jctr.org.zm - Quarterly Bulletin; Bulletin 67

Since the HIV and AIDS pandemic began mostly in the 1980s, many strategies have been used to halt the spread of the pandemic. HIV and AIDS has continued to affect the health of individuals and families but most sadly, it has affected development especially in sub-Saharan Africa. Sister Marie O’Brien argues that despite anti-retroviral treatment providing relief, more needs to be done in prevention, knowledge of one’s status, education, and change of cultural attitudes.

My answer to the above question is “NO”. I believe we are not winning the battle against AIDS with ARVs. As one who has been involved in Community Home Based Care Programmes for HIV and AIDS clients since 1993 I have witnessed remarkable changes in that period.

First of all, it is right that we acknowledge some of the wonderful benefits of ARV’s such as:

There are many reasons to the question of whether we are winning the battle against HIV and AIDS, but let me mention three: (1) Attitudes to HIV and AIDS, (2) high risk behaviour, and (3) increase in number of HIV babies and children

In the early days, it was heartbreaking to see the terrible suffering of so many. Our patients had so many opportunistic infections, one after another – chronic diarrhoea, herpes zoster, rashes, fungal infections etc. Life was a misery. Funerals were the order of the day.

In 2004 we were part of a pilot scheme set up by the Archdiocese of Lusaka to dispense ARVs and within a short time there was a remarkable improvement in the health of our clients. At that time, there was a certain fear of getting this cruel disease and posters and advertisements showed skeletal figures, skulls and cross bones, which in some way acted as a deterrent and made people more aware of the danger of acquiring the virus.

Today, thanks to the introduction of ARVs, what do we see in our posters? Very attractive, healthy looking young men and women, admitting their status so that they can live positively with the virus, knowing that ARVs will be available and they are even free. ARVs have removed that fear and have led to more people engaging in high risk behaviour knowing that there is some treatment.

People on ARVs now look very healthy and may be symptom free, but they carry the virus and can spread the disease. Before the advent of ARVs people had all the signs and were not so free to move around. Many people do not want to know their status, and only go for VCT when they are sick. They may be very active sexually and many have concurrent partners which increases the risk of further spread, and even re-infection. An example is of one single HIV-positive mother with twins who, when asked if the father would support the children, replied “How can he because his wife delivered twins the same week as I did?”

In our programme (Ng’ombe Community Home-based Care) we have regular support meetings for those on ARVs and these are well attended and enjoyed as clients challenge and support each other. I noticed then that these support meetings were becoming Marriage Bureaux as men and women became friends. Now our support groups resemble child welfare clinics. At a meeting of 30 to 40 clients there can be 10 to 15 small babies. At present in our programme we have 350 clients, and the majority are on ARVs.

Sad to say out of the 350 clients we have 77 children from small babies to teenagers. Many of these babies have been supplied with infant formula as the mothers were advised not to breastfeed. Some of the babies are positive because the mother could not afford to go to the clinic or hospital for delivery and so the baby was deprived of preventive treatment. Neviriprime was the drug used but not always effective so now WHO has stopped this and recommend Zidovudine. Another new development is that babies can be found positive at 6 weeks through the use of the PCR test so babies as young as 8 weeks are now been given ARV suspension. Mothers are encouraged to breastfeed as so many cannot afford infant formula, and babies are suffering from malnutrition and are given all kinds of things. I have seen small babies been given maheu, and black tea.

I would like to share a few stories about these children. One day I was visiting a family and I asked the grandmother to show me the actual bottles of ARV suspension that she was giving the small child; she produced 7 bottles, 6 of them unopened. It was obvious that the poor old lady did not understand the correct dosages.

Another child who is actually 14 years but due to stunted growth looks like 9 years of age has been moved around among various relations. One evening his aunt had him working hard and at one point he refused to do any more chores, as he felt sick. The aunt told him then to get out. So he did get out and was found wandering and ended up at the police station while we were contacted. We found that he was not being given his ARVs and had some nasty boils. His uncle was asked to report to the police station and admitted that the child was being neglected. Later I visited my little friend and found he was not in school due to his clothes being unwashed and he had no shoes on him that cold morning because they were broken. We appreciate that the extended families are being overstretched but it is sad to see small children on ARVs suffering like this.

So ARVs is giving us a new generation of very small children who will be on ARVs for life but will not survive unless they receive better nutrition and loving care.

We have all heard of ABC = abstinence, faithfulness and condoms. But let me mention a few other things we can do.

If we are to win this battle it calls for a concerted effort by everyone, men, women, youths, Governments, NGOs and Faith Based Organizations.

A change of attitude and behaviour is needed as we encourage more people to know their status and to change their life styles. Men should be encouraged to engage in positive male behaviour. Most men only go for VCT when they are sick and often it is then too late.

Cultural values – I am told that women are more respected when they have a man! The status of widows and single women need to be appreciated and we need to promote women’s economic security and empowerment.

I share a few examples – a divorced woman who is now pregnant, welcomed back her husband while he is living with another woman. Another case of a separated husband who when he became very ill with TB and AIDS came back to be nursed by his former wife and then gives her a child before he disappears again.

I see many examples of male domination with regard to even the taking of ARVs – some women who were tested at the ante natal clinic are afraid to disclose their status to their husband who will blame them for bringing AIDS into the home. There is much abuse of women. Example – I found a woman who was in great pain, with cracked ribs having been beaten by the husband. Two weeks later I visited the same woman and asked what was happening. She told me the husband had beaten her again and she went to the police – the husband spent one night in the cells and the police opened a docket. When the in-laws arrived they told the young woman to drop the case and she agreed. Women need to know their rights!

Correct information – we have been amazed at some of the ignorance of our youth with regard to HIV and AIDS. One would think at this stage with so much information being circulated they would have the correct facts. But there are still many misconceptions where there is limited access to accurate information.

Change of behaviour programmes need to be organized with good follow up. We know the important role that education plays in reducing vulnerability to HIV but in most of the compounds there is no High School. In Chipata Compound, the drop out rate of school going children is 35% We need to try to keep the girl child in school longer and avoid early marriages.

The UN General Assembly a few years ago stated that “poverty, underdevelopment and illiteracy are among the principle contributing factors to the spread of HIV and AIDS.” So much remains to be done in this area in Zambia.

In spite of all these challenges, we must have hope as we continue to do what we can to prevent the further spread of HIV and AIDS. We must remember that with God all things are possible. We must continue to try to win the battle against HIV and AIDS and not give up the struggle.

Quarterly Bulletin

Bulletin 80 2nd Quarter 2009