Kristin Palitza interviews HENRY MALUMA, Oxfam Zambia essential services coordinator
CAPE TOWN, Sep 30 2009 (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.
HIV prevents many Zambian children from attending school. Credit: Kristin Palitza/IPS
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.
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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.
