Zambian AIDS Epidemic, World Pulse on Ground!

Dispatches from the Zambian AIDS Epidemic

This July, World Pulse Managing Editor Corine Milano traveled to Zambia as an International Reporting Project Fellow to cover health issues from the epicenter of the HIV/AIDS epidemic. With one of the highest HIV infection rates in the world—14.3% of the adult population—the Zambian people face an uphill battle.

This series of interviews and firsthand accounts from World Pulse community members in Zambia reveals the strength of the country’s women, who are holding together families and communities through an enduring health crisis. They are taking the lead as heads of household, community activists, outspoken survivors—and even soap opera actresses. They are the voice of a changing Zambia.

After close to 30 hours of travel, I’ve arrived in Zambia!

For those of you who don’t know, I will be spending the next fifteen days in Lusaka and neighboring cities reporting on HIV/AIDS, Malaria, and Tuberculosis with the International Reporting Project. I am so thrilled to have the opportunity to meet with women on the ground who are on the front lines of these global health issues.

I’ll be updating regularly about my experience here in my World Pulse journal. I’ll also be meeting with the amazing World Pulse ladies who hail from Zambia to help them tell their stories to a global audience.

AND, at the end of the month, I’ll be hosting a meet up of Zambian members in Lusaka. I can’t wait! It will be a powerful experience to be surrounded by the women and men who are leading change in this beautiful country.

“It’s the elephant in the room, in the country,” says Dr. Manasseh Phiri, renowned physician, journalist, and activist. He goes on to say it’s large, hard to ignore, and consumes a massive amount of resources.

He’s talking passionately about HIV and AIDS in his community, and he has every right to be impassioned. Zambia, where Dr. Phiri resides, is at the epicenter of the AIDS epidemic, with 14.3% of its 13.3 million people affected.

Since arriving in Lusaka on Sunday, it’s been a whirlwind of site visits, panel discussions, and personal interviews with grassroots women leaders. I’ve learned a lot about the condition of women in Zambia—especially as it relates to HIV/AIDS.

“The face of the Zambian epidemic is the face of a woman,” says Dr. Phiri. And from what I can tell, he’s right. Everyone I have met with to discuss the topic has mentioned that cultural traditions that oppress women are at the heart of the spread of this disease.

“The woman’s lot in Zambia: You are born to make your man happy,” says Dr. Phiri.

Dr. Phiri tells us that it’s not unusual in this country—or particularly frowned upon—for a married man to have multiple, concurrent partners. A woman is encouraged by her peers and elders to tolerate this behavior and stay in a marriage despite the risk it puts her at for infection.

What’s more—transactional sex is rampant: In a country where 64% of the population lives below the poverty line and going to school requires access to resources like school uniforms, books, and writing utensils, it’s not uncommon for a young girl to trade sex for a high school diploma. And it’s of course difficult for a girl in this position to advocate for this sex to be safe and protected.

“Women have no right to demand for safe sex, even in the context of marriage,” says World Pulse member and HIV/AIDS activist Prudence Phiri. “In our tradition, it’s taboo for a woman to say ‘I can’t have live sex with you.'”

That makes negotiating condom use next to impossible for a woman in Zambia. This, combined with the issue of concurrent partners, means that the disease disproportionately affects women: 16.1% of women suffer compared to 12.3% of men.

That statistic coupled with the negative cultural traditions that contribute to infection, leads Dr. Phiri to believe that empowering women is the key to eradicating the illness.

“If we can get women to have the strength to control how they have sex, we can go a long way in dealing with (HIV/AIDS),” he says. “It is a personal belief that women are key to solving [this crisis],” says Dr. Phiri.

So how does one go about making such a huge cultural shift?

Dr. Phiri believes it starts with educating girls—but more than that, it’s about “changing the mindsets of the men who they are sleeping with every night.”

Changing the mindsets of men in order to reduce HIV/AIDS infection rates may seem like a tall order, but Zambia’s done it before.

