World AIDS day Indaba draws lessons from Zambia’s success stories

THE 19th International Conference on AIDS convened by the International AIDS Society (IAS) was held in Washington DC, United States of America from July 22 – July 27, 2012 with an expected attendance of 21, 000 people. Under the theme “Turning the Tide Together”, delegates presented and reviewed the latest scientific research and built a momentum toward ensuring that financing and global leadership across all sectors kept pace with scientific progress against HIV. By the July 27, the count of delegates, participants, countries and activities had swelled as follows: • 23, 767 participants.

• 17,066 delegates • 1,904 media delegates • 12,042 participants from the US • 183 countries represented • 12, 433 abstracts submitted • 3, 837 abstracts accepted • 19 plenary speeches • 14 special sessions • 210 exhibits • 265 global village exhibits • 185 satellite meetings • 60 workshops 2012 marked the first time the conference would be held in the US since 1990. It had been held in Atlanta in 1985. In 1990 the International AIDS Society (IAS) had resolved to hold the meeting only in countries where participants would not be barred due to their HIV status.

This decision therefore excluded the US as a location due to its restriction on international visitors who were HIV positive. In 2009, US President Barack Obama reversed the then 22 year ban and the IAS announced that the 2012 conference would mark the return to the United States. I noted that US leaders who participated in the conference included US Secretary of State Hillary Clinton, former US President Bill Clinton, former US First Lady Laura Bush, American billionaire computer programmer and philanthropist Bill Gates, US.

Secretary of Health and Human Services, Katheleen Sebelius, Congresswoman Barbara Lee, Washington DC Mayor Vincent Gray and Ambassador Mark Dybul. Joining them from the global arena were the Champions for a HIV Free Generation led by former president of Botswana Festus Mogae and Zambia’s First Republican President Kenneth Kaunda. Other notable dignitaries were also former Tanzanian and Mozambican presidents Benjamin Mkapa and Joachim Chissano respectively, former Ugandan vice-president Speciosa Wandira and former chairperson of the Kenyan National AIDS Control Council Professor Miriam Were.

Others were the South African Deputy President Kgalema Motlanthe, the World Bank Group President Jim Yong Kim, UN Secretary General Ban Ki-moon, the UNAIDS Executive Director Michel Sidibe and out-going IAS President Elly Katabira. I was happy that Zambia had a delegation of 77 headed by Deputy Minister in the Ministry of Community Development, Maternal and Child Health, Jean Kapata, perhaps the biggest delegation that the embassy of Zambia in Washington DC had ever hosted in recent years. From the onset, Zambia was on a positive spotlight at the conference.

Former president Kenneth Kaunda was instant Zambia’s flagship at every appearance, each and every presentation, and every workshop and every plenary session. First were accolades from Ambassador Mark Dybul, former US Global AIDS Co-ordinator (who led the implementation of the President’s Emergency Plan for AIDS Relief – PEPFAR during the presidency of George Bush) who showered Zambia with praises on how the country was dealing with the issues related to HIV and AIDS, women empowerment and orphans.

He specifically mentioned Chikumbuso (which unfortunately was spelt as “CHICKEN-BUSO” on the big, wide over-head projector), a grassroot project in Ng’ombe Township in Lusaka, that provides an alternative lifestyle to vulnerable children and women as in free schooling, adult training, capacity building, income generation activities and community building programme.

He cited a Zambian woman who has built business and increased her economic empowerment by collecting plastic bags in collection depots in Lusaka which are eventually made into what he called “gorgeous handbags and purses” that are sold locally and are also exported to the United States of America Ambassador Dybul further added that women at Chikumbuso Project also turned what used to be a bar into a community centre to build a school that started with 30 children and had now grown to over 300. The best part, he went on, is that the entire school is free.

Through the implementation of a tailoring course for single moms and widows, a grandmother support group and a feeding programme, the team at Chikumbuso is able to cover a variety of aspects to make the project run successfully. The women participate on every level… six widows are bankers that handle sales, pay out salaries and make and collect micro-loans. Another group of widows serve as the community leaders – they help out in times of desperate need, go to the community to visit sick neighbours and assess ways in which Chikumbuso Project can be a “light” for the rest of the community in Ng’ombe.

Former First Lady Laura Bush also took the stage to praise the conference attendees for their courage and persistence even as she brought up the next battle – Helping Women Who Live With HIV stave off other deadly disease. “Because we are seeing women living with HIV and dying of Cervical Cancer, the George W Bush Institute has launched the Pink Ribbon Red Ribbon Campaign,” she said. The campaign provides screening and treatment of breast and cervical cancer of women in the developing world.

