ZAMBIA:
'Clear Lack of Commitment to HIV'
Kristin Palitza interviews HENRY MALUMA, Oxfam Zambia essential services coordinator
CAPE TOWN, Sep 30 (IPS) - A United Nations mid-point review of Zambia's efforts towards reaching
the Millennium Development Goals (MDGs), released in September, has
revealed that HIV/AIDS might prevent the southern African country from
meeting the targets.
The HIV pandemic has had "devastating effects" on all aspects of human
well-being, including poverty and hunger, education, child mortality and,
of course, health, the report revealed.
Almost one million Zambians, or 16.5 percent of the population, live with
HIV and AIDS, according to United Nations Development Program (UNDP)
statistics. Average life expectancy is only 38 years in Zambia.
IPS: A UNDP mid-review report found that HIV is complicating Zambia"s
efforts to reach the MDGs. What are the big stumbling blocks?
HENRY MALUMA: It's about the direction in which the fight against HIV has
been taken. The emphasis has been on treatment, excluding prevention
strategies.
The treatment component has also excluded health systems
strengthening. HIV has been treated as a separate issue from the general
health system. That's why we didn't achieve results.
We don't see much-needed leadership at all levels of society that
addresses the root causes of HIV, such as culture and traditions, like
polygamy, wife inheritance and initiation ceremonies that accelerate the
spread of HIV.
Zambia does have an opportunity (to reach the MDGs) but there isn"t
sufficient political will. Government needs to allocate more resources, but
there is actually a decline in the (proposed) health budget from 11.5
percent in 2010 to ten percent by 2012. That's a clear lack of commitment to
HIV.
IPS: A key issue is that due to poverty and hunger, many HIV-positive
Zambians don't have access to good nutrition that would help them to
stay healthy. How can this be addressed?
HM: There are a number of pilot projects throughout the country that
focus on food for the terminally ill. But what we need to solve the issue is
a large-scale food security programme. But there is more talk and good
theories than financial commitment and practical implementation.
IPS: Some health experts say that because of escalating poverty levels
in rural areas, HIV is more a socio-economic than a health management
problem. Would you agree?
HM: In rural areas, antiretroviral (ARV) treatment isn't available in a
comprehensive manner. Those with financial resources can access
treatment, but the others can't.
The rural areas have experienced a huge setback because there are not
enough (health) facilities, qualified staff and resources. Most of the (HIV-
positive) poor are either left to die or treated with medication for
opportunistic infections, but not with ARVs.
IPS: Zambia might not reach the MDG of reaching universal primary
education due to an increased death rate of teachers. What impact will this
have on the next generation of Zambians?
HM: Yes, the rate of teacher deaths is high, but we still have an
opportunity to reach the MDGs. Zambia has made tremendous progress in
primary education and now HIV has been a setback.
This will have a negative impact on literacy levels. Yet, education is the
backbone of development and if we need to address poverty
comprehensively.
IPS: Oxfam is pushing for HIV to be included in the curriculum. What
impact are you hoping this will have?
HM: We are still not seeing the (behaviour) change we would like to see in
people's lives to reduce infection rates, so we need to put in place
strategies, hoping that knowledge will lead to change.
It requires comprehensive education, starting with the youngest.
IPS: Child mortality has been on the increase. Is enough done to
ensure prevention of mother-to-child-transmission (PMTCT) of HIV?
HM: According to international standards, the PMTCT programme is
supposed to reach 80 percent of mothers. In Zambia it is at 35 percent " far
below the required standard.
Again, this is due to lack of human resources, financial resources and
infrastructure. There are some success recorded in urban settings but a
lot more needs to be done.
IPS: On the upside, Zambia has made progress in reducing stigma and
increased the number of people being tested for HIV. How can we build on
that?
HM: The rate of HIV testing has gone up. That's correct. But scaling up the
voluntary counselling and testing) programme is not sufficient. It ought
to be accompanied by access to ARV treatment.
HIV-positive people need drugs to keep their lives going. It's a violation of
their rights to test them but then not have treatment available.
IPS: What should Zambia do to stem HIV-TB co-infections that present
a huge problem in the country?
HM: I believe we should implement a health test that tests HIV, TB and
other diseases in all public health facilities.
It's a new way of thinking. You don't call it mandatory test, but a general
health test. It will give you the figures necessary to solve the problem.
The test, combined with a much stronger prevention strategy and a
predictability of resources to ensure drugs are available will help solve the
problem.
(END/2009)
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