Zambia

LUSAKA, ZAMBIA / GENEVA, SWITZERLAND, 18 July 2022—Leaders meeting at the Africa Union summit in Lusaka, Zambia, have pledged their support for the Education Plus initiative at its continental launch, commiting to take action to keep adolescent girls in school, which will dramatically reduce their vulnerability to HIV.

Every week, around 4200 adolescent girls and young women in sub-Saharan Africa acquire HIV. In 2020, six in seven adolescents aged between 15—19 years old acquiring HIV in the region were girls. More than 23000 young women died from AIDS-related illnesses in 2020, making it the second leading cause of death among women aged 15—29 after maternal mortality in sub-Saharan Africa.

Keeping girls in secondary school and providing them with life skills, training and employment opportunities is key to ending the AIDS pandemic in Africa. Research shows that ensuring that girls complete secondary education reduces their risk of acquiring HIV by up to half, and that combining this with a package of services and rights for girls’ empowerment reduces their risk further still. 

Education Plus calls for free and quality secondary education for all girls and boys in sub-Saharan Africa by 2025; universal access to comprehensive sexuality education; fulfilment of sexual and reproductive health and rights; freedom from gender-based and sexual violence; school-to-work transitions, and economic security and empowerment. 

“My government has committed to the provision of free primary and secondary education for  all,” said President Hakainde Hichilema of Zambia, who hosted the summit. “Education is the greatest equalizer and with appropriate education, everyone is given an opportunity to explore their full potential and be able to participate in the development process. Access to education empowers both girls and boys as it enhances their ability to access decent jobs and other means of production thus alleviating poverty.”

The President of Senegal and current chair of the African Union, Macky Sall, launched the initiative flanked by three other presidents and  the Chairperson of the African Union Commission Moussa Faki Mahamat.

“It is my pleasure to join you on the occasion of the ceremony to launch the continental “Education Plus Initiative” under the leadership of the Organisation of African First Ladies (OAFLAD) in support to children and young girls in particular,” said President Sall. “There is need for action to promote women’s rights and autonomy, to fight against the discrimination and violence which girls and women face. We must address gender inequality at all stages of life. At the continental level, AU Member States are committed to accelerating the implementation of gender-specific economic, social, and legal measures aimed at combating the HIV/AIDS pandemic by adopting various policy and legal frameworks including the Maputo Protocol.”

The launch was held in partnership with the Organisation of African First Ladies for Development, convened by the First Lady of Zambia, H.E Mutinta Hichilema. 

“I am confident that Education Plus will enable us all to protect, provide and preserve the lives of adolescent girls and young women by enhancing education standards and preventing new HIV infections by use of various interventions,” said Ms Hichilema.

“We lend our voice to the transformative call for gender-inclusive education in Africa,” said Leyla Gozo, Executive Secretary of  the Organisation of African First Ladies for Development, “First ladies are uniquely positioned to amplify this inititiative.”

The Education Plus initiative has taken on even greater urgency as the COVID-19 pandemic pushed millions of girls out of school. Even before the pandemic, almost 34 million adolescent girls aged 12—17 years old in the sub-Saharan Africa region were not in secondary school. Evidence also shows that girls are less likely to restart school once they have dropped out.

Ten African countries – Benin, Cameroon, Eswatini, Gabon, Gambia, Lesotho, Malawi, Sierra Leone, South Africa and Uganda – have so far committed to the initiative which is jointly convened by five United Nations agencies, UNAIDS, UNESCO, UNFPA, UNICEF and UN Women, and brings together governments, civil society and international partners.

“We are making progress in Africa but not fast enough,” said UNAIDS Executive Director, Winnie Byanyima in her address to the launch. “We need to urgently address the gender inequalities that still plague the continent, with devastating impacts on poor girls and young women. We don’t have a minute to wait.  Working together, we can all end discriminatory laws and harmful social norms, so that our girls are healthy, educated and empowered and can lead our continent, Africa, forward.”

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

GENEVA/LUSAKA, 18 June 2021—UNAIDS is deeply saddened by the death of the first President of Zambia, Kenneth Kaunda, and expresses its sincere condolences to his family, his friends and the country. Mr Kaunda was a strong supporter of the AIDS response and showed great leadership and courage in speaking out against HIV-related stigma and discrimination in the early days of the epidemic.

