By Dominique Soguel
Friday, December 28, 2007
Zambia is receiving hefty U.S. funding for its anti-AIDS effort but is showing much less for it than nearby Rwanda. A comparison of the countries suggests two key ingredients of success: strong condom promotion and support of women's rights.
(WOMENSENEWS)--It started with a cough.
In 2004, Sandra Banda went to a health clinic in her hometown, Lusaka, the capital city of Zambia. Her husband was away so she made the visit alone.
Nurses received her with two rapid fire diagnoses: tuberculosis and HIV.
"In Africa, when you have TB you have to immediately think HIV. At least 90 percent of cases are related," Banda told a small gathering of people in New York on Nov. 29.
Recently, Banda--31, HIV-positive, a mother of two and a staffer at a Zambian group that supports the government's anti-AIDS battle--came to the United States for the first time in a visit sponsored by the Student Global Aids Campaign in Washington, D.C.
She hoped to raise the profile of Africa and HIV-AIDS in the presidential primary debates.
"What you decide here, affects us there," she told a small gathering of activists and media representatives recently. "We want the candidates to know that they will be held responsible for their AIDS policy."
President Bush launched in 2004 the largest single-nation initiative to combat AIDS, a five-year, $15 billion initiative, with Zambia one of 15 recipient countries.
"AIDS is not a partisan issue," says Matthew Cavanagh, general director of Global Justice, a Washington-based advocacy group. "Clinton underfunded the fight against AIDS and prevented the distribution of generic medicine. Bush is funding the largest program in U.S. history."
AIDS-related funding for Zambia rose to $216 million in 2007 from $81.6 million in 2004.
But in 2007, the country's health statistics stubbornly failed to show improvement. Seventeen percent of the adult population has HIV-AIDS, 57 percent of whom are women, according to a joint report from the United Nations and the World Health Organization published in December.
Banda and others say statistics like these indicate that effective AIDS policy goes beyond funding.
The contrast between Zambia and Rwanda seems to support that premise.
In Rwanda--another recipient of emergency funding--HIV prevalence rates fell to 3 percent in 2005 from 9 percent in 1998, the U.N.-WHO study found. In the same period Zambia's rates dropped to 17 percent from 22 percent.
The secret to an effective national HIV-AIDS strategy, Banda says, is not only to fund every effective anti-AIDS tactic--including condoms--but also to combat domestic violence and shore up women's rights.
Sen. Aloisea Inyumba, a member of the Rwanda Women Parliamentary Forum, told Women's eNews during a recent visit to New York that in post-genocide Rwanda women are in the majority--56 percent of the population--and a significant pocket of them are pushing for a strong HIV-AIDS agenda.
Visitors to the country marvel at how President Paul Kagami comes on TV and champions condoms.
"This is a weapon," Kagami says, raising a gun at the camera. "This is what killed us."
With his other hand, he lifts a wrapped condom. "This too is a weapon and it will save us."
Inyumba says the president has introduced voluntary testing in public and private institutions, including the Senate and Parliament. The first lady, Jeannette Kagame, has won awards for her own HIV-awareness campaigns. Rwanda has a minister devoted exclusively to the fight.
Key local partners, says Inyumba, are women's groups, schools and faith-based organizations. Sida clubs (anti-AIDS groups) are increasingly common in schools. And faith-based organizations do not shy away from a comprehensive education to promote prevention.
"There is a sense of national commitment," said Inyumba. "It has been mainstreamed in every policy of our country."
To replicate Rwanda's success, Zambia faces several challenges.
First comes the country's basic approach.
A public health consensus has developed about the "ABC" of AIDS prevention, referring to three core approaches: Abstinence, Be faithful and use Condoms.
The President's Emergency Plan for AIDS Relief, also known as PEPFAR, reserves one-third of AIDS prevention money for programs that emphasize abstinence and faithfulness only.
In Zambia, though, the condom message is scarce.
Zambians reached by programs promoting abstinence and fidelity numbered 1,419,800, according to the President's Emergency Plan 2007 report, while fewer than 311,000 heard about condoms and related prevention services. The United States shipped zero condoms to Zambia in 2006.
Unlike Rwanda, Zambians appear to be paying closer attention to U.S. rules.
"There are so many guidelines and conditions attached to this money," Banda says. "The only message we can preach is abstinence."
The AIDS prevention programs that de-emphasize condom use have not delayed the age of sexual debut for young Zambians or prevented individuals from having unsafe sex with multiple partners.
Infection rates are still rising among the young. Girls and women between 14 and 25 are four times more likely to be infected with HIV than their male counterparts.
"When you look at abstinence-only messages, you have women married at age 15," Banda says. "Do you want married women not to have sex? You know people will have sex. God put it in us. If they are going to have sex, how should they protect themselves? These programs are not working. But we can't say no because the funders want an abstinence message."
Meanwhile, health workers say domestic and other gender violence is also conducive to the spread of AIDS.
Zambia conducted a national health survey in 2002 and found that half of the married women surveyed had been beaten by their husbands. The Young Women's Christian Association in Lusaka reported in November 2006 that its shelter recorded 10 cases of rape each week.
A Human Rights Watch report earlier this month warned the Zambian government that it would fail to provide universal health care for AIDS victims, its goal for the year 2011, if it did not address domestic violence, which prevents women from insisting their partners use condoms and from obtaining antiretroviral treatment.
"We have a culture where the final decision of sex lies with the man," says Banda. "If he doesn't want to use a condom the women can't say no because she depends on him for her survival."
Dominique Soguel is Women's eNews Arabic editor.
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"Uganda's Shift in AIDS Policy Tied to U.S.":
Human Rights Watch, "Hidden in the Mealie Meal," Zambia report:
The United States Presidents Emergency Plan for Aids Relief:
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