ABC

In most countries trying to combat the HIV pandemic, prevention strategies have adopted the ABC approach. That is Abstain, Be faithful, or Condomise. Sometimes, D is added for ‘you Decide’. This is not so popular in more conservative countries where it is felt that abstinence should come first and condoms should only be for high-risk groups such as sex workers. In Chipata, where the HIV infection rate is around 26% its difficult to see who isn’t a high-risk group. Something I’ve been puzzling about is whether the Zambian preference for abstinence-focused prevention campaigns comes from the country’s tendency towards conservatism, or whether it comes from following the money donated from the USA through PEPFAR (the Presidents Emergency Plan For AIDS Relief). PEPFAR is a massive donor, and has saved lives particularly through the provision of anti-retroviral drugs, but its funding is also controversial as this recent exert from a Zambian HIV/AIDS newsletter shows:
Treatment Advocacy and Literacy Campaign (TALC) activist Paul Kasonkomona is alive today because of PEPFAR support. He receives his supply of life-prolonging ARV drugs through the PEPFAR-funded CIDRZ program. This is what he has to say about PEPFAR and US Government funding in Zambia:

“The drugs keeping me alive are provided through PEPFAR, and that is good. My genuine feeling is they are doing the right thing when it comes to treatment, but there are some issues that we need to look at. When the US Government came in, the first thing they did was fund the treatment programme and said we buy the treatment from the US pharmaceutical companies, which sell drugs that are around 10 times more expensive than those from Indian and Brazilian companies”.

“While things have since changed, that US monopoly led to less Zambians receiving treatment. So while the US Government is trying to do the right thing, there is also selfishness there. We need to look at treatment for discordant couples (where one partner is HIV positive and the other is HIV negative) and when they say we shouldn’t talk about condoms with PEPFAR money.”

“What about when we have a HIV positive person in a committed relationship who is receiving ARV treatment? If they do not know about using condoms and do not have access to them then they will continue to have unprotected sex and risk re-infecting themselves, or infecting their partner, with a new strain of HIV. There is also the reality of women in relationships where they do not have the power to say ‘no’ to sex with their husbands, despite knowing that HIV is present in the relationship and that the risk of re-infection is real. Programmes that preach abstinence are not relevant to such women, and in fact do more to disempower them, and leave them more vulnerable to increased risk of AIDS.”

“Being re-infected with HIV makes you resistant to treatment, ultimately undoing much of the usefulness of the US Government supplying the treatment in the first place. It seems PEPFAR cares about treating HIV, but not about avoiding resistant strains of HIV.

“I’m not saying that abstinence is bad, but let us balance this campaign. Let those who choose abstinence have it, but let us still help those who have sex and teach them to take responsibility and use protection.

“The impact is also evident on the youth when we are made to say the youth should practice abstinence. I was asking a youth worker just this week how they relate to youth who have tested HIV positive.

“When you talk about HIV infection, the youth are the most at risk and so many are obviously sexually active already. So what use is an abstinence message to them? It pushes HIV positive away from treatment, care and support.

“What is needed from the US Government is funding choices that are left in the hands of Zambians. They have got to give Zambia a platform and say, “We have this amount of money, what are your priority areas?’ and then let us as Zambians be the one’s to decide.” (originally published in Partners Zambia newsletter, 25th July)

In Zambia, American Christian Fundamentalists have found fertile ground for their abstinence-only messages. Zambia is already a deeply conservative country, or at least people express conservative, moral sentiments at the public level. What happens in reality, unsurprisingly, is that a majority of people do have sex before marriage. This is the same as what happens in the USA, but Bush and the Christian right are not willing to promote condoms there either.

Abstinence-only funding can be even more inappropriate in countries such as Thailand where many people are infected through sharing of needles in intravenous drug use.The Global Fund, supported by Britain and many other countries is not free of error either. While in my view it has the right intentions, the gaps between the donors, the co-ordinating body in Zambia and the community organisations implementing activities lead to skewed and often ineffective results.No New Money Logo

 

Many activists, and now the US Congress are pushing for changes so that each country can determine how money can best be spent there. But as I said I’m not sure that the prominence of abstinence-only messages in Zambia is entirely the fault of PEPFAR. If the Zambian people are given control of how the money is spent, might there be an even greater degree of moralising and condemnation of those who have sex? The Zambian government has kept a ban on condom distribution in schools because it is suggested it will promote promiscuity among young people, despite evidence to the contrary.