Mr Kaunda, who lost a son to AIDS in the 1980s, was one of the first members of the Champions for an AIDS-Free Generation in Africa, a distinguished group of former presidents and influential African leaders mobilizing political leadership to end AIDS as a public health threat on the continent by 2030. Mr Kaunda also dedicated time and effort to the AIDS response through his Kenneth Kaunda Children of Africa Foundation and through the Zambian Chapter of the Brothers for Life Campaign, which aimed to encourage healthier lifestyles among young men.

In 2018, UNAIDS conferred its Leadership Award on Mr Kaunda for his services to the global, regional and national AIDS response. Upon accepting the honour, he dedicated it to the people who had died of AIDS-related illnesses as well as those on the front line of fighting HIV. Mr Kaunda is also fondly remembered for performing at public events his song: We Shall Fight and Conquer AIDS.

“The sun has set on a great and good man, freedom fighter, pan-Africanist, founding parent of the Organisation of African Unity and giant of the HIV response,” said UNAIDS Executive Director, Winnie Byanyima. “He was brave, compassionate and tireless in confronting HIV-related stigma and discrimination from the early days of the epidemic and his contribution to Africa’s response will not be forgotten. We shall fight and conquer AIDS.”

Phenomenal Positive Youths are young people living positively with HIV, working towards the elimination of stigma and discrimination, adherence to HIV treatment, access to sexual and reproductive health and rights services and mental health support in Zambia.

UNAIDS has facilitated sexual and reproductive health and rights training for the Lusaka team of Phenomenal Positive Youths and plans to extend it to other districts in Zambia. The training will now include the impact of the COVID-19 outbreak on young people living with HIV, which is currently being evaluated through an impact assessment survey.

Currently, its members are part of the multisectoral risk communication community engagement pillar, as recommended by the World Health Organization’s COVID-19 Strategic Preparedness and Response Plan. Under this pillar, they are involved in creating and disseminating messages on COVID-19, busting myths, social listening and raising awareness, under the guidance of the Ministry of Health in Zambia.

UNAIDS has advocated for the implementation of multimonth dispensing of HIV treatment in Zambia. As a result, the Ministry of Health has issued a national circular to accelerate the implementation of the multimonth dispensing policy, instructing health facilities to provide three to six months of antiretroviral medicines to people living with HIV. Phenomenal Positive Youths is encouraging its members and health-care workers to follow the new guidelines.

While the policy is being implemented, Oswald Chisenga, the team leader of Phenomenal Positive Youths, said the organization has noticed that young people have experienced challenges in accessing their monthly supply of HIV treatment. “The limitation of travel during the COVID-19 outbreak, the fear of exposure to the coronavirus and the associated stigma is restricting people from visiting health-care facilities, even with the revised national guidelines,” he said. “Even messages on COVID-19 have been misinterpreted by people as meaning they should not go to a health facility, even when the need arises.”

Thus, the organization has developed an unconventional and innovative approach to ensure that its members have an ongoing supply of antiretroviral therapy, called chilimba (a commonly used local word meaning to loan or advance a colleague something). Members of the organization loan their antiretroviral medicines to one another until the person in need can obtain their supply, at which time the medication is returned.

“We help each other so that no one skips a day or does not have enough antiretroviral therapy due to different circumstances. It may be because of illness, or the person is very far from the health facility or they have no documentation to access the health facility,” said Mr Chisenga. “We communicate with one another using our social media groups. This helps us to maintain adherence, encourages openness and virtual interactions or physical ones while observing social distancing guidelines,” he added. 

This is only one of the innovations that Phenomenal Positive Youth has brought into the youth-led movement in Zambia. The group was also among the first associations to speak openly about mental health among young people, especially among young key populations and young vulnerable people.

The UNAIDS Executive Director, Michel Sidibé, has completed a five-day visit to three countries in southern Africa. The mission included high-level political discussions, the launch of the Lesotho HIV health and situation room and a frank and open dialogue with women activists about how to address sexual harassment and abuse.

Beginning in Lesotho, Mr Sidibé attended the launch of the HIV health and situation room with the Deputy Prime Minister, Monyane Moleleki. Special guest Naomi Campbell was invited by UNAIDS to join the two-day country visit to learn more about the HIV response.

The Lesotho HIV and health situation room shows real-time service delivery data, producing a comprehensive picture and understanding of Lesotho’s HIV epidemic. It enables quick feedback on results at the national and community levels and identifies bottlenecks in access to health-care services.

“The launch of the Lesotho HIV and health situation room gives us access to data to shape impactful and efficient health programmes. These are the kind of innovations that will bring services to those who need them most and ensure that no one is left behind by the AIDS response,” said Michel Sidibé, the UNAIDS Executive Director.

