This is one of a set of three related pages, which also includes an introduction to HIV & AIDS in Zambia and an account of prevention and care programmes.
| 1964 - The British colony of Northern Rhodesia becomes the independent Republic of Zambia, with Kenneth Kaunda as president. |
| 1984 - The first case of AIDS in Zambia is reported. In all probability, HIV has been around in Zambia since the 1970s. |
| 1985 - In Lusaka, 17.5% of hospital patients are found to be HIV-positive; of those in antenatal care, 8.7% have HIV.1 |
| 1986 - The National AIDS Prevention and Control Programme and National AIDS Surveillance Committee are established. |
| 1987 - President Kenneth Kaunda announces to the world that his son, Masuzyo, has died of AIDS. |
| 1987 - A short-term emergency plan is invoked to ensure safe blood and blood product supplies. Meanwhile, a survey of pregnant women in Lusaka finds that 11.6% have HIV. |
| 1988-92 - The First Medium Term Plan coordinates responses to the epidemic. Frederick Chiluba is elected president in 1991. |
| 1990 - The Zambian ANC-based National HIV/STD Sentinel Surveillance System (NSS) is set up. The first attempt is made to survey the national epidemic, though initially only a few sites are included. |
| 1992 - In urban areas, 27% of pregnant women tested have HIV; elsewhere, rates are around half this level. These prevalence rates remain more or less unchanged in all subsequent years. |
| 1994-98 -The Second Medium Term Plan unifies the AIDS, STD and TB programmes. |
| 1999 - The Prevention of Mother to Child Transmission (PMTCT) Initiative is launched. |
| 2000 - The National HIV/AIDS/STD/TB Council (NAC) is created and develops the National Strategic Framework. |
| 2001 - Levy Mwanawasa is elected president. |
| 2002 - The NAC becomes a legally-established body able to solicit funding. |
| 2002 - Public provision of ARV treatment begins at two trial sites in Lusaka and Ndola. |
| 2004 - The government declares HIV/AIDS a national emergency in a bid to boost treatment and prevention efforts. By the end of the year, around 20,000 people are receiving ARV drugs, of an estimated 149,000 in need. |
| 2005 - In February, it is announced that user charges for public sector ARV treatment will be dropped. |
In 1986, within two years of the first report of AIDS in Zambia, the National AIDS Surveillance Committee (NASC) and National AIDS Prevention and Control Programme (NAPCP) were established to coordinate HIV/AIDS-related activities. A short-term plan was instigated the next year to deal with the safety of blood and blood product supplies. This was followed by the First Medium Term Plan in the period 1988-92, which focused mainly on medical issues and saw the appointment of AIDS coordinators at the provincial and district levels.
During the late 1980s, the HIV epidemic was expanding at a very rapid rate. AIDS had been a notifiable disease since 1986, but only a very small proportion of cases were ever reported. Most AIDS deaths were attributed solely to tuberculosis - rates of which were soaring - or to some other infection. Yet, in 1988, the chairman of the NASC said, "if you compare AIDS to other health problems we have in Zambia, AIDS won't even appear on the scale". He said that WHO estimates of at least 10,000 AIDS cases were absurd, and insisted that the reported total of 1,066 was accurate.2
Much of what was known about HIV prevalence was kept secret by the authorities, and senior politicians were reluctant to speak out about the growing epidemic (President Kaunda's announcement that his son had died of AIDS was a notable exception). As The Times newspaper acknowledged in 1987, "a few years ago there was an unwritten rule not to discuss the presence of AIDS in Zambia so as not to discourage tourists from coming here".3 For Zambians, the policy of denial meant that ignorance and stigma went unchallenged while the virus silently spread to all parts of the country. National surveillance began in 1990, though initially only four sites were included.
As early as 1992, the WHO recommended the establishment of a National AIDS Advisory Council in Zambia, led by the president or vice president. However, the newly-elected Deputy Minister of Health did not favour this idea. A report into the issue stated that, "the new government has not paid any more attention to AIDS than the prior government. Instead it puts most of its efforts into reconstructing the bankrupt economy and paying off the country's debt. The new Minister of Health claims health workers are putting too much emphasis on AIDS while malaria kills more people than HIV."4 By this time, it was estimated that around one in five adults had been infected with HIV.
In the absence of a National AIDS Council, a Second Medium Term Plan covered the years 1993 to 1998. This plan recognised that the government's initial responses to HIV and AIDS had been inadequate and should have looked beyond the medical issues. It aimed to take a more "multisectoral" approach by involving a wider range of institutions and organisations, and by unifying the HIV/AIDS, STD and TB programmes.
In 1998 and 1999, the government consulted with a wide range of stakeholders to analyze its response to HIV/AIDS so far. Their verdict was far from a ringing endorsement. It was found that the Medium Term Plans had a blanket approach and were not tailored to different populations. There was no mechanism to evaluate the plans' implementation or impact, and collaboration within the government was highly fragmented. On the subject of leadership, the consultation found that there was no high-level political commitment or advocacy, and no strategic management of the HIV/AIDS programme at central level.
