Getting to Zero

Saturday, 1 December was World AIDS Day. It was commemorated in Mwandi in the customary fashion. On the Friday evening, a march through the village, ending with an all-age Inter-Denominational Church Service in the Hospital Chapel to remember lost loved ones who died from HIV Aids took place. The march, starting at the MTN cell-phone tower, was led the Boys Brigade Drums, followed by hospital staff, local Church people and the children from the OVC carrying red balloons and smaller A4 posters saying, HIV is going to lose. A banner carried by staff displayed the official message: Zero New Infections, Zero Discrimination, Zero Aids-Related Deaths.

In the Chapel the UCZ youth choir and Praise Team led the worship with appropriate choruses and songs.
The UCZ Deaconess opened in prayer while one of the Pentecostal pastors was the Master of Ceremonies, the Wesleyan Pastor gave the homily and the Roman Catholic Father came straight from Mass for the candle-lighting and moment of silence. The doctor also spoke. Before the blessing, there was a wonderful and moving testimony given by a young woman living with HIV/AIDS. This was a first for us where a person spoke openly and publicly about her status.
The next day we were blessed by rain, so instead of having an outside ceremony at TB Square, the commemoration was held inside, again in the chapel. A former Deaconess, the Hospital Administrator, the UCZ Minister and the Doctor all graced this meeting which comprised of prayers, speeches, dancing, poems, drama and songs.

For the first time, a task force, comprising of young people, employed at the hospital organized and ran both events. It was a resounding success. As one of them said it was like one of these reality TV programmes - The Apprentice, sprang to mind, where you are given a task, a time constraint and then told to get on with it!
Some of the local constraints and challenges the hospital is facing needs to be highlighted. The annual AIDS Relief budget from PEPFAR is being reduced each year but an increasing number of patients are accessing ARVs and requiring care at the same time. The Zambian Government contribution to the budget has to reach 15% of the budget and they are being expected to take over the programme in its entirety in 4 years. There are still many gaps. Our lab machines often lack reagents as none are available at Central Medical Stores. While supplies of ARVs are usually adequate, medicines and drugs for treating opportunistic infections are in short supply or unavailable.
According to some recent statistic published in The Post newspaper on Saturday, the National AIDS Council recorded 69 000 new infections. 27 000 are young people between 15 and 24, and shamefully over 16 000 of them were girls.
The UNAIDS Report for 2012 shows Zambia has reduced new HIV infections by 58% and 80% of them are receiving HIV treatment. The national prevalence rate is just over 14%, but our testing rate is, regionally, one of the lowest standing at 28%.

In another article in the same paper an Italian Professor Paolo Marandola points out that the war against HIV is far from being won. Even if the number of people each year dying from the disease is lower than the number of the newly infected it means the HIV positive population is growing, so prevention is obviously weaker than treatment. Increased access to ARVs is for those with a CD4 count of less than 350. Those HIV positive individuals with a higher CD4 count are still apparently healthy and sexually active.
Resistance and adherence are looming problems that need to be addressed. Neither of these are helped by the current policy of waiting until a lethal disease such as HIV TB or cancer manifests itself then beginning treatment. In response to these problems, universal testing, universal early treatment and universal sex education in schools are suggested even although there will be objections raised about the cost of these steps.
The dream of getting to zero can only be realized if the Zambian people take their destiny into their own hands by owning the response and actively preventing new infections.