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HIV and AIDS

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The Human Immunodeficiency Virus, or HIV, is a type of virus known as a retrovirus that infects the cells of the human immune system, mainly the CD4-positive T-cells and macrophages. The virus either destroys these cells or impairs their ability to function. Over time, infection with HIV leads to the deterioration of the immune system, or immune deficiency. The immune system is considered deficient when it can no longer fulfil its role of fighting off infections and diseases. Immuno-deficient people are more susceptible to a wide range of infections, most of which are rare among people with healthy immune systems. Infections associated with severe immunodeficiency are known as 'opportunistic infections' because they take advantage of a weakened immune system.

Acquired Immunodeficiency Syndrome, or AIDS, is diagnosed when a HIV-positive person shows the signs, symptoms, infections, and cancers associated with the deficiency of the immune system. The majority of people infected with HIV, if not treated, develop signs of HIV-related illness within five to ten years. However the time between the initial HIV infection and an AIDS diagnoses can be 10 to 15 years, or sometimes even longer. Antiretroviral therapy, or ART, can slow down the progression to AIDS by decreasing the infected persons viral load or the amount of HIV present in the body. Currently, antiretroviral therapy is the only known treatment for HIV and AIDS. There is no cure for HIV or AIDS. Transmission of HIV HIV transmission predominantly occurs through three mechanisms:

Sexual transmission Exposure to infected blood or blood products Mother-to-child transmission (including through breastfeeding).

The likelihood of transmission is heavily affected by social, cultural, and environmental factors that often differ markedly between and within regions and countries. There is also some indication that molecular, viral, immunological, or other factors in an individual might influence that persons chance of contracting or spreading HIV. The history of HIV and AIDS in Zambia Zambias first AIDS case was reported in 1984. Within two years the National AIDS Surveillance Committee (NASC) and National AIDS Prevention and Control program (NAPCP) were established to coordinate HIV and AIDS-related activities. In the early stages of the epidemic, much of what was known about HIV prevalence was kept secret by the authorities under President Kaunda. Senior politicians were reluctant to speak out about the growing epidemic (the Presidents announcement in 1987 that his son had died of AIDS was a notable exception), and the press did not mention the virus. By the early nineties, it was estimated that as many as one in five adults had been infected with HIV, leading the World Health Organization to call for the establishment of a National AIDS Advisory Council in Zambia. The new millennium signalled a marked change in political attitude. The National HIV and AIDS/STD/TB Council (NAC) became operational in 2002 when Parliament passed a national AIDS bill that made the NAC a legal body able to apply for funding. The prospect of a large World Bank grant provided much of the necessary motivation for the establishment. At that time, the NAC became the single, high-level institution responsible for coordinating the actions of all segments of government and society in the fight against HIV and AIDS. NAC is in charge of guiding the implementation of the National HIV and AIDS

Strategic Framework (2006-2010). Although Zambia received hundreds of millions of dollars for HIV programs from donor country governments, HIV prevalence has not dropped significantly. The rate has remained more or less stable since the 1990s and is as high as 25 percent in some urban areas. Today, the country has one of the worlds most devastating HIV and AIDS epidemics. More than one in every seven adults in the country is living with HIV and life expectancy at birth has fallen to just 39 years. In 2009, nearly 76,000 adults were newly infected with HIV, representing about 200 new infections each day. The impact of HIV in Zambia Unlike in some countries, HIV in Zambia does not primarily affect the most underprivileged. Infection rates are very high among wealthier and better educated populations. HIV is most prevalent in the two urban centres of Lusaka and Central province, and less concentrated among poorer rural populations. However, the movement of miners, seasonal agricultural workers and young men between rural areas and urban centres has spread HIV to new areas. Overall, the epidemic has mainly affected women, children, and economic productivity. HIV prevention in Zambia Awareness-raising programs to prevent HIV and AIDS began early in Zambia. An American journalist in 1988 reported, "Zambia is waging one of the world's most aggressive educational campaigns against AIDS, surpassing anything being done in the United States." Much of the early campaigning involved pamphlets and posters that warned of the dangers of AIDS and promoted abstinence before marriage, with messages such as, "Sex thrills, but AIDS kills." Over the years, a wide range of media has carried messages about AIDS, and children have been taught the biological facts in school. Condoms are highly effective at preventing sexual HIV transmission, when used correctly and consistently. Nevertheless, the role of condoms in curbing the spread of Zambia's epidemic has been a subject of prolonged controversy in the mainly Christian nation. There are still many misconceptions about HIV and AIDS in Zambia. In 2007, almost two-thirds of young people aged 15 to 24 could not both reject major misconceptions about HIV transmission and correctly identify ways of preventing sexual transmission of HIV. If behaviour is to be changed, young people must be a priority target. It is often said that Zambia's youth offer the nation a "window of hope" the hope of an AIDS-free future. Nearly half of all Zambians are between 0 and 14 years old. Relatively few of these young people have HIV and they are all eager to learn. Effective education therefore has the power to change attitudes and behaviour for life. Zambia's prevention of mother-to-child transmission (PMTCT) initiative was launched in 1999, beginning with a three-year pilot program in Copperbelt Province. In 2004, it expanded and 74 health facilities in four provinces offered antiretroviral drugs (primarily nevirapine) to expectant mothers and infants. By the