On the eve of the launch, Mr Sidibé and Ms Campbell visited the Queen II Hospital in Maseru, Lesotho, and met with young women living with HIV and others affected by the epidemic.

“I commend the Government of Lesotho and its partners for the progress made in the AIDS response. But the work is far from done. The reality is that we are not reaching adolescent girls and young women. I leave Lesotho today empowered, inspired, encouraged and determined to do all I can to highlight this critical issue,” said Ms Campbell.

In South Africa, Mr Sidibé addressed the Pan African Parliament and underlined the importance of integrated health approaches that were people-centred. He urged parliamentarians to commit more domestic funding for health services to increase the sustainability of the AIDS response and to put in place more preventative measures to improve people’s health. In addition, he called for laws to protect women and vulnerable groups. 

Mr Sidibé left the parliamentary session to meet civil society activists concerned by UNAIDS' response to allegations of sexual harassment and abuse in the organization.

At a follow-up meeting the next day, Mr Sidibé and women activists met to discuss their concerns.

Mr Sidibé agreed with activists to issue a statement following the meeting. The statement begins:

‘During my recent visit to South Africa, I listened carefully to you, I heard you. The HIV epidemic is inextricably linked to sexual and gender-based violence and the two can never be separated. We need the passion of advocates to move issues forward.`

During his visit to South Africa, Mr Sidibé held separate meetings with the President, Cyril Ramaphosa, the Deputy President and South African National AIDS Council Chair, David Mabuza, and the Minister of Health, Aaron Motsoaledi. They discussed plans to increase the number of people on treatment by 2 million by 2020 and the need to empower local and provincial authorities to bring treatment and prevention services closer to vulnerable communities.

The last leg of Mr Sidibé’s visit saw him arrive in Lusaka, Zambia, to confer the 2018 UNAIDS Leadership Award upon Kenneth Kaunda for his efforts in strengthening the AIDS response.  

New data show that the test and treat approach is having a significant impact on the number of people accessing HIV treatment. After Uganda adopted such an approach in 2017, according to government data the number of men newly initiated on treatment rose from 60 000 in 2016 to 80 000 in 2017, while the number of women newly initiated on treatment increased from 107 000 to 138 000 in the same time period.

Just as importantly, the treatment gap between people newly diagnosed as HIV-positive and people newly initiated on HIV treatment has shrunk for both men and women in Uganda. The gap for men narrowed by 45%, from 33 000 in 2016 to 18 000 in 2017, while for women it narrowed by 60% in the same time period, from 48 000 to 19 000. Although more women are testing HIV-positive than men, the HIV treatment gap is closing for both women and men.

Similar trends were observed in Zambia after the start of its test and treat policy in 2017. Zambia has seen the number of people newly initiating HIV treatment increase from 23 000 in the first quarter of 2016 to 45 000 in the final quarter of 2017, according to government data—an increase of 65%.

Through a test and treat approach, if a person tests HIV-positive, he or she is immediately enrolled on HIV treatment. Before the advent of test and treat, people living with HIV had to wait for their CD4 count to drop to a particular level before starting treatment.

Both these effects of test and treat were seen after the recent launches of so-called situation rooms in both Uganda and Zambia. The situation rooms are interactive software platforms that centralize data for HIV and other diseases to improve tracking of the diseases and programming in order to reach more people with services.

Zambia has made good progress in its AIDS response. In 2016, the country had more than 800 000 people on HIV treatment, with 83% of pregnant women living with HIV accessing it. To better understand the progress, and the challenges, Michel Sidibé, UNAIDS Executive Director, visited the Chilenje health facility in Lusaka, Zambia, during a visit to the country from 5 to 7 March.

The Chilenje facility offers HIV treatment, a prevention of mother-to-child transmission of HIV programme and tailored services for adolescents and young people. At the facility’s youth-friendly space, peer educators facilitate service uptake by young people and reach out to schools and other groups within their community with counselling and sensitization.

“We need to build cities of the future where services are not only available to people, but they are also tailored to their needs. This is the rationale behind the Fast-Track cities initiative, of which Lusaka is an excellent example,” said Mr Sidibé during his visit.

The facility offers extended hours in the evening and weekends so that people who are unable to access health services outside of standard operating hours can access HIV treatment and other services.

“Young people often fall through the cracks of the health system for fear of judgement or stigma. Owing to the large number of adolescents and young people in our community, we have set up a youth-friendly space,” said Malinba Chiko, the Superintendent of the Chilenje health facility.

