Responses to the pandemic

Civil Society in Zambia: A Response

The view of Women for Change on the pandemic

The fight against HIV and AIDS can only be undertaken successfully when there is a clear focus on women, putting them at the centre of the whole pandemic and ensuring that women take full control of their own bodies. For WfC, the fight is against gender imbalances and cultural practices that perpetuate power relations inimical to women’s health. HIV and AIDS in Zambia is a power relation issue and it is also a class issue. Unless we break these barriers, we will not succeed in fighting the HIV and AIDS scourge. WfC will therefore concentrate on the above-mentioned issues in a practical way in the communities

As an organisation, WfC considers the following as urgent priorities in the fight against HIV and AIDS in Zambia and particularly in its operational areas:

  • Support interventions aimed at enhancing the quality of life for orphans and vulnerable children and this includes:
    • Facilitating support to orphans by providing them with school needs
    • Facilitating capacity building for out of school orphans to enable them look after themselves
    • Facilitating the attainment of food security for families caring for orphans
  • Working towards poverty eradication in the communities where WfC works because of the link between poverty and HIV infection
  • Intensifying advocacy on the plight of HIV and AIDS orphans and vulnerable children including social support for orphans and widows in HIV and AIDS prevention
  • Continuing to campaign for policies and practices that are gender-sensitive, just and effective in responding to the plight of the poor and those affected and or infected by HIV and AIDS
  • Creating public awareness on rights of people living with HIV and AIDS
  • Intensifying activities in gender analysis and awareness raising to ensure both women and men are sufficiently gender sensitive and able to act on gender issues that perpetuate contracting the virus and its transmission. Through gender-focused programmes, power relations that perpetuate the spread of HIV and AIDS infection such as sexual cleansing, sexual violence, abuse and rape in homes should also be challenged
  • Working with traditional leaders to advocate for the banning of negative cultural practices that put women and men at risk of contracting the virus

The Official Government Response

HIV and AIDS became a public health issue in the early 1980s in Zambia. In 1986 the Government of the Republic of Zambia initiated its first response to this in the form of the National AIDS and Prevention Control Programme (NAPCP). As with other government responses at the time, it became apparent that the initial response to HIV from the Zambian Government was insufficient as it focused only on the biomedical aspect, with very little, if any, focus on the social aspects of the disease. Throughout the 1990s, non-governmental organisations, community based organisations and faith based organisations partnered with the government to attempt to address the gaps in the response to HIV. This then led to the formation of the National HIV and AIDS/STD/TB Council (NAC) to effectively control, co-ordinate and manage all government and civil society interventions.

Since its establishment in 2000, NAC has overseen the development of a number of initiatives to address the issue of HIV and AIDS such as the National HIV and AIDS Intervention Strategic Plan (NAISP) 2002-2005, the National Monitoring and Evaluation Plan, the National Decentralisation Policy 2003-2012, the 2005 National HIV and AIDS Policy, the National HIV and AIDS Strategic Framework 2006-2010 and the Fifth National Development Plan among a number of other policies, plans and laws. The Sixth National Development Plan is in the process of being agreed and implemented.

It has been argued that the most important of these initiatives is the National Decentralisation Policy 2003-2010. The policy’s main aim is to devolve responsibilities for resource allocation, human resource management and accountability to the provincial, district and community level. This includes Provincial AIDS Task Forces (PATFs), District AIDS Task Forces (DATFs) and Community AIDS Task Forces (CATFs), which are then all part of the Provincial Development Co-ordination Committees, the District Development Co-ordination Committees and Neighbourhood Health Committees respectively. At the international level, Zambia has also ratified a number of key instruments in order to further address the issue of HIV and AIDS including the Maseru Declaration on HIV and AIDS which, once translated into national practice through the HIV and AIDS strategic framework, has promoted the access to care, treatment and support and, most importantly, free Anti-Retrovirals (ARVs).

