AIDS in Zambia
The life expectancy in Zambia plunged from 49.7 years in 1970-75 to 32.4 years in 2000-05, according to the Human Development Report for Zambia by the United Nations Development Programme.
CHAMBOLI, Zambia Thousands of wood and metal markers stud the bare earth surrounding the resting place of Enock Chinsense.
Shovels are at work a few feet from his fresh grave. In the distance, wailing rises near the children's plots. Trucks, buses and cars carrying the bereaved rumble along an unpaved road that bisects acres of makeshift tombstones.
Three people pray quietly for Chinsense amid the din, the dust, the bustle of the Chamboli Cemetery.
Chinsense, 72, died of AIDS. His mourners, Phaides Sankalimba, a niece, and her friends, Godfredah Mwelwa and Martin Chisulo, also have AIDS. Mwelwa has lost three adult children to AIDS and now cares for eight orphaned grandchildren in nearby Luangwa.
It is the dry season in Luangwa, a shantytown just south of the Congolese border in the heart of the world AIDS epidemic.
Of Luangwa's 2,000 residents, 900 either have the AIDS virus or have been widowed or left parentless by the disease, said Chisulo of the Copperbelt Health Education Project.
An estimated 600,000 Zambians have died because of AIDS in the past 20 years. By 2015, 1.5 million more are expected to join them. Out of a population of 10.6 million, 1.2 million, including one in five adults, are infected with HIV or have AIDS.
The life expectancy at birth has plunged from 49.7 years in 1970-75 to 32.4 years in 2000-05, according to the Human Development Report for Zambia by the United Nations Development Programme.
The transmission rate of new cases in Zambia may have peaked, but the effects of the disease, which takes years to be fully realized, are now hitting virtually every segment of Zambian society.
AIDS is striking down parents who have nothing to leave their children; killing teachers - 600 in the past year - who cannot be replaced by universities fast enough; and claiming the lives of social and health-care workers needed to cope with the epidemic.
Zambia is not the hardest-hit country in the region. But it presents many of the complicated problems associated with AIDS that confront the $15 billion effort President Bush has pledged to fight the disease in Africa and the Caribbean.
In Zambia and elsewhere in Africa, HIV is principally spread through heterosexual relations. The deference women pay to men, promiscuity and the hopelessness of youth all abet its transmission. Poverty is so dire in some areas that women prostitute themselves for food to feed their families.
And there are destructive superstitions at work. Chabu Kangale, an AIDS activist, says that one of the more dangerous is the belief that sex with a young girl can cure AIDS.
The poor suffer the most. According to the World Bank, the annual per-capita income for Zambians in 1999 was $330; 73 percent of the population lives in poverty. The World Health Organization says the annual per-capita amount spent on health care in 2000 was $49.
Near the banks of the Kafue River, in the shantytown of Mufuchani, Memory Mwape, 31, severely ill and a wisp of her former self, lies on a blanket and a straw mat. The mother of three rests alone on the ground in the shade of a tree.
Some rowdy neighbors have been drinking chibuku, a local brew made from corn and sorghum. Goats and chickens scurry about.
Mwape's face is pained, its flesh drawn. Her husband, Robson Kaingu, 31, joins her. He says there is no money for medicine.
The "chairman" of Mufuchani, a wiry 58-year-old named John Kabune, says 500 families live in the community's stone and mud-brick huts. "We have no school, we have no clinic, we have no store," he complained.
The day before, he said, the town buried three AIDS victims, a normal day's toll.
The drugs for treating HIV and AIDS are beyond the reach of most Zambians. Those working with victims estimate that only a small percentage receive the antiretroviral drugs. The United Nations says that at the end of 2001, 28 million people in Africa were living with HIV, yet fewer than 30,000 were receiving antiretroviral drug treatment.
Zambian officials promise that there are enough drugs available to meet the needs of the severely ill until the end of the year. One counselor said the cost is subsidized by the government and is about $10 a month.
But Lukama Imbuwa, with an orphan-assistance program in the city of Kitwe, said, "It's typical of our government to make such statements." Officials will say drugs are available in hospitals when they are not, he said.
Most nongovernment AIDS workers say that in order to obtain a steady source of the needed drugs, one must go to private sources and pay as much as $100 to $150 a month, an amount far beyond the means of most Zambians. Even those who can pay for it may have to choose between the medicine and an adequate diet.
The medications can cost too much even for employed Zambians. But businesses, such as Copperbelt Energy, have found that in the long run, it is less expensive to buy the drugs for ill employees than it is to replace a skilled worker.
The incidence of HIV/AIDS is highest in urban areas, where nearly 30 percent of even the low-risk population - those not involved in prostitution - test positive.
Girls and young women are most vulnerable, said Kangale, the AIDS activist and programs manager for the Copperbelt Health Education Project. In a male-dominated society, they are sometimes the victims of abuse by older men and relatives.
Girls orphaned by AIDS sometimes turn to prostitution to support themselves. The prostitutes further contributed to the problem in the late 1990s by offering unprotected sex - though at a higher price, he said.
Bishop Joshua H.K. Banda of the Northmead Assembly of God Church in Zambia's capital of Lusaka agrees. In many areas of Zambia, the men are in charge.
"Women do not have much of a say. The man can have many sexual partners," he said. This year, Banda was one of several African church leaders invited to the White House to discuss needs with Bush's advisers.
There are some encouraging signs. According to AVERT, a British AIDS charity, a new study has shown success in Zambian prevention efforts. The study reported that urban men and women were less sexually active, fewer had multiple sex partners and condoms were used more consistently.
Those findings are consistent with reports that HIV infection declined significantly among 15-to 29-year-old urban females, from 28.3 percent in 1996 to 24.1 percent in 1999, and in rural females ages 15 to 24, from 16.1 percent to 12.2 percent in the same period.