end of 2008, 939 health facilities offered antiretroviral therapies (ARVs) to expectant mothers and newborns. As of 2009, all 1,563 private and public health facilities in the country offered voluntary counselling and testing (VCT) services. In that year more than 1.5 million people ages 15 and above were tested for HIV and received their results. This was double that of the previous year and quadruple that of 2006. Funding for HIV and AIDS treatment in Zambia State provision of ARVs began in Zambia in late 2002, although initially very few people could afford the monthly payments for the drugs. Free treatment started in 2004, when the Global Fund committed 254 million dollars over the course of five years. Zambia also represents one of the most highly funded PEPFAR countries, with 149 million dollars dedicated in 2006 alone. Support from these donors and other sources make free access to ARVs possible. The delivery of free ARVs relies on the involvement of many NGOs, churches and communities. Almost three-quarters of funding for HIV and AIDS programs in Zambia is from foreign donors, and it has been reported that HIV programs are among some of the worst affected by corruption scandals and resulting in disruptions in donor funding. The majority, about half, of Zambia's donor funding comes from PEPFAR, followed by the Global Fund and the World Bank. The Southern African AIDS Trust has voiced concern over this reliance on donor funding and has urged the Zambian government to scale up its own funding for HIV and AIDS programs. They have involved faith-based organisations, civil society and NGOs, and have also entered into a partnership with the private sector to administer some of the treatment. Moving forward, Zambia must continue to strive to make ARV therapy equally accessible to all those in need. Links between gender and HIV The feminization of HIV and AIDS is increasing. Today, 37.8 million people are infected with HIV worldwide. Almost half 48 percent of all adults living with HIV are women, representing 17 million people. This is up from just 35 percent in 1985. Globally, young women are 1.6 times more likely to be living with HIV and AIDS than their young male counterparts. In sub-Saharan Africa, women make up 57 percent of those living with HIV. Young African women ages 15 to 24 are three times more likely to be infected than their male peers. Recent surveys reveal that in South Africa, Zambia and Zimbabwe, young women are five to six times more likely to be infected than young men of the same age. Factors affecting the spread of HIV and AIDS among women and girls are poverty, early marriage, trafficking, sex work, migration, lack of education, and gender-based discrimination and violence.

Women and young girls are affected in a very specific way due to physical, emotional and material differences and due to important social, economic, and political inequalities that exist between women and men. In countries where women cannot own or inherit land, the wife and children of a man who died of AIDS may lose access to their source of livelihood. Other forms of economic inequality and social disempowerment prevent poor women from controlling the timing and safety of sexual intercourse. Poverty increases women and girls susceptibility to commercial sex work. Labour migration puts young women at risk of sexual exploitation and creates unequal ratios of men to women, increasing the possibility of HIV transmission through shared partners or sex work. Women and girls are also disproportionably susceptible to the growing trade of trafficking. Violence, or the threat of it, also limit womens ability to protect themselves from HIV infection since it can prevent them from insisting on condom use during sex. The vulnerability of women is greatly exacerbated by conflict. There are several factors that contribute to the spread of HIV and AIDS in emergency situations. Sexual violence is often used as a weapon of war, or as a way to break down social structure and legal protections. When families are displaced or separated, family units and sexual relations become transitory. Traditional HIV prevention strategies have tended to focus predominantly on ABC: Abstain, Be faithful, use a Condom. While the ABC approach has undoubtedly prevented large numbers of people from becoming infected, many of the worlds women are simply not in a position to abstain from sex, rely on fidelity, or negotiate condom use. ABC can only be a viable and effective prevention option for women and girls if it is implemented as part of a multi-faceted package of interventions that seek to redress deeprooted gender imbalances. Sexually Transmitted Infection (STI) A sexually transmitted infection, or STI, is an infection passed from person-to-person through intimate sexual contact. STIs are also called Sexually Transmitted Diseases, or STDs. There are more than 30 different sexually transmissible bacteria, viruses and parasites. The most common conditions they cause are gonorrhoea, Chlamydia, syphilis, trichomoniasis, chancroid, genital herpes, genital warts, HIV and hepatitis B. The prevalence of sexually transmitted infections is high in many developing countries. In Zambia, STIs account for up to 10 percent of diseases for which adults seek health care services. How do you get an STI You can get an STI by having intimate sexual contact with someone who already has the infection. You cant tell if a person is infected based on appearance alone, because many STIs have no symptoms. However, even when no symptoms are present, STIs can still be passed from person to person. They are

spread through vaginal, anal or oral sex or during genital touching. It is possible to get some STIs without having intercourse. Not all STIs are spread the same way. STI health problems Every STI causes its own unique different health problems. Overall, untreated STIs can cause cancer, pelvic inflammatory disease, infertility, and complications in pregnancy, widespread infection to other parts of the body, organ damage and even death. Symptoms of STIs Many STIs have only mild symptoms or even no symptoms at all. When symptoms do develop, they often are mistaken for something else, such as urinary tract infection or yeast infection. This is why STI screening is so important.

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