Of the world’s 25.8 million people estimated to be living with HIV and AIDS, 60% are sub-Saharan Africans. 90% of children living with HIV and AIDS and 80% of those orphaned by HIV and AIDS also live in this region. Zambia is one of the countries worst hit by HIV and AIDS in Africa - 17% are estimated to be living with the virus. As a result, there are an estimated 710,000 AIDS orphans in Zambia. The Southern Province, where SAPEP operates, has the highest prevalence rates outside the capital.

The effects of untreated HIV cases can be catastrophic for a community. Those most at risk of HIV infection are the most sexually active, who are also often the most economically active members of society. AIDS-related deaths lead to children losing their parents, a community losing its back bone and a country losing its economically active. This inevitably leads to further poverty and can make the disease self-perpetuating.

As a direct result of the AIDS epidemic, life expectancy has now crashed as low as 33 years old by some estimates.

HIV prevalence rates are generally higher in urban areas than rural areas. However, prevalence in rural areas is on the up. Comprehensive knowledge about AIDS (defined as correctly identifying two ways to prevent HIV/AIDS and rejecting 3 misconceptions) in rural areas is considerably lower than in urban areas. 43% of the urban female population and 46% of the urban male population have comprehensive knowledge about HIV and AIDS, in rural areas, only 23% of females and 30% of males have this knowledge.

Gender relations are in turmoil. Modern interpretations of Tonga customs and traditions coupled with western influences and a money-based economy have disempowered women and robbed them of the ability to make responsible decisions about their sexual activity. Lobola (bride price), sexual cleansing, nkolola (initiation into womanhood) and other customary practices all directly or indirectly perpetuate the spread of HIV and AIDS.

There are signs of behaviour changes among some groups but misconceptions are still rife. The 2005 Zambia Sexual Behaviour Survey showed that comprehensive knowledge of HIV and AIDS prevention was particularly low among those living in rural areas.

Just 13% of Zambian adults have volunteered to be tested for HIV and know their status. There is lots of work to do to make people aware of the benefits of voluntary counselling and testing.

Free antiretroviral treatment for those living with the virus began in 2004 with strong cooperation between government, NGOs, churches and communities. Over 50% of those who need treatment are accessing it – remarkable in a country whose health infrastructure is so weak. However, access is much more difficult in rural areas. In addition, adherence to antiretroviral treatment programmes – which require that the individual takes their pills at the same time each day and eats a balanced, nutritious, diet – is not 100%.

Sources:
UNAIDS/WHO, 2005
UNDP, Human Development Report, 2007
Zambia Demographic and Health Survey, 2002
AVERT, 2008