Care and Support Services for People Living with HIV/AIDS (PLHA) in Zambia

Introduction

With an HIV prevalence of 17 percent (UNAIDS 2006:506), Zambia is one of the countries that are bearing the brunt of HIV/AIDS. Coupled with high poverty levels (Ministry of Finance and National Planning 2002:18-23), the task of providing care, treatment and support services for more than one million PLHA is a major developmental challenge to an economy that is reeling from three decades of economic stagnation. Over the years, HIV/AIDS has produced severe consequences at all levels (POLICY 2001:28). In many cases, it has been observed that older and poor women are left with the task of looking after PLHA (Akintola 2004; Juma et al. 2004). These women lack both the material and technical resources required for the care and support of PLHA. This has implications for prevention as well as treatment programmes as PLHA may not receive the counsel they need. Consequently, adherence to antiretroviral therapy and treatment of opportunistic diseases may also be affected.

After the adoption of the '3 by 5 strategy'¹ in 2004, the Zambian government facilitated the establishment of various HIV/AIDS services and set a target of providing ART to 100,000² people by the end of 2005 (National HIV/AIDS/STI/TB Council [NAC] 2006:4). However, as of 2006, only 65,000 people were on ART (Times of Zambia 2006). There is also anecdotal evidence suggesting that many people have continued to die from AIDS because they are failing to access the much needed antiretroviral (ARV) drugs on time as they tend to rely more on traditional healers than modern health institutions. In many places, including the city centre of Zambia's capital, Lusaka, there is enough evidence of HIV/AIDS patients seeking medical assistance from traditional healers.

Using data from the Zambia HIV Voluntary Counselling and Testing Study (ZHVCTS), this report discusses care and support services for PHWA in Zambia with a view to providing insights into the main challenges facing HIV/AIDS programmes in Zambia.

Data and methods

Data for this report were drawn from the predominantly qualitative ZHVCTS, which was conducted between January and June 2006. Permission to undertake this study was granted by the Australian National University (ANU), Ministry of Health (MOH) in Zambia and the Network of Zambian People living with HIV/AIDS (NZP+). This purposive cross-sectional study was conducted in Lusaka and North Western Provinces. Lusaka represented the urban setting while North Western represented the rural areas. Two districts were selected per province; Lusaka and Chongwe in Lusaka Province and Solwezi and Zambezi in North Western Province.

Based on the budget and time, a target sample of 35 health centres was determined. Three specialised data collection instruments were developed and used to elicit information from research participants. These are the in-depth interview schedules, focus group discussion (FGD) schedule and the mini questionnaire. In-depth interviews allow for collection of sensitive information that an individual may not divulge during FGDs. The in-depth interview schedule was used during the one-on-one interviews with various research participants.

The FGD schedule was used to collect information from groups of 10-15 research participants. These schedules were translated into four local languages (Kaonde, Lunda, Luvale and Nyanja) spoken in the study districts. The translations were made by three research assistants and verified by experts in the Department of Literature and Languages at the University of Zambia (UNZA). The mini questionnaire was used to collect information about each health centre. At each health centre, the Officer-in-Charge filled in the questionnaire using administrative records. Information collected included staffing and number of clients for HIV/AIDS services.

Individuals aged 15+ were targeted for interview. These included people living with HIV/AIDS; people who had HIV-negative status and were aware about it; people who did not know their HIV status; voluntary counselling and testing (VCT) service providers, health workers (including home-based-care providers) and traditional healers; health managers; and leaders (including traditional, political and religious leaders). Notes, Dictaphone and mp3 player were used to record some interviews. In many cases...