One of the main areas of focus in the National HIV and AIDS Strategic Framework (NASF) 2006-2010 is to intensify prevention of infection. As a result of the Zambian Mid-term Review of the NASF, four priority prevention areas were identified:

  1. Prevention of sexual transmission of HIV
  2. Prevention of mother-to-child transmission (PMTCT) of HIV
  3. Counselling and testing
  4. HIV prevention in health care setting, including post-exposure prophylaxis (PEP)

Policy areas covered by the NASF include:

  1. Protection and human rights (including the protection of vulnerable groups such as women, young people, prison inmates and migrants. This, however, does not include protection of people living with HIV and AIDS)
  2. Universal access (to prevention, treatment, care and support for men and women)
  3. HIV testing (the national policy on HIV counselling and testing stipulates that this service should be provided free of cost to all users)
  4. HIV education in school (and that each curriculum should be responsive to local culture)
  5. Sectoral and workplace policies and strategies
  6. Ethics in research (A Research Ethics Committee reviews and approves any HIV and AIDS research protocols involving human subjects)

As is mentioned in the vulnerabilities section of this report, HIV and AIDS is a ferocious attack on women. While women display a number of common vulnerabilities with men, it is apparent from the evidence illustrated in this report that women also display a number of significant and unique vulnerabilities which must be recognised, understood and addressed with specific, focused and ‘gendered’ interventions if they are to be effective. However, this is not reflected in the policies, plans and strategic frameworks listed above. Although women are identified as being a vulnerable group, this does not address the severity of the issue for women in Zambia.

A traditional leader responds

…we need to talk business, not talk rubbish. We need to accept one another. We need to stop criticising one another. We need to bring development, not gossip.

Chieftainess Mwenda is fifty five. She is married with four children, all of them girls. Professionally she is a nurse, but she is now a chief of the Tonga people. She is the ‘umbrella’ for the Tonga people, a ‘roof’ for their house, a role given to her by God. There have been chiefs in Zambia historically and when the British arrived in Zambia, there were already many tribal structures and laws. Her tribe has powers of rainmaking – they would pray for rain and God would bring that rain.

She is the ninth chief since records began while there have been many chiefs, there has not been a woman. Chieftainess Mwenda is the first female chief. Historically, they used to send women to the ancestral shrines to be sacrificed to appease ancestors. At that time, women were never involved in decision making or in giving orders or involved in the administration of the people. They had to struggle in a court of law for her to become chief. They had to get a court to rule that a woman could be chief as there is still a lot of stigma where women leaders are concerned. While she has stood strong as a chief for her people, even now, many struggle with the reality of being ruled by a woman. People call her names, and tell her she cannot rule them because she does not have hair on her chest. She understands this, but insists they will eventually have to accept her. She wants to bring change for her people but it is the people who can bring real changes, with the help of the international community.

The two most important things that need to be done – education, we need to share what we know and learn, we need to educate young people. The second is empowerment in order to fight poverty.

HIV and AIDS have affected her personally because she has lost many of her people to it. As a Home Based Care (HBC) nurse, she lost many, many friends, including educated people within her family. She says it has driven her family backwards and that even now, it is difficult sometimes to care for her family and people. She has seen people die and they are still dying. She regularly thinks that if this person or that person was still alive, they would have made a big change in the area. She needs men in her community as they are supposed to be builders and pillars of the community. Men have a lot of knowledge, but they need to change. She feels HIV has impacted hugely on her life – she has a great interest in it because of this.

She believes men are more affected but then they infect women ‘Initially we lost a lot of men, but now we are losing their wives. This means they leave a lot of orphans’. She cares for a large number of orphans and is trying to educate them. If the women were still there, they would care for the children. If men were still there, they could also care for their children. She is also the mother to the children of her brothers. She feels there is a lot of pressure on her as a chief because people believe she can care for all of these children, but it is a huge strain on her.

In Chieftainess Mwenda’s view, the practice of sexual cleansing contributes a lot to the spread of HIV and AIDS. It has been practiced for a long time within the tribe. In order to remove the ghost of a husband who has died before he is buried, the pants of the husband are exchanged with those of the wife. She must wear them while he wears hers and is buried in them. After five days of mourning, she has to remove the pants, take a bath, and then a man would be brought from her late husband’s tribe to have sexual intercourse with her. If she refuses, then people will come and force her to have sex. It is then assumed that that man can have sex with the woman whenever he wants after this.

There needs to be a law prohibiting sexual cleansing because it is dangerous, especially if you do not know if the husband died from HIV-related illnesses. If the husband was HIV positive, then this would mean that the woman brings HIV to this new man and his other wife/wives. Once he has ‘cleansed’ her, this means the HIV will spread.

There is also a strong tradition of witchcraft and she believes people have tried to bewitch her. In order to protect themselves from such bewitching, people believe that they need to get protective tattoos, which are done by people who are not educated, using the same razor blades on different people often promoting infection.