The practice of male circumcision is a scientifically proven method of curbing HIV infections in men, but it’s never been a widely practiced tradition in Zambia—until now. Through government efforts, support from tribal leaders, and advocacy campaigns, Zambia has managed to circumcise an estimated 300,000 males, with a target of circumcising 80% of all HIV negative uncircumcised adult males aged 15 to 49 years, according to The Post, one of Zambia’s leading newspapers.

If we can find a way to replicate this success when it comes to men’s attitudes about sex with their female partners, we might just find a solution to one of the biggest global health crises the world faces today.

“Today marks day seven in Zambia — about the half way mark of my journey with the International Reporting Project—and I’m sitting outside on the steps of my accommodation at the Macha Research Institute in Macha, Zambia. I’m typing in a Word Document because Internet access is hard to come by in rural areas like this. It’s here—available by Airtel data purchases that allow Zambians to connect online via their mobile phones—but the cost is expensive and often prohibitive.

I’m awaiting sunrise, because there’s something magnificent about the way the sun comes up in Africa. I remember it from my time in Kenya and Rwanda two years ago. The light casts a soft pink glow on everything around, and the sky seems to glow.

It’s 6:30 in the morning and the air is cold and crisp—it’s winter in Zambia, after all. Roosters are crowing from the homesteads around the Institute, signaling that it’s time to wake up, and the birds are singing a beautiful morning song. The sounds here are different from what I hear back in Portland, Oregon, reminding me that I am a long way from the place I call home.

As I mentioned, I am in Macha—a beautiful, rural village about 300 KM outside of Lusaka in the Southern Province. Yesterday, we had a full day of programing that included a site visit to the local mission-run hospital. We had the opportunity to tour the grounds, meet with doctors, and discuss health issues with patients with the assistance of a translator.

I learned that of the 208 beds in Macha’s hospital, most are in the women’s ward. That’s because the most common ailment treated here is complications from pregnancy. As a World Pulse staff and community member, this doesn’t surprise me. I’ve been passionate about maternal health for a long time, primarily because so many of the women in this community write fiercely about the challenges they face when it comes to maternity care.

In May, I worked with our community to detail these challenges and to propose potential solutions to the issue. I was deeply moved by the stories we received, and deeply affected by the power behind each woman’s submission. Still, it’s a different thing to read about what many women face when it comes to maternal health care than it is to see it first hand.

At the hospital, I met Melody Hachibamba, a 26-year-old young mother of two who gave birth to a stillborn child three weeks ago. The doctors suspect she has fistula—a hole in the vagina or rectum caused by prolonged labor. Left untreated, it can lead to severe complications and death. The pain in Melody’s eyes was palpable, the loss of her child obvious and heartbreaking. But she is one of the lucky who is receiving treatment for her physical ailments. UNFPA estimates that there are two to three million girls and women in developing countries who, like Melody, are living with obstetric fistula. Many do not have access to health care.

I left that hospital feeling a bit hopeless. It seemed to me that Melody and her community members are fighting an uphill battle. And they have little access to a place like World Pulse where they can come together, share, learn, and express. Accessing our site via mobile is costly; language barriers are an issue. This is all good feedback for us as a team as we begin to develop the next phase of our online platform — a version of our site that is less heavy and easier to access via mobile, that uses crowd-sourced translations to allow even those in rural villages who speak tribal languages to connect and reach out.

Then, I remembered all of my World Pulse sisters who are fighting exactly these things: issues of access, issues of poverty, of oppression, of disparities in health care across the world. I am strengthened knowing that Melody has women on her side who are championing her, who are speaking out about what needs to be done to prevent this very preventable disease…and others like it. I said goodbye to Melody knowing that there are mothers, activists, health care workers, journalists, and grassroots women leaders across the world who can speak for her until we are able to provide the right platform for her to speak for herself.

