The Face of the Zambian AIDS Epidemic

"It’s the elephant in the room, in the country," says Dr. Manasseh Phiri, renowned physician, journalist, and activist. He goes on to say it’s large, hard to ignore, and consumes a massive amount of resources.

He’s talking passionately about HIV and AIDS in his community, and he has every right to be impassioned. Zambia, where Dr. Phiri resides, is at the epicenter of the AIDS epidemic, with 14.3% of its 13.3 million people affected.

Since arriving in Lusaka on Sunday, it’s been a whirlwind of site visits, panel discussions, and personal interviews with grassroots women leaders. I’ve learned a lot about the condition of women in Zambia—especially as it relates to HIV/AIDS.

"The face of the Zambian epidemic is the face of a woman," says Dr. Phiri. And from what I can tell, he’s right. Everyone I have met with to discuss the topic has mentioned that cultural traditions that oppress women are at the heart of the spread of this disease.

"The woman’s lot in Zambia: You are born to make your man happy," says Dr. Phiri.

Dr. Phiri tells us that it’s not unusual in this country—or particularly frowned upon—for a married man to have multiple, concurrent partners. A woman is encouraged by her peers and elders to tolerate this behavior and stay in a marriage despite the risk it puts her at for infection.

What’s more—transactional sex is rampant: In a country where 64% of the population lives below the poverty line and going to school requires access to resources like school uniforms, books, and writing utensils, it’s not uncommon for a young girl to trade sex for a high school diploma. And it’s of course difficult for a girl in this position to advocate for this sex to be safe and protected.

"Women have no right to demand for safe sex, even in the context of marriage," says World Pulse member and HIV/AIDS activist Prudence Phiri. “In our tradition, it’s taboo for a woman to say 'I can’t have live sex with you.'"

That makes negotiating condom use next to impossible for a woman in Zambia. This, combined with the issue of concurrent partners, means that the disease disproportionately affects women: 16.1% of women suffer compared to 12.3% of men.

That statistic coupled with the negative cultural traditions that contribute to infection, leads Dr. Phiri to believe that empowering women is the key to eradicating the illness.

"If we can get women to have the strength to control how they have sex, we can go a long way in dealing with (HIV/AIDS)," he says. "It is a personal belief that women are key to solving [this crisis]," says Dr. Phiri.

So how does one go about making such a huge cultural shift? Dr. Phiri believes it starts with educating girls—but more than that, it’s about "changing the mindsets of the men who they are sleeping with every night."

Changing the mindsets of men in order to reduce HIV/AIDS infection rates may seem like a tall order, but Zambia’s done it before.

The practice of male circumcision is a scientifically proven method of curbing HIV infections in men, but it’s never been a widely practiced tradition in Zambia—until now. Through government efforts, support from tribal leaders, and advocacy campaigns, Zambia has managed to circumcise an estimated 300,000 males, with a target of circumcising 80% of all HIV negative uncircumcised adult males aged 15 to 49 years, according to The Post, one of Zambia’s leading newspapers.

If we can find a way to replicate this success when it comes to men’s attitudes about sex with their female partners, we might just find a solution to one of the biggest global health crises the world faces today.

I’ve flown to Zambia as a Zambia Health Fellow with the International Reporting Project. For the next two weeks, I will be meeting with experts on global health issues; going on site visits to some of this country’s most successful projects; and meeting with World Pulse community members who call Zambia home.