Men have too much power. We have been taught to submit to men – we have been told, we cannot say no to sex. If your husband approaches you, whether you are ready or not ready, you have to say yes to sex. Women have no control over their bodies. You do not know how a man is using his body. You do not know how many partners he is meeting. But when he goes to his wife, she cannot refuse him. You have to let him do what he wants. He can bruise you, but you cannot cry out. It is like women are being bought to be sex machines.

Within the tribal meetings, when they are discussing developmental issues, HIV is always included. She believes that education about HIV is very important, especially within schools. What worries her the most, however, is the need to change people’s lifestyle. Despite the fact that people have knowledge, people do not want to change their lifestyle. They still want 2, 3, 4 or 5 wives. They are still having sex with many partners, before and during marriage. The Chieftainess says there is knowledge that if someone is HIV positive, you cannot sleep with them, but you must take care of them. If you inherit an HIV positive wife, you can care for her, but not have sex with her.

As a Christian, the Chieftainess promotes abstinence. She argues that people need to open their eyes as ‘we are living in a changing world. My children do not even believe the same things I believe. So I do promote the use of condoms, but also for people to stick to one person, one sexual partner at a time. You cannot have sex with lots of people – you will become immoral. As a HBC nurse, and a Christian, I used to carry condoms to give to my patients. When I worked as a nurse, people would ask ‘Aunty, do you have anything for me?’ and people would be happy because I gave them condoms’.

Men have too much power. We have been taught to submit to men – we have been told, we cannot say no to sex. If your husband approaches you, whether you are ready or not ready, you have to say yes to sex. Women have no control over their bodies. You do not know how a man is using his body. You do not know how many partners he is meeting. But when he goes to his wife, she cannot refuse him. You have to let him do what he wants. He can bruise you, but you cannot cry out. It is like women are being bought to be sex machines.

The Chieftainess focuses on widows in the community, on empowering them and helping them educate the community. She finds it is difficult to work with the women in her community as they try to intimidate each other, and there is too much gossiping. A change our mindset is needed in order to become proper leaders – ‘we need to talk business, not talk rubbish. We need to accept one another. We need to stop criticising one another. We need to bring development, not gossip’.

She feels HIV is becoming static now as there have been so many deaths in the young age groups. Changes in the living style of men are badly needed. Men’s behaviour is a huge issue.

The two most important things that need to be done. Firstly, education. We need to share what we know and learn, we need to educate young people. The second is empowerment in order to fight poverty. If people have something to eat, they do not need to sell their bodies in order to feed their family. We need more honesty in the aid that is given to Zambia. There needs to be a ‘down up’ approach as we need to feed the roots to empower the leaves. If you feed the leaves, everything becomes dry. The government needs to not enrich themselves, but enrich the roots.

The Chieftainess would like young women to be taught that they do not need to submit to men. When they say no, it should mean no.

A ‘no’ must be said. We need to have rights, just like men. If a man finds a woman in a relationship outside of marriage, they can sue them. But women cannot if they find a man is doing the same. Men need to be punished for this also. Proper practical equal rights are needed between men and women, not theoretical ones. Practical ones. If we continue to crawl in front of men, they will continue to look down on us. Stand up and show them that we are making a change. Raise your head and tell them that we are teaching men to make a change. Change has to begin with me, you and him and her, so that others can also change.

In Africa, there are no laws to prevent polygamy and affairs like there is in the rest of the world.

As easy as we are breathing the air now, a man can live how he wants to live, and no one will say anything. There is too much freedom. We need to harness this. If the government would give us more power to set rules for our people, I would change things. If you found your husband was having an affair, you should be able to sue him, because he is bringing HIV to your family. We need to strengthen our government set up and rules. We can play a better game.

Let us talk about things that are supposed to be taboo in our custom. Let us talk about sex. Let us be open so people can learn. That way we will be able to fight HIV. There is no way that we will begin to develop if we lose young people from our area. We need to be empowered. We need to keep the family circle tight in order to fight HIV and AIDS.

Irish Aid responds

By Nicola Brennan

For Irish Aid, it was clearly evident that HIV and AIDS was having a huge impact on people’s daily lives. There were many teachers, health workers and ordinary members of the community dying. People were phenomenally affected and very little was being done. This was the development challenge to which Irish Aid responded.

Irish Aid was among one of the first bilateral donor countries to develop an organisational strategy in response to this HIV and AIDS crisis. It was developed in 2000 as a direct response to the impact of HIV and AIDS on people in the areas where Irish Aid was working – particularly in Sub-Saharan Africa including Zambia. The strategy identified women and children as being disproportionately vulnerable to HIV and AIDS and also looked at the impact of the virus and its consequences on women and children in particular.