I leave Macha today with prayers for Melody and the other women in the ward in my heart, with hope that together we will create the systems that are needed to overcome the immense barriers that women in rural areas face each day. I leave Macha today knowing that we, together, can do this.”

OTHER HELPERS ON SITE: Phil Thuma, MD, managing director of the Malaria Institute at Macha, says that there has been a remarkable decrease in malaria case load in Macha since the research institute has been carrying out research studies. Thuma believes that credit goes to the remarkable local community cooperation with the research studies and ownership by the community and MIAM staff of the research programs, which has led to a wonderful research working environment.

Since its inception, MRT and its sister institution Macha Mission Hospital have witnessed remarkable improvement in the health and well-being of the Zambian people living in regions surrounding Macha. Of particular note is the drastic reduction in infant and child mortality rates from malaria over the past 10 years, with a more than 97% reduction in malaria case load at Macha Hospital during that time period.

Research work at Macha Research Trust on human malaria, HIV/AIDS and tuberculosis is an effort to alleviate worldwide suffering and death from these diseases.

Since the vast majority of malaria occurs in endemic areas of Africa, most of the clinically based research must be conducted in that continent. MRT is uniquely situated in a rural area of Zambia that is endemic to these diseases. HIV/AIDS and tuberculosis are commonly found in Zambia. Various aspects of the laboratory-based research are carried out with collaborating institutions within Zambia and internationally. All research projects at Macha are carried out using the principles of ethical science with the ethical approval of local (Zambian) Ethics Review Boards and the Institutional Review Boards of funding institutions

Research interests
Johns Hopkins Malaria Research Institute, International Center for Excellence in Malaria Research (ICEMR)

CORINNE: “Today is my last day in Zambia. My flight leaves at 9:30 tonight, and I am eager to soak in the last little bits of this country in the few hours I have left.

Today will be spent meeting with two strong Zambian women—Dorcas Chewe, who wrote the piece ZAMBIA: Picking up the Pieces, and Sally Chiwama, a local blogger and reproductive rights activist based in Lusaka. Both have not yet joined the community, and I am excited to walk them through the process and help them reap the benefits of World Pulse.

Dorcas lives in the Copperbelt—about a five-hour bus ride from Lusaka. She was unable to attend the meet up given the distance, but she was determined to meet with me before I leave, eager to learn about World Pulse and how she can become more involved in the community. This morning, she boarded the bus for the long journey to Lusaka so that we might meet in person. I am excited to share with her the work we do and to learn from her about how we can best support her community.

This is the energy I am seeing in Zambia—excitement about connecting with others, excitement about sharing stories, excitement about the future of this beautiful, emerging country. It is energizing and motivating. These connections renew my commitment to broadcasting the voices of women around the world; these connections renew my commitment to this community we have so lovingly built.

How will it be when I return home, I wonder? I am eager to share my learnings with the rest of the team, eager to see my family, eager to maintain the connections I have built in Lusaka. Technology will make that possible—email, Skype, and of course World Pulse!

And yet, I leave Zambia with a bit of a heavy heart. There is so much work to be done here, and in other parts of the globe. There is immense pain, immense loss. But there is also immense hope as women band together to fight the issues that affect them. I wish I could stay in Zambia and see these efforts through to the end. Zambia’s women’s movement is on the verge, and when women come together great things happen.

I will follow along as the women I’ve met post in their journals; I will keep Zambia close to my heart, and hopefully, I will find a way to return to this beautiful country where so much remains possible.”

Corine Milano
Managing Editor, World Pulse | Member since 2007

My Passions:
My family, reading, writing, traveling, learning, expressing.
My Challenges:
Impatience. Recognizing that it takes time.
My Areas of Expertise:
Media analysis, web 2.0, global and US based feminism, obsessing over the details, all things literary.
My Languages:
English, French

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I’ve flown to Zambia as a Zambia Health Fellow with the International Reporting Project. I will be meeting with experts on global health issues; going on site visits to some of this country’s most successful projects; and meeting with World Pulse community members who call Zambia home.