LUSAKA, ZAMBIA – Ireen Mpundu, 17, works as a tailor and sells tomatoes, vegetables and sweets at a market near her home in Garden, a compound of Lusaka, Zambia’s capital. Mpundu says she has to earn money to look after her young brother and herself because both their parents died from HIV.
“My mother was the first to die,” she says with teary eyes. “She died in 2008 when I was 14 years old. Then, several months later, my dad also became very ill and passed on.”
Mpundu, who is living with HIV, says she was born with the virus. She says that after her parents died, none of their relatives bothered to take her and her brother in.
But she says she is used to being a caretaker. Mpundu says that she had to nurse her father, a plumber, during his illness. She looked after him at home and at the hospital until he died.
When her parents died, she says she stopped going to school for while.
“I was so depressed that I could not concentrate at school, and I also did not have any support or money to buy books and pay for my fees until eventually I started to do some tailoring and to sell tomatoes and vegetables at the market near home,” says Mpundu, whose mother had been a tailor.
She says she uses the meager profits she accrues from selling tomatoes, vegetables and sweets to look after her and her brother’s basic needs. She is now back in school, and she uses the money she earns from her tailoring to buy their books and pay for their school fees.
“My brother goes to school during the day while I am sowing and selling,” she says. “Then I go to school in the evening.”
But she says that living with HIV makes these daily responsibilities difficult. Health practitioners have advised her to maintain a balanced diet, but she can’t always afford proper meals. Some days, she says she feels too sick to attend classes and to take care of her brother.
There are many other young women in Zambia who, like Mpundu, are directly or indirectly affected by the HIV and AIDS epidemics.
With HIV prevalence higher among women than men in Zambia, experts say the epidemic now has a women’s face here and, therefore, requires more specialized intervention programs. Women living with HIV say that women must be taught how to live positively with it. The government offers free antiretroviral drugs, ARVs, and Zambians look to their newly elected president to continue efforts to combat the epidemic here. Meanwhile, nongovernmental organizations, NGOs, are working to support people living with HIV and AIDS and to prevent new cases.
With a prevalence rate of 14 percent, Zambia has one of the world’s worst HIV and AIDS epidemics, according to the United Nations. The HIV prevalence rate among Zambians ages 15 to 49 is 12 percent for men yet 16 percent for women, according to the most recent Zambia Demographic and Health Survey in 2007.
Women are biologically more vulnerable to HIV infection than men, according to AIDS Epidemic Update 2009, a report by the Joint United Nations Program on HIV and AIDS. The report attributes this vulnerability to entrenched gender norms and inequalities that lead to power imbalances in relationships, reducing the ability of women to control or negotiate sexual relations and condom use.
Professor Nkandu Luo, a renowned Zambian HIV and AIDS activist, researcher, health consultant and gender activist, says that the HIV epidemic in Zambia no longer affects the population generally. Rather, she says that it affects young women here the most.
Luo says that the rates of HIV infection in Zambia are higher among women than among men. Moreover, she says that women, considered the caretakers in society, carry the burden of care because they are the ones who look after HIV-infected people.
Luo says that since the HIV epidemic in Zambia has a “female face,” HIV interventions should be designed to deal with specific needs of vulnerable groups, which include women, children and people with disabilities. She cites a need for increased and concrete efforts to prevent HIV in Zambia, especially among young women, who she says are most affected by the epidemic here.
She recommends specific plans that focus on risks, vulnerabilities and disparities specific to young people. She says these plans must also account for how factors such as poverty, gender inequalities and human rights violations play into the HIV epidemic in Zambia. Luo also says that researchers should explore the role that culture and tradition play in the increasing HIV transmission rates among young women.
“There is [a] need to do away or alter cultures that are harmful to women in Zambia, in that they subject them or place them in a position where they are at higher risk of contracting HIV,” Luo says. “Misconceived cultural and social beliefs – such as the belief that sex with a virgin can cure AIDS in men, sexual cleansing, wife inheritance and other such beliefs – must be abashed.”
Luo emphasizes the need to keep meaningful dialogue going with relevant stakeholders and the affected and infected persons, whose involvement she says is lacking in current HIV-reduction interventions in Zambia. She says that the current programming and HIV prevention and reduction efforts are too general to effectively respond to some of the HIV problems and difficulties faced by some vulnerable groups, such as women, girls and the disabled.
Viola Morgan, Zambia country director of the United Nations Development Program, says it is important to ensure that mainstreaming gender in HIV programs is done properly. She points out the need to double up efforts in coordination and response to HIV-related problems.
“There is no doubt that the main drivers of the HIV pandemic remain a challenge for most women and girls, who at the same time are the most infected and affected,” she says.
Morgan says that HIV-prevention programs need to begin involving young women at all levels. She says that for a long time now, women only hear and learn about HIV, but that this is not enough. Instead, she says they need to be included in the planning stages of all HIV-prevention programming so that they can contribute because they have a better understanding of their own needs. She says that people must begin to think outside the box to find ways to expand HIV-prevention options, especially for women living with HIV in Zambia.
Luo and Morgan both spoke at Zambia’s first Women’s HIV Prevention Convention, which took place in Lusaka in August. Coordinated by Luo, the convention drew policymakers, U.N. representatives, national and international researchers, civil society members, advocates and national program implementers.
Clementine Mumba, executive secretary for Network of ARV Users, a support and advocacy network of people living with HIV and AIDS, says she has lived with HIV since December 1998. She says women living with HIV in Zambia must be helped and taught how to live positively, as she has done for 12 years now. Mumba says that if women are taught how to live positively, there will be less children orphaned by the HIV epidemic.
“To start living positively, first of all I prayed and then God gave me peace of mind,” she wrote in an email. “After that, I reassured myself that it is my life, and if I have to live longer, I better accept the verdict and start living normally, which I have done up to this time.”
She says this has helped her health overall.
“I have never been hospitalized with a serious illness,” she says. “I took myself to the hospital when I suffered from TB, and, even then, I was looking healthy and fit to move on my own and have maintained this. Once in a while, I get some flu, coughs, chest pains, but I have never suffered from malaria since 1998.”
Mumba says that women in Zambia living with HIV must adhere to their treatment, eat balanced diets, stay in a clean environment, excercise regularly and do things that make them happy. She also advises that they avoid stress, smoking, drinking beer and having unprotected sex.
To help these women, she says that she hopes that the government and other institutions involved in HIV prevention in Zambia will start supplying women and children with food supplements, as most female-headed households in Zambia have inadequate food. Mumba says that these authorities must also address the long lines at the centers that dispense antiretroviral treatment, ART.
“Those long lines at ART centers are not healthy,” she says. “We spend half a day or the whole day at the clinic each time we go for reviews or refills.”
The Zambian Parliament passed a law in 2002 that created a national council to address HIV, AIDS, sexually transmitted diseases and tuberculosis. The government declared HIV and AIDS a national emergency in 2004 and began distributing free ARVs nationwide.
Many say they hope that newly elected President Michael Sata, who took office at the end of September, will address HIV-related problems in the country and introduce more HIV-prevention programs.
There are also various NGOs that work with women affected by HIV and AIDS in Zambia, such as the Coalition of Zambian Women Living With HIV/AIDS, Planned Parenthood Association of Zambia, Microbicides Development Program Zambia, and the Society for Women and AIDS in Zambia. These organizations strive to help women living with HIV and AIDS and to prevent new infections through workshops, research, surveys, radio, TV, community outreach programs, nationwide campaigns, school discussions and support groups.
