 7 years

    The problem of HIV like other problems we have can not be solved because Zambians are not comfortable discussing issues openly. How many times have you been to a funeral and people just whisper in dark shadows about what killed a victim. That is precisely the problem. Change the stale culture and talk openly to your children about sex and other dangers and the problem will go overnight.
    The imprisoned guy in the US is a typical case we can use here. This guy does not think twice about spreading the virus.
    Forget about solving this problem and many others if we can not change our ways of doing things. KK showed a good example when his son died of the disease. After that everybody else dies from pneumonia and cancer. Being in denial and living a lie is not a solution but part of the problem.

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    Treatment is the best option for reducing the rate of HIV. Male circumcision is expensive and not yet proven. If male circumcision were as good as they claim it is, then a survey of the men already circumcised would show a market decrease in the HIV rate. Has such a survey been done, yet? Based on neighboring countries, male circumcison does not have a large impact on the infection rate.