Whether this moralising first came from US AIDS money, British Christian missionaries or the Zambian people long before this doesn’t really matter. What does matter now is that the international community ensure money is spent on evidence-based ways of tackling HIV/AIDS.

More information:

AVERT UK based AIDS information service

PEPFAR-watch US based organisation promoting accountability of US Global AIDS programmes through Information and Advocacy

No New Money US based organisation fighting against abstinence-only programmes in the US

PreteNdGOs

July 23, 2007

Working in Zambia has been a bit of an eye-opener for me. In the UK I was involved in campaigning for ‘global justice’ with several organisations. These organisations portray the poverty in Africa and suggest how individuals can help either by campaigning for changes from governments and companies, or by donating to relief and development projects. While this simplified message is understandable given the short attention span of the public, the reality has left me a bit disillusioned. Most Zambians I know are not remotely interested in global justice. They want cars and iPods. But because of donor money available they do set up organisations which claim to fight poverty.

There are over 10,000 NGOs registered with the Zambian government. Almost all have a mission, vision, moto, logo, constitution and strategic plan. My experience is that only about 1 in 10 are implementing activities at any one time. In a country with over 50% unemployment, people seek the easiest route to employment. This is often starting a non-governmental organisation as Zambia is one of the countries which has received the most aid since independence.

In Chipata, the fourth largest town, the UN are represented by the World Food Programme and UNAIDS volunteers. There are several large international development NGOs, World Vision, Care International, Plan and Africare. There are perhaps 50 medium-sized organisations with staff, premises and activities, and several hundred smaller organisations. Most upwardly mobile young people I speak to are trying to set up NGOs not businesses because of the easy money that comes with it.

There is a great deal of learnt dependency. People are used to getting money from willing donors so have tired of coming up with ways in which they can work themselves out of poverty. Of course I am working in an urban setting, and many rural Zambians would never have even seen a white person, never mind accepted donations. And its wrong to suggest that Zambians are lazy. They work incredibly hard tilling fields and cycling the produce to market.

In a bid to avoid corruption, donors will often only fund projects, rather than overheads and staff. This is understandable given the lack activities carried out by organisations. However it also leads to organisations collapsing, reforming, and failing to develop over a number of years. Inactive organisations are labelled ‘briefcase’ organisations, and are usually characterised as being run by inexperienced people. But the problem I have run into is organisations run by ill-intentioned people who are very experienced in fiddling money from donors, what I call PreteNdGOs. Given the poverty levels, most people are not willing to volunteer. This coupled with the corruption is confusing coming for people coming from Britain where people who are not willing to volunteer are seen as selfish and those who steal from charities as the spawn of the devil. These concepts don’t hold here, which is a big reason why in my opinion aid doesn’t work as well as it could.

However I would not want to understate the poverty here. There are many people who do not eat enough, die unnecessarily and have few if any material possessions. But this is not because their is a lack of food, or a lack of money to solve these problems. Its because this food is not distributed fairly, and people do not have either the power or will to solve their problems. The lowest rank of Zambian society, often illiterate and malnourished, can not challenge the government because they do not know how. But the organisations that are supposed to help them do this are staffed by people who have managed to create a comfortable existence for themselves by Zambian standards and do not seem particularly intent on changing the status quo.

I don’t know if the solution is to cut all aid to Zambia as this would almost certainly make things worse, but cutting it a bit and making sure people have to work hard to gain it again wouldn’t hurt. One thing I am surer of is that if development is to happen it has to come from the people affected, or its likely to be pointless and misdirected.

Vulture Funds

April 25, 2007

Vulture FundsAs if Zambian politicians didn’t have enough problems effectively managing public funds, a private company which bought up debt several years ago recently tried to claim $55 million from the public coffers. A portion of Zambia’s debt was bought up by a company called Donegal International for $3.3 million. They tried to claim $55 million from the Zambian government, but a British Court reduced this to $15 million.

It’s quite a bizarre way to make a profit, so if you want to take action on these so-called ‘Vulture Funds’ then you can write to Donegal International’s Michael Sheehan and tell him to drop this claim against Zambia. Click here to go to Oxfam’s site and write the nice man a letter.

One of the shocks for overseas people coming to work here is the slow pace at which things get done. Bureaucracy and a massive capacity for doing bugger all mean that things that would take a stressed out Brit about 10 minutes to get done can take several months.