Nevertheless, HIV continues to spread.
Thousands who live in the Copperbelt Province in the north rely on jobs in the area's copper mines, where there have been recent widespread layoffs. Some of the jobless have turned to drink, which in turn leads to promiscuity, which in turn leads to AIDS, Kangale said.
AIDS orphans roam the streets, getting high on glue fumes, in Lusaka and Kitwe, a city of 700,000 and the second-largest in Zambia. Orphanages and child-assistance programs run by churches and charities are springing up, but they cannot meet the demand.
In Lusaka, life is a struggle enough for most. By day, tens of thousands commute on foot or in mini-buses to the markets and marginal employers near the city center.
They live in "shanty slum" areas such as Lusaka's Chainda, where children, in groups of a dozen or more, race about wildly.
Yoram Siame, program and projects manager for Youth Alive Zambia, an AIDS prevention group, says the economy is so bad that many youths live only for the moment and turn to drink just like adults.
If you talk to young people about HIV/AIDS, you also have to talk about alcohol abuse, Siame says. If they get drunk, they forget everything about AIDS safety.
The police are stretched thin. Like underage drinking, prostitution is not a high priority with law enforcement, according to those who try to aid women.
Linda Lungu, 22, a petite woman, began working as a prostitute when she was 13. Her friends had money and she did not. She says she decided to earn some the only way available.
Chade Chita, 23, started selling herself on the streets when she was 12. Her parents were dead, she says. She does not know if AIDS killed them.
The two women quit the business. Lungu left three years ago and Chita, five. Beatings, the murder of friends and the risk of AIDS became too much. They turned to the Tasintha Programme for help.
Clotilda Phiri is the coordinator of Tasintha, which helps prostitutes either leave the business or practice safe sex. Phiri says that when Tasintha first started in 1992, the prostitutes' ages ranged from 16 to 35. Now, she says, as the economy worsens and AIDS catches up with the older women, the age range is 11 to 20.
Phiri said that many are aware how AIDS is spread. "They say, 'We know it kills. But HIV/AIDS will kill us in five or 10 years' time - hunger will kill us now.'"
Many of the women who come to Tasintha's clinic are unwilling to be tested for AIDS. Lungu and Chita have refused. Though the odds are seven out of 10 that, as former prostitutes, they have the virus, they said they feel quite healthy.
Some of the sex workers have concluded they are HIV-positive without even going for a test, Phiri said. Her job is discouraging at times, but removing just one prostitute from the streets saves many lives, she said. "To us, that's an achievement."
The virus does not confine itself to the streets and poor. At Copperbelt University, with more than 2,000 students and 1,000 staff, Chisebwe Fumbeshi, 23, and David Kampeshi, 24, help run a campus AIDS awareness program.
Though cases among the students are rare, they say the incidence of other sexually transmitted diseases such as syphilis and gonorrhea indicate that HIV is likely present among students.
Dr. Charles Lalusha, who helps run the school's health program, said there are no official statistics, "but we know that AIDS has claimed the lives of many of our staff."
Because of the strong stigma of AIDS, Lalusha said, some well-educated university staff members who have contracted the disease have died without treatment rather than submit to testing and seek medicine that might save their lives.
All areas in the country are affected. Le'vi Lingwabo, 24, is with the Society for Family Health, which runs programs that make condoms available to cross-border truckers so they will not bring AIDS into and out of Zambia.
They also work in the lake area in the north where women, some of them wives and mothers, wait for fishing boats to return with a day's catch. "It's sad to see people selling their bodies so they can get fish," Lingwabo said.
AIDS patients are admitted to government hospitals such as Kitwe Central Hospital for free treatment of infections or other illnesses that take advantage of their weakened immune systems. Once treated, they return home for home care. Home care is handled by a number of groups, many of which must use volunteers to meet the demand.
Chisulo, the Copperbelt Health Education Project worker, accompanied two of his friends who are also volunteers, Sankalimba and Mwelwa, to the graveyard one Saturday last month where Enock Chinsense was buried. They work with those dying of the disease in the Luangwa area, near Kitwe.
Kangwa Samundengu, 47, does similar work. She helps manage the home care of some 800 AIDS victims in the Kitwe area with help from the Catholic Dioceses of Ndola.
She sometimes sees to it that victims receive maize flour, beans, rice and cooking oil. Antibiotics and other medicines - but not expensive antiretroviral medicines - are also made available when possible, she says.
Workers help look after the patients' children, seeing that they have shoes and go to school. Finally, she says, they assist with funerals, which can cost as little as $30, casket included.
Donald Musonda has the rough hands of a carpenter. The 32-year-old father of two started a coffin-manufacturing business in Kitwe a little more than a year ago; he said he is making a go of it.
He has two shops, each located near a hospital, and averages 10 orders a week. The coffins are built of wooden boards and particleboard and cost $17. One day last month, a dozen were sitting in the sun, shellac drying, outside one of the shops.
Some are quite small.
Amid the devastation of AIDS, many Zambians turn to their faith for hope and comfort.
One Sunday last month, the ridge-top Jordan Chapel of the African Methodist Episcopal Church in Wusakile was rocking with joy.
Just a stone's throw from a copper mine, the white, ramshackle building stood out against an azure sky. Inside, worshippers sang with an enthusiasm that belied the poverty crippling their lives and the unseen killer that stalks them.
With 120 members, the church now has 12 orphans because of AIDS. The pews grew silent as the Rev. Elias Mwansa began a prayer.
"As we come to you, Lord, we ask you, Lord, to cleanse us," he pleaded. "HIV and AIDS, Lord - we ask you, Lord, in all your power, Lord, to defeat it, Lord. We cry, Lord, we really cry."
"Amen," responded his flock.