Earlier in the day, Mr Sidibé met with members of civil society, who raised the issue of access to HIV and sexual and reproductive health services for key populations, especially gay men and other men who have sex with men and sex workers. Mr Sidibé reiterated that civil society is at the heart of the AIDS response and, for it to be sustainable, the voice and decision-making of civil society are essential.

A new tool to track progress and identify gaps in health programming in Zambia has been launched. The Zambia Integrated Health Situation Room centralizes data for HIV, tuberculosis, maternal and child health and malaria to improve programming and reach more people with services.

The situation room—the first integrated situation room in Africa—was launched on 6 March by Inonge Mutukwa Wina, the Vice-President of Zambia, and Michel Sidibé, the Executive Director of UNAIDS. It shows real-time service delivery data and produces a comprehensive picture of key health areas in Zambia.

Enabling quick feedback on results at the county and community levels, the situation room identifies bottlenecks to service delivery. It also enables programme staff to intensify local efforts to ensure that adults and children living with HIV have regular access to care and that HIV medicines are replenished quickly if stock-outs occur.

Earlier in the day, Mr Sidibé congratulated Edgar Chagwa Lungu, the President of Zambia, for his government’s leadership in ensuring that no one is left behind by the AIDS response in Zambia. Mr Lungu expressed his commitment to ensuring access to medicines and expressed his commitment to local pharmaceutical production. He reiterated his commitment to not only reach the 90‒90‒90 targets, but to make the target of reaching 100% of people living with HIV in Zambia a reality.

Zambia has launched its AIDS Response Fast-Track Strategy 2017–2021, which provides a road map to achieve the global Fast-Track prevention and 90–90–90 targets whereby 90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status are accessing treatment and 90% of people on treatment have suppressed viral loads.

Building on the results achieved so far, the strategy has three main objectives: establish clear approaches to accelerate the HIV response for everyone, including key populations; set yearly targets at the national and provincial levels; and estimate costs and the resources gap.

So far, the government’s commitment has had significant impact: new HIV infections have decreased from 69 000 in 2005 to 59 000 in 2016 and coverage of pregnant women receiving antiretroviral medicines to prevent mother-to-child transmission of HIV has increased to 87%. Efforts to reach the most vulnerable people are being made, and new national policies outline targets and strategies to intensify prevention services in all the 10 provinces of the country.

The strategy provides for specific facility-based and community-led programmes, such as accelerating HIV testing and counselling in districts with high HIV prevalence, targeting key populations and integrating testing with other health-care services. 

The strategy will guarantee access to HIV treatment and care services and improve HIV testing services. One of the treatment goals emphasized in the strategy is the total elimination of new HIV infections among children.

The strategy was developed by a technical task team led by the National HIV/AIDS/STI/TB Council and UNAIDS.

Zambia has adopted the World Health Organization’s (WHO) guidelines on offering all people living with HIV antiretroviral therapy regardless of their CD4 count. Edgar Chagwa Lungu, the President of Zambia, made the announcement at the launch of Zambia’s inaugural HIV Testing, Counselling and Treatment Day in Lusaka, Zambia. The day replaces the annual Voluntary Counselling and Testing Day, which was commemorated between 2006 and 2016.

Of the estimated 1.2 million people living with HIV in Zambia, only 67% know their status. There are therefore approximately 400 000 people in Zambia who do not know that they are living with HIV. This situation calls for intensive, innovative and effective HIV testing strategies that are in line with WHO and UNAIDS global guidance.

Zambia has adapted the WHO consolidated guidelines on HIV testing services in line with the key principles of consent, confidentiality, counselling, correct test results and connection to HIV prevention, treatment and care (the 5Cs principles).

The World Health Organization and UNAIDS do not support mandatory or compulsory testing of individuals on public health grounds.

The only mandatory testing that the World Health Organization and UNAIDS support are:

• Screening of donors prior to all procedures involving transfer of bodily fluids or body parts, such as artificial insemination, corneal grafts and organ transplant.
• Screening for HIV and other blood-borne infections of all blood destined for transfusion or for manufacture of blood products.

Zambia has been implementing provider-initiated testing and counselling since 2008. WHO and UNAIDS have welcomed the government’s call to reinforce the implementation of universal routine HIV testing in line with the 5Cs principles. In this regard, WHO and UNAIDS will continue to collaborate with the government and other stakeholders to provide technical support and guidance in the review and dissemination of HIV testing services protocols and standard operating procedures to ensure that they are in line with the global recommendations of human rights-based approaches.