Guardian Examines Continued Challenges in Fight Against HIV/AIDS in Zambia, Uganda

Despite successful efforts to reduce its HIV/AIDS prevalence, Zambia, which "has weathered one of the world's most devastating assaults by" HIV, continues to face obstacles to effectively fight the disease, London's Guardian reports. The country's HIV/AIDS prevalence rate has decreased from about 30% in the 1990s to 14.3% this year, but an estimated 300 to 500 Zambians still contract HIV every day, according to the Guardian. Transmission remains high in the country's urban centers and industrial copper belt, and rural communities are especially affected because of a lack of access to health facilities, chronic shortages of trained health care workers, and cultural stigma and discrimination associated with HIV/AIDS.

According to the Guardian, the European Union-funded Antiretroviral Treatment Community Education and Referral program, run by the International HIV/AIDS Alliance Zambia, since 2004 "has been trying to bridge this gap between health care services and local communities" by building networks of support groups for people living with and affected by HIV/AIDS. "The idea is that these groups will play an active role in shaping and delivering HIV/AIDS treatment and services to their local communities, by encouraging the uptake of treatment and testing," the Guardian reports. More than 200 HIV-positive volunteers also have been trained as treatment support workers and community mobilizers and now provide in-clinic services such as counseling and outreach programs, including home-based care services to complement existing antiretroviral programs. The Guardian reports that the program is so successful that it has been adopted by the International HIV/AIDS Alliance Uganda, where there are now more than 1,200 volunteer "network support agents" working in more than 400 health facilities across 40 districts.

Nevertheless, the Guardian reports that an increasing reliance on volunteers in Zambia has caused concern among some government officials. Albert Mwango, national antiretroviral treatment coordinator at the Ministry of Health, said, "The health system and donors have discovered that these volunteers are a very useful resource to plug the chronic staff shortages we have in our national health system," adding, "Just as the volunteers get dependent on their small monthly stipend, so local health staff end up depending on volunteers. But when they burn out or leave because there is another better paid volunteering job somewhere else, the system suffers."

Following the government's 2005 decision to provide antiretrovirals at no cost, there are now 220,000 Zambians receiving treatment, compared with 15,000 in 2004, the Guardian reports. According to the health ministry, there are an additional 150,000 HIV-positive people who should be on antiretrovirals but cannot be reached because of deficits in trained health care workers who can run drug distribution programs (Guardian [1], 11/24).

In related news, the Guardian reports that although Uganda's battle against HIV/AIDS is regarded as "one of Africa's success stories" since its prevalence rate decreased to about 6% from a peak of 30% in the 1980s, the country's new National HIV/AIDS Strategic Plan "bleakly states the country is some way off beating the epidemic." According to the Guardian, the number of HIV-positive Ugandans is expected to increase from 1.1 million in 2006 to 1.3 million in 2012.

Elizabeth Namagala, senior medical officer for HIV care and treatment at Uganda's Ministry of Health, said, "I think there has been a certain complacency that now we have [antiretrovirals], AIDS isn't the death sentence it once was. Maybe we have taken it for granted that people would still be absorbing the prevention messages." She added, "The situation at the moment is that for every one person we're getting on treatment, there are another five new incidences. Seventy percent of medical admissions are HIV-related, yet we're already facing chronic health care staff shortages. So it's going to be a serious challenge to contain this over the next five years." Milly Katana, country director at AIDS Alliance Uganda, said, "Unfortunately, we are not winning the war against this pandemic at the rate at which we are fighting it," adding, "New infections are increasing and this is an indication that ground is being lost. It's going to take a lot more investment in our health service and a commitment to keep funding the network model of community participation if we want to have a chance of beating it" (Guardian [2], 11/24).

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