World AIDS Day

December 1 was "World AIDS Day". Here at MEF, we observed it with a morning educational workshop on HIV followed by free testing and counseling offered by a community agency and Sister Margaret, the nurse in our clinic. Later in the day, some of the high school students who are participants in projects sponsored by MEF practiced dances, drumming, drama and poetry they had developed. They commemorated the day on Saturday in a youth-oriented event.

One in seven Zambian adults is HIV+, with the highest rates in urban areas. Life expectancy has declined to 39 years. Out of a population of under 12 million, there are at least 700,000 AIDS orphans. The epidemic has created labor shortages in many sectors, including education.

HIV/AIDS is manifested differently in sub-Saharan Africa than in other parts of the world. Here, 60% of the people living with HIV infections are women. Young women, between the ages of 15-24, have a rate four times higher than young men of the same age here in Zambia. Several factors seem to account for this. First, there is little comprehensive sex education, and misinformation about HIV abounds. There is a tendency for teenage girls to begin sexual activity at a young age, and with much older men. Gender violence is common, both within and outside marriage. Women are socialized to believe that they should never say no to their husbands or partners, or ever demand the use of a condom. A cultural norm of men having multiple sexual partners, even after marriage, contributes to the spread of HIV infections among women.

The HIV infection rate within Zambia's prisons is nearly 30%. Official rules state that sexual activity between inmates is prohibited, so condoms are not allowed, despite efforts of various groups to advocate for a change in this policy. When ex-offenders return home, they may spread the infection to their wives and girlfriends.

Even though churches have begun to participate in HIV/AIDS education and many have even encouraged condom use, there is still a high degree of moral judgment and stigma evident. Family members are said to have died from malaria or TB or other conditions, without acknowledging, even to themselves, that HIV/AIDS was the underlying cause. I was surprised to hear so little mention of anyone caring for an infected friend or relative. With over 200 students and probably 40 staff (including security, kitchen, housekeeping, and special projects plus lecturers and administration), there is no support group on campus for those living with HIV. MEF does have an AIDS policy assuring that there will be no discrimination and giving medical leave for treatment.

Zambia has made a commitment to the Millennium Development Goal related to combating HIV/AIDS. How close the country will come to its aspirations is the issue. Prevention and treatment efforts here have been hampered by the inadequate health care system and corruption within the Ministry of Health. Antiretroviral treatment is available to less than 2/3 of those who need it.

Where do we go from here? The medical community, social workers, and the church could mount a strong, visible campaign to get people to talk about HIV/AIDS without shame or judgment. I'm planning to engage in some low-key informal activities at MEF that might lead toward the formation of a support group if there is interest and willingness among the students and staff. Any other suggestions?