Zambia: AIDS at a Turning Point

The 2009 theft from Zambia’s Ministry of Health of at least $3 million in donor money targeting AIDS turned out to be just the first in a series of events to highlight international issues surrounding a historic effort aimed at one disease.

At least some of the missing money in Zambia had been used, it turned out, to buy cars for each of a ministry bureaucrat’s seven girlfriends—in a country where HIV prevention efforts stress abstinence and faithfulness messages.

Within weeks of the theft, outraged health workers went on strike, bringing the country’s fragile health system to a standstill. Donors froze funding, which quickly led to shortages of AIDS-fighting medicine.

Then, two reports appeared that year showing that U.S.-funded efforts to prevent transmission of the virus were missing their intended Zambian audience. One report, presented by the Sexuality Information and Education Council of the United States, concluded that US-funded efforts were heavy on ideology, but short on practical solutions—including making condoms and comprehensive sexual education adequately available and involving local organizations. The other, funded by USAID and carried out by a private research firm, concluded that counseling offered to people getting tested for the virus that leads to AIDS didn’t offer meaningful information about transmission risks.

Then, as hopes hung more than ever on a scientific solution to the epidemic, the outcome of a clinical trial for a microbicide to prevent HIV transmission was widely misreported by local bloggers who said trial subjects had been infected with the virus by researchers, leading the government to suspend further research.

With failures in accountability and effectiveness, and with the country’s fragile health system in crisis, Zambia is confronting challenges that have led donors to question the value of fighting a single epidemic in countries lacking basic health services.

At this turning point in the epidemic, Zambian AIDS activists—physicians, patients, church leaders—are grappling with the fallout from the failure of local and donor efforts while they strive to guide the future of the fight against HIV in their own country and chart a new course in the struggle to subdue the world’s longest epidemic.

Antigone Barton, a 2010-2011 Nieman Global Health Fellow and former Knight Health Journalism Fellow who spent 2009 working with health journalists in Africa, returns to Zambia on a Pulitzer Center grant to cover the state of the HIV response there.

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