Women were identified as being more susceptible than men biologically but also culturally where in terms of sexual relations, women could not always demand protection, leaving them particularly vulnerable. Another area in which women were identified as being particularly vulnerable was in the burden of care. Women and particularly young girls take on the role as care-givers when someone becomes ill within the family.

Men, it is clear, are the decision makers in families and there is a lot of work to be done in working with both men and women to address unequal power relations especially in relation to sex. Irish Aid has a strong gender based approach in its work to reduce poverty and address the impact of the HIV and AIDS pandemic.

The prevention of further HIV infection is at the core of Irish Aid’s approach which also addresses issues of treatment access and care for those living with HIV and AIDS. Prevention is still central to our work. There is no magic bullet when it comes to HIV prevention and Irish Aid looks to a range of strategies including Behaviour Change Communication.

Education and Prevention

Irish Aid invests a lot in education prevention campaigns and education for girls – in Zambia this is the largest component of the aid programme. Access to education for girls is vital and research has shown that education in itself is a preventative mechanism so it is critical that girls get access to education and the longer they stay in formal education the better – this is critical.

Irish Aid also supports direct HIV prevention education, working with teachers in terms of building their skills and capacity to teach about the virus etc. We also support peer education and youth groups as a method of educating young people about HIV and AIDS. In Zambia, Irish Aid has a particular focus on supporting community schools where education is accessed by the most vulnerable children, many of whom have been orphaned and whose vulnerability has increased as a result. Statistics would suggest that the majority of those orphaned are often as a result of HIV and AIDS. Irish Aid also supports schools through working with civil society organisations and government to reduce child abuse in schools and provides bursaries for very vulnerable children to ensure that they can go to school. In addition, we support country wide HIV campaign prevention campaigns, access to voluntary counselling and testing, and the prevention of HIV being transmitted from mother to child during and after birth.


Irish Aid invests in long-term research and development with the objective of identifying a suitable HIV preventative vaccine. Some but slow progress is now being made in this area. The identification of such a vaccine could provide immediate protection against HIV infection. We need to continue this investment if we are going to have a long term impact on this pandemic. Irish Aid has also invested in the development of microbicides1 and was among the first bilateral donors to fund such which includes the public sector donors who provide the funding and the pharmaceutical industry who provide the science and research. There are different types of microbicides currently being tested in clinical trials with varying levels of progress. Trials are taking place in South Africa, West Africa, India etc. A fully effective result has not yet been discovered but when it is, the benefit to women will be great. It will mean they will be able to access microbicides as an individual and determine their use. Studies have shown that many women are excited because they will be able to take control themselves while others are less optimistic and a little concerned about the reaction by their male partners.

Nutrition and Care

Nutrition plays a key role in relation to HIV and AIDS. People who have adequate access to food can stave off infection initially and if HIV positive, can halt the spread of the disease to AIDS if their access to food is good and consistent. Irish Aid works to ensure that people infected and affected by HIV and AIDS have adequate and consistent access to a stable and nutritious diet. In the area of care, we work at a number of different levels.

As regards policy and advocacy, we support government to respond to the vulnerability of HIV and also provide advocacy support to civil society so that they can represent the voices and reality from community level in their dialogue with government and in influencing policy and programming. Irish Aid provides significant support to civil society organisations in their work on HIV and AIDS – both direct service delivery – particularly in relation to education on HIV, support to women’s groups, support to children and people living with HIV and AIDS.

For example, in Northern Province in Zambia, there is a women’s group outside Kasama who were given a small grant of about 10,000 euros. They developed a support group within the community and gave direct support and home based care kits to those affected by HIV and AIDS. They encouraged people to deal with opportunistic infections and supported people in terms of access voluntary counselling and testing and getting to the clinic. As a general strategy, Irish Aid supports civil society organisations to deliver services. Block grants are given to a number of community-based organisations.

Irish Aid also supports cash transfers given by the Zambian government to communities as a social protection measure in order to tackle vulnerability. While Zambia as an economy has being doing very well, the gap between rich and poor is ever increasing. Cash transfers and direct funding of food vouchers are for people who are extremely vulnerable. The child grants scheme covers children up to the age of 5 years old.

