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  Zambia strategies its fight against HIV

Submitted by Violet about 4 months ago

SINCE the identification of HIV virus in 1983, HIV prevalence has evolved with different characteristics and at different paces. The epidemic in Southern African countries grew to unprecedented levels. According to the UNAIDS report 2008, prevalence tended to be higher among females than among men, and higher in urban areas than the rural areas. Although there is a generalisd understanding of the factors that affects the progression of HIV epidemics, the details of how they operate to shape the epidemic are not well understood. It appears that individual factors such as behavioural change and biological susceptibility and broader factors such political, economy, inequalities (wealth, gender,) urbanistion, modernisation and social cultural factors all play a role in determining transmission dynamics of HIV. According to the 2008 Report on the Global AIDS Epidemic, an estimated1.9 million people were newly infected with HIV in Sub Saharan Africa in 2007, bringing to 22 million the number of people living with HIV in the region. These new infections happened and continue to happen despite 20 years of experience with implementation prevention Programmes. Success in accelerating access to treatment has not been matched by similar success in prevention: for every two people who start anti- retroviral treatment (ART), five others get newly infected (UNAIDS). Underpinning the shortcomings in prevention is the inadequate use of evidence to inform program decisions. The results has been prevention interventions of sufficient effectiveness, non optimal use of available resources and lost opportunities to address the specific factors driving infection in the population most at risk within each country. The existing HIV prevention programme, based on the abstinence, being faithful to one sexual partner and consistent and correct use of condoms (ABC) model, has resulted in a number of positive development such as partner reduction, increase of age at first sexual debut and increase in the number of people visiting voluntary counseling and testing (VCT) services. In 2001, African Health Ministers meeting in Gabarone made a declaration and prepared a Road Map towards Universal Access to Prevention, Treatment and Care and Support for HIV and AIDS by 2010. Further, in 2005, the African leaders made an earnest appeal for concerted efforts in combating new HIV preventions by declaring 2006 the years for the “Acceleration of HIV Prevention in the Africa Region” Following the declaration, the Initiative for the Acceleration of HIV Prevention in Africa was launched in Addis Ababa, Ethiopia on 11 April 2006. Zambia also launched this initiative the same day. Despite these initiatives, the pandemic is still a serious threat to any meaningful socio economic development in Sub Saharan Africa, in general and Zambia in particular. The Proportion of people in Zambia with HIV dramatically increased in the 1990s and then stabilised at very high level. Declines in prevalence in general population was almost significant (p= 0.051). The continued high adult prevalence rate of 14.3 coupled with low numbers of people seeking to know their HIV status sends a strong message for Zambia to rethink and redirect prevention interventions. It was against this gloomy background that the Ministry of Health together with its implementing partners revisited its prevention strategies and improve on them. The first HIV prevention Convention that was held from the 3rd to 5th November looked at among other things the drivers of HIV. The purpose of the convention was to enable Zambia to align its HIV prevention efforts (programmes and funding) with their best knowledge of where new cases of HIV are occurring. Minister of Health Kapembwa Simbao attributed mobility and migration as one of the drivers of the further spread of the disease because of people being away from home which increased the risk of for all in stable employment including Government staff. He said more nights away can increase risk for the traveller and /or those who stay home, especially for women and mobile workers and migrants form sexual networks with women who sell sex. The minister said large mobile groups in Zambia include truck drivers, sex workers (including informal), fishermen/women and fish traders, seasonal agricultural workers, cross border traders, miners, uniformed services personnel, prisoners, and refugees “Migrant labour is associated with both males and females seeking partners outside marriage and has been a leading factor in the spread of STIs in the recent past and needs to be seriously addressed,” he said. Mr Simbao said high education, mobility, urbanised and being female increased the risk as HIV prevalence was higher in women (including young women) who are well educated, mobile and live in urban settings. He said well educated people were also more knowledgeable and likely to change behaviour and these factors confound each other, so the pathway is not clear. The following recommendations were made in trying to address prevention of HIV -Behaviour change communication programme for Couples, the youth, mobile populations and MSM. -Social and cultural norm strengthening and change communication programme for Community leaders targeting elders and advisors in the community. -PMTCT programme for all pregnant women and their partners - Counseling and Testing for Couples in urban areas and Individuals who request the service. The ministry of health will be able to effectively respond to the fight when it addressed the following challenges. Are HIV prevention policies based on the latest available evidence and global best practice? Do HIV prevention programmes respond to the key drivers of the Zambian epidemic(s)? Is the funding allocated for HIV prevention directed where it is most needed? Maybe with the establishment of AIDS Fund to sustain current investment by government will meet some of the challenges in addressing the major drivers of HIV.

Keywords: HIV prevention strategies Zambia

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