 

We were all shocked then, when last month the government caved into pressure from the gender equality lobby and declared a public holiday for International Women’s Day with only hours to go. Everybody snapped into action to spread the message of this impromptu day off and made sure that they definitely would not go to work the next day.

 

Its not so much that Zambians are lazy, as the huge loads carried on bicycles show, but that they don’t seem to get bored with inactivity. 10 young people will happily sit in our office for hours on end, doing literally nothing. If they have malaria then they put their heads down and rest, but the rest of the time they can fill sitting and staring. Its also not that they don’t want to do anything, but more that they’re not sure what to do. If I give them a mundane task they will leap to get it done, but if they’ve got to come up with their own tasks they seem to struggle.

 

There is very little exposure to external creative influences although both Craig David and Westlife have recently penetrated the Zambian music scene so watch this space.So Unbelievable

Climate Impacts

February 12, 2007

It’s been sunny here in the Eastern Province of Zambia for a few days which is good news for farmers. The rainy season had been wetter than most years, with no break which meant that fertiliser had washed away and the crops had insufficient sunshine.

Most people here grow their own maize, which they grind to form the national dish, nshima. Changes in the climate such as happened this year are hard to predict. The Met office had predicted a good year for agriculture, so the government was able to sell off food surpluses from last year to other countries. But the predictions proved inaccurate leaving many people vulnerable to a lack of food for the whole year.

I’ve been frustrated with some Western development workers here who suggest that Zambian’s don’t care about their environment, while they jet about the globe for week-long breaks. The emissions from my flight out here meant that I had already exceeded sustainable levels of greenhouse gas emissions for the year by several times. I use more electricity than most Zambians, and I will travel considerably more over the course of the year. Much of the food I buy is imported while most of theirs comes from within 100 yards of their house. It is people like me who cause climate change, not the huge majority of Zambians. But for now it’s them who have to deal with the problems.

It’s true that there is rubbish at the side of the road, but in the UK we produce much more, it just gets put out of sight in landfills. People love banging on about uncontrollable population growth in developing countries as the major cause of environmental degradation. But Zambia has 10 million people in an area 4 times the size of the UK. They’re hardly squeezing in.

  Charcoal cyclist

Most people walk, those that don’t use bicycles even to carry roofs, charcoal and goats. In a town of over 300,000 people I haven’t seen a traffic jam. In fact if you removed the vehicles of the development agencies, there would be very few cars here at all. Rurally very few homes have electricity, and health centres are usually powered by solar panels. If you enter Zambia as a tourist by car or air you have to pay a carbon tax. At £12 to travel the length of the country it doesn’t exactly break the bank, but it’s enough to make people think (or at least moan).

Glass bottles are always returned and reused. Everything is fixed and repaired until it can’t possibly be used anymore. The front tyre of my bicycle is now composed of several former inner-tubes cobbled together.

I’m not suggesting Zambians are angelic greenies, and I’m sure if most had the money, they would get a car or fly like we do in the UK. But its important to recognise that there are environmental problems caused here, by the activities of people in the UK and the rest of the West. Most of the excess carbon dioxide in the atmosphere, does not come from China and India or other developing countries, it comes from Europe and the USA. We can’t keep shifting the blame.

The average Zambian emits 0.19 tonnes of CO2 per year while the figure for Britain is 9.4 tonnes (US Department of Energy’s Carbon Dioxide Information Analysis Center, 2003). This is FIFTY times as much.

Present global emissions per annum are estimated at about 8GT Carbon (IPCC) which equates to 30 GT of CO2 which is 30 000 MT. So in other words the USA is responsible for about 20% of all emissions, the UK for about 2% and Zambia for 0.006%! This places it 184th out of 211 countries in the world.

The most credible model of cutting greenhouse gas emissions is that of contraction and convergence. This is where rich countries reduce their emissions to a target, say 1 tonne per person, while poor countries are allowed to increase theirs to this level. If the world decides to tackle climate change in this way, Zambia will be allowed to increase its emissions by 5 times.

Maybe, rather than getting annoyed with my jetsetting colleagues, I should be comforted by the fact that Britain will warmly embrace all the climate refugees who leave Africa when their crops permanently fail…..

The Field

January 22, 2007

 lundazi-road.JPG

After 3 blogs by Zambians I’m back! Please ask any questions you have for Henry, Yokonia, Linda and any other Zambians on HIV/AIDS.