These transfers are provided in a number of districts – a small amount of money is given to the poorest people on a monthly basis. Among the criteria determining who receives the transfer is being chronically ill (TB, repetitive malaria, etc). Community groups come together and identify those most vulnerable in their community and they get cash in hand on a monthly basis. Irish Aid has contributed to this but we also monitor the programme to see what people do with the money they receive and how it affects their livelihoods such as building up household assets, seeding and planting, buying livestock, children in school, spending on local healthcare, etc. At the moment, the evidence is that this approach is producing considerable impact. Because HIV is a driver of vulnerability especially among the poor, anyone who is HIV infected has increased vulnerability. If they have resources then they have options. If they don’t have resources, then their options are limited.

Throughout all of this work, the emphasis is on building the resilience of the people who are most vulnerable, especially women and children.

HIV Treatment

Irish Aid also does considerable work on access to HIV Treatment where the main approach has been to strengthen health systems overall. It is important that health workers are trained, laboratory services are functional and support services are in place for people to access HIV treatment. Irish Aid was one of the founding members of the Global Fund to fight AIDS, TB and Malaria in 2001/02 and I sat on the Board of the Fund for 6 years. Zambia is a key recipient of the Global Fund where they have been able to extend HIV treatment to all 72 districts and ensure that over 50% of people who need HIV treatment now get access to it.

Treatment is not just the delivery of drugs but also having systems in place, training health workers, providing laboratory support services, follow up, treatment education and support to people on treatment. Irish Aid also supports services relating to PMTCT.

Irish Aid has a specific focus on Northern Province in Zambia. Irish Aid supports four districts as well as the province itself where NGOs have over the years, been funded to provide a range of services as well as care and support in the community. In certain areas, Irish Aid has supported improved water and sanitation access. Through their work, Irish Aid has been monitoring the impact access to water has for care givers, vulnerable households as well as monitoring impact on water charges on female headed households.

Irish Aid has supported a home based care programme in Northern Province; originally we worked with a large number of NGOs and now we are working to ensure that the district council’s strategic plans take into consideration the needs of people living with HIV and AIDS.

Work with National AIDS Council (NAC)

It is essential to develop and strengthen institutional structures in Zambia, building the government’s capacity to deliver services to the people. In this regard, the National AIDS Council (NAC) is a critical body in the national response to HIV and AIDS and works across a wide range of sectors within government itself as well as in society more broadly. The Council is mandated to coordinate national HIV-related policy and strategy in Zambia and NAC also supports district level structures – Provincial AIDS Task Forces and District AIDS Task Forces to ensure planning at provincial and district level is taking HIV and AIDS adequately into account.

Research and analysis must be strong and accurate and this is a key determinant of HIV and AIDS approaches within the country, informing policy and planning. Irish Aid continues to engage directly with the Zambian Government in areas such as the Sixth National Development Plan (SNDP) to ensure that HIV was informing and shaping priorities.


It is unacceptable that the disease is hidden as a result of stigma and discrimination. It is heartbreaking to think about what many people have gone through without being able to talk about being infected and the impact of the disease on them and their families. There is still too much silence around HIV and AIDS.

In 2006, Irish Aid launched a National HIV stigma campaign in Ireland. Known as Stamp Out Stigma the implementation of this campaign was linked into the overseas development programme to ensure that the reality of people’s lives both in Ireland and in sub-Saharan Africa helped to inform and shape education about HIV and policy responses to HIV.

Irish Aid has a progressive HIV workplace policy; it supports its staff on prevention, treatment and care. We have regular discussions on HIV with staff in the workplace and we provide HIV treatment for staff and their dependents if they need it.

The legal dimension

Irish Aid is playing a role in trying to get a Gender Based Violence Bill in Zambia passed by Parliament and we support community and civil society organisations to assist in developing the Bill and in ensuring that it gets a hearing in Parliament. This is an important piece of legislation which is about protecting and empowering women.

1- Although there are many approaches to preventing sexually transmitted diseases in general and HIV in particular, current methods have not been sufficient to halt the spread of these diseases — particularly among women and people who live in less-developed nations. Sexual abstinence is not a realistic option for women who want to bear children or who are at risk of sexual violence. In such situations, use of microbicides could offer both primary protection in the absence of condoms and secondary protection if a condom breaks or slips off during intercourse. Microbicides may eventually prove to be safe and effective in reducing the risk of HIV transmission during sexual activity with an infected partner

Nicola Brennan is a Development Specialist currently working with Irish Aid in Zambia.