In 1999, The Post newspaper wrote in an editorial, "we feel [there] has been a very poor approach to the HIV/AIDS problem by our government - especially cabinet ministers, including President Chiluba. A look at what our government has allocated to the AIDS/HIV fight in this year's budget clearly reveals this irresponsibility."5 Such opinions were echoed by Stephen Lewis, the UN's Special Envoy for HIV/AIDS in Africa, who in 2003 said,
"The bitter truth is that in the regime of the previous President, nothing was done. He spent his time disavowing the reality of AIDS, and hurling obstacles in the way of those who were desperate to confront the epidemic. I can recall personally … sitting down with the then President Chiluba, and asking him what he intended to do about AIDS, and he simply wouldn't talk to me about it."6
In response to such accusations, former president Chiluba called Stephen Lewis "highly unprofessional" and denied ignoring him. He said that, "African governments should be conscious of attempts by imperial forces to narrow down Africa's immense problems to only HIV/AIDS and corruption", and that if issues of poverty and underdevelopment were not dealt with then the fight against HIV/AIDS would be in vain.7
The National HIV/AIDS/STD/TB Council (NAC) was created in March 2000, a little under two years before the end of Chiluba's presidency. However, it did not become operational until December 2002, when Parliament passed a national AIDS bill that made the NAC a legally-established body able to apply for funding (the prospect of a large World Bank grant provided much of the necessary motivation). At the passing of this bill, the NAC became the single, high-level institution responsible for coordinating the actions of all segments of government and society in the fight against HIV and AIDS. It is an autonomous body given political guidance by a Committee of Ministers from some fourteen ministries. Members of the Council represent government, NGOs, religious and traditional leaders, media, youth, the private sector and people living with HIV/AIDS.
In October 2000, the NAC published a National Strategic Framework. This document served two main purposes. Firstly, it provided a comprehensive overview of the HIV epidemic in Zambia. Secondly, the Framework outlined guiding principles for the national response, as well as priority areas and strategic goals. It aimed to take into account the specific needs of different groups of people; to be flexible; and to work at the district level as well as nationally. The Framework guided the actions of the NAC in the years 2001-03, and has served as the basis of subsequent plans and policies.
In recent years, there seems to have been a marked change in political attitude. Although much more progress is needed, and it is impossible to overstate the scale of the problem, at least responses to HIV and AIDS in Zambia have attained a higher priority. In 2004, President Mwanawasa declared HIV/AIDS a national emergency and promised to provide antiretroviral drugs to 10,000 people by the end of the year; having exceeded this target, he set another of 100,000 for the end of 2005. Government ministers and officials at all levels are now much more willing and able to talk about the epidemic. Even former president Kaunda has changed - he is now one of the most vocal and committed AIDS activists in the country.
"The shift in the response to HIV/AIDS was palpable. Don't misunderstand me: there was pain and frustration and death in egregious quantity, but there was also an entirely new level of determination and hope that I had not encountered before. As a result, I left Zambia in an unaccustomedly hopeful frame of mind." - Stephen Lewis, February 2005.8
Zambia is one of the poorest nations on earth. Government spending on HIV and AIDS is alone not nearly sufficient, and most responses must rely on other sources of funding.
The Strategic Interventions planned by the NAC for the years 2001-2003 were originally budgeted at just under $560 million, of which $184 million was to pay for hospital care and $159 million for antiretroviral treatment. The government's contribution was expected to be $126 million, almost all of which would be spent on hospital care.9
The interventions planned for the period 2002-2005 were also budgeted at just under $560 million, of which $88 million was for antiretroviral treatment and $107 million for all other forms of treatment and care.10 The WHO independently estimated that scaling up antiretroviral treatment provision would cost between $228 million and $248 million in 2004-2005 alone.11 The government committed $95 million for all HIV/AIDS related activities (excluding treatment of opportunistic infections) in the years 2002-2004.12
Many national governments and NGOs fund the fight against HIV and AIDS in Zambia, but the principal donors have been the Global Fund, the President's Emergency Plan For AIDS Relief (PEPFAR) and the World Bank.
After her economy was crippled in the mid-1970s - when a sharp fall in the price of copper coincided with a rise in the cost of oil and other imports - Zambia listened to the prevailing wisdom of the time and started to borrow money. But the general economic situation failed to improve, and the nation's external debt soon became unsustainable.
The government was left with little option but to accept the debt management services of the World Bank and International Monetary Fund (IMF), most recently under their Heavily Indebted Poor Countries (HIPC) Initiative. The price of such assistance was compliance with a set of strict economic rules, which in general promoted privatisation and limited public spending. Many non-governmental organisations working in Zambia, including ActionAid International USA and the Global AIDS Alliance, believe that the imposed policies hampered Zambia's response to HIV and AIDS, in particular by constricting the health and education budgets (the IMF denies this).13 Certainly the policies failed to reduce poverty. In 2004, the government spent $129 million servicing the $6.8 billion it owed - more than it spent on either healthcare or education.14
Eventually, the creditors acknowledged that comprehensive debt relief was the only way forward. In April 2005, the IMF approved a $4 billion debt relief package under the HIPC Initiative. Then, just two months later, the Group of Eight (G8) rich nations annuounced that all debts owed by poor countries to multilateral institutions would be cancelled. Zambia expects to receive an additional $2.5 billion in debt relief under the G8 deal.
Debt reduction does not remove the need for much more development assistance - especially for healthcare and education without which the war against HIV/AIDS can never be won - but it is a step in the right direction. Following the G8 announcement, Zambia's Finance Minister said that some of the money saved from debt relief would be used to provide more free antiretroviral drugs to people living with HIV.15
Zambia's many responses to HIV and AIDS include education, condom promotion, testing, and treatment programmes. Find out more about HIV and AIDS prevention and care in Zambia.
Author: Rob Noble.
Last updated July 26, 2005