“Cervical cancer is the leading cause of cancer death in Sub-Saharan Africa and… it is up to five times more common in women whose immune systems are already compromised by HIV,” Mrs Bush said. She went on to say that she and former US President George Bush had visited Zambia recently to see how the Ribbon Campaign they launched in December, 2011 was doing. In her own words, they were “thrilled” to see the progress.

The Pink Ribbon Red Ribbon (PRRR), which is endorsed by President Michael Sata and First Lady Christine Kaseba “has expanded from the capital city of Lusaka to health clinics across the country. ” “Already, more than 14,000 women have been screened. Of these, nearly 40 per cent tested positive for HIV while a third tested positive for cancerous or precancerous cervical cells. Of those women showing signs of cancer, more than 80 per cent could be treated immediately with a therapy that kills cancer cells by freezing them,” she said.

Meanwhile, US Secretary of State Hillary Clinton took to the stage and in her keynote address to the gathering mentioned Zambia by name four times… all in the positive! She noted that the new numbers of HIV/AIDS cases and especially mother to child transmission in Zambia had been decreasing adding that the Barack Obama Administration would keep up the momentum on prevention of mother to child HIV and AIDS transmission and scale up male circumcision.

Mrs Clinton observed that steps taken by her Government in Zambia would reduce the number of new sexually transmitted infections by more than 25 per cent over the next five years. “Think of the lives we will touch in Zambia alone- all the mothers, fathers and children will never have their lives ripped apart by the disease. And now multiply that across the many countries we are working with,” she said.

To add to the accolades was Microsoft Founder and billionaire Bill Gates, who last March visited Zambia on a field trip to appreciate the work of the Bill and Melinda Foundation that provides funding for the elimination of malaria in the country. During that visit, he told the conference, he had a chance to meet with His Royal Highness Chief Mumena of the Kaonde people. In his own words, “Chief Mumena is one of Zambia’s most respected traditional leaders. He has been using his voice to encourage Kaonde men to embrace voluntary medical male circumcision as a strategy to prevent HIV transmission.

The discovery that male circumcision can reduce a man’s risk of acquiring or transmitting HIV by up to 60 per cent is an exciting breakthrough in HIV prevention, but the message about male circumcision’s life-saving potential still has not reached enough people. Traditional leaders can play an important roie in expanding demand for male circumcision and Chief Mumena is showing the way,” he said As the AIDS Conference was coming to a conclusion, I could not help but take stock of how Zambia had been represented by the huge delegation.

I had in mind the several abstracts by members of the delegation covering topics such as: •Integrating Cervical Cancer Prevention Services Into Mobile HIV Counselling and Testing Services To Reach More Women With Life-Saving Cancer Interventions or indeed a topic such as “Reducing HIV Incidence Rates Through Repeat Testing And Post Test Risk Reduction Education: The Case of the Zambia Defence Force Counselling and Testing Programme by the Zambia Defence Medical Services and Project Concern International.

Other abstracts that were of interest came from USAID /PEPFAR Projects in Zambia such as : •Sytems of Early Infant HIV Diagnosis in Zambia-Skipping the Graveyard: Effective of Door to Door and Mobile Drama HIV/AIDS Sensitisation in Rural Zambia •Improving Paediatric Access to HIV Testing and Treatment: The Role of Provider Initiated Counselling and Testing in Outpatient Departments in Lusaka •Partnering With the Church To Turn the Tide of HIV in Zambia •Strengthening the Capacity of Nurses and Midwives as frontline Providers in Tackling the HIV/AIDS Pandemic: The Heartbeat of the Healthcare System and many more.

From the Japan International Cooperation Agency (JICA) SHIMA project in collaboration with the Ministry of Health district health offices, came abstracts titled •Poor Linkages Between TB and HIV Services Affect The Quality of Care: A Retrospective Cohort Study of TB/HIV Co-Infected Patients from HIV Testing to ARTY Initiation in Rural Setting in Zambia – Chongwe •The Factors and Barriers Influencing Retention in pre-ART Care Services: Assessing the Quality of Care In A Resource-Limited Facility In Zambia- Kalomo.

•Decentralisation of HIV Care Services In A Rural District In Zambia: A Comparative Analysis of the Quality of Care Between The District Hospital And Rural Health Centre – Kalomo •Social Support And Improved Adherence To AntiRetroviral Therapy: An Observational Longitudinal Study In A Rural Setting of Zambia – Mumbwa After a hectic five days of discussions, debates, workshops and satellite meetings, it was abundantly clear in my mind that the Zambian delegation had been “spot on”.

Thanks to the National AIDS Council (NAC) and the Zambian embassy staff in Washington DC for the countless tele-conferences between Washington DC and Lusaka in realising a worthwhile, productive assignment. This should serve as an integral part of planning and follow up by NAC leading to AIDS 2014 in Melbourne, Australia.

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