 

On Monday I went to The Field. Here this means going to do some work in the rural areas. Typically rural areas are poorer and have greater adherence to tribal and traditional ways of life. But their isolation means that HIV and some of the other problems of urban life aren’t as pronounced.

 

I was trying to explain to my Zambian friends that in the UK rural villages do exist, but was struggling to explain that they can be both wealthy and backward….should have brought a copy of the Daily Mail.

 

I was in Temanda, an hour north of Chipata. We stayed at Temanda Basic School, on the floor of a disused classroom. In the evening the Zambians played drums and sang songs. We ate Nshima (ground maize porridge) and kapenta – smelly little fish. There were no rats or snakes, and my sleeping bag ensured the only mossie bite I received was a corker on my forehead.

 

The volunteers doing the field work were from my organisation, but it was with a sister organisation called the National Cultural Peaceworkers team. They’ve been to the same 10 rural areas in 1998 and 2002 asking the same questions on HIV/AIDS and child defilement. At the end of each research period they present drama and deliver peer education tailored to the needs of the cluster of villages round the school at which they’re staying.

 classroom.JPG

As I was technically skiving, I only hung about for one night. Kampala the village we visited in the morning looked really nice. The rainy season has made the surrounding hills green, and there were a good number of goats, pigs, chickens and tortoises roaming around.

 pigs-2.JPG

We chatted to a young man who said he knew about HIV/AIDS, but wasn’t aware of any child defilement cases in the village. Next we chatted to an old woman who said there had been a case of child defilement but it had not been reported to the authorities. Instead the father had left his daughter a dowry of a cow. We couldn’t talk to any other people, as they were several miles away tending the fields.

tortoise-2.JPG

I was left thinking that while village life wasn’t as fast-paced as the swarming metropolitan hub that is Chipata, it was much nicer. You can’t really be unemployed in the village as you just tend the fields and livestock, while unemployment among young people in the town is above 50%.

 

If there’s one thing that’s clear here, its that gender inequality is a massive problem. Even the volunteers I was with, who are active on gender inequality, fell into the usual traps. They started well by insisting to the school headmistress that they could stay in the same building without having sex. But by the evening, the girls were cooking and washing up while the guys did the important work of meeting the headman, and carrying the water. The morning was worse with all the girls up at 5.30am busy cleaning then preparing breakfast. The boys lay in for an hour and a half until the rice was ready. When I insisted I could wash my bowl myself and they should make the other boys do the same, they laughed and said it’s just Zambian tradition. I don’t know where they got this respect for crap traditions, maybe they have been reading the Daily Mail.

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Two boys were convinced to give me a bicycle taxi the 5 miles to the main road, which was really pleasant for about 10 minutes and then really painful. He didn’t understand English and my Chichewa didn’t stretch to “can I pedal now” so he just laughed when I kept pointing at the saddle.

 

After 10 minutes’ wait I hitched on a big truck going to Chipata. I was a little concerned overenthusiastic traffic police would pull over such a knackered truck, especially with the promise of a muzungu bribe. But it turned out it was a Roads Department vehicle. I had also been warned that they would try and charge me 25-30 pin, when I should be paying 15. As usual Zambians confounded the stereotype and only charged me 10. Not to mention that they let me sit in the cab for the second half of the journey with a chicken on my feet at no extra expense.

The biggest issues facing young people in Zambia are unemployment, boredom, and HIV/AIDS. As young people are the most productive group in society HIV has a big impact.

 

The solution is to promote condoms among youths rather than abstinence – they may be hearing the words but youths are not changing their behaviour as girls as young as 13 are having babies. Condoms are still stigmatised – people say ‘why would you eat a sweet with the wrapper on’.

 

I found out I was positive in 2002 after going for Voluntary Counselling and Testing. Before finding out I was positive I knew very little about HIV. When I found out my status I laughed…but soon became very depressed.

 

I felt like I was already dead. But I started taking action on HIV/AIDS in Chipata which helped. I am now a peer educator and an active member of the Network of Zambian People Living Positively.

 

I have had four children, the third was born HIV positive and died young, but my last born is now two and is HIV negative. I carefully followed all the precautions such as not breastfeeding so as not to pass on the virus.

 

A year ago Anti-Retro Viral drugs would have cost £60 for a course which barely anyone could afford, but the government has committed to provide them for free now. There are side-effects, but when people take them it improves their appetite. My CD4 count fell below 50 recently, I would be eligible for free ARVs with a count below 200 but haven’t taken them. I believe that a positive attitude and strong faith keeps me healthy.