Chikankata HIV/AIDS Prevalence

The origin of HIV/AIDS programme under Salvation Army Chikankata Hospital in March 1987 was preceded by the diagnosis of a skin condition, Kaposi’s sarcoma, in a patient in 1986, with another 37 more cases of AIDS diagnosed later at the end of that year.[1] As more patients with AIDS crowded the hospital wards, the idea to build a hospice was debated by the hospital staff and the community leaders and finally rejected. It was felt that the numbers of patients who would require care would soon overwhelm a hospice. Knowing that caring of the sick by families at home is an inherent strength of Zambian society, home based care approach of people living with HIV/AIDS was adopted. The system involved the family, neighbourhood and community with Chikankata Hospital as the key player. [2] This approach has been adopted up to this time due to the positive impact it has on the community.

The trends in general:
Chikankata Hospital’s Anti-Retroviral Therapy (ART) Clinic named Muka Buumi (“Mother of Life” in Tonga), together with the Voluntary Counselling & Testing (VCT) services was started in 1st September 2004. At the start of VCT in 2004, out of a total of 391 people tested, 276 (70.58%) of them were positive for HIV. In 2005, the percentage of HIV positive result came down to 60.21% (660 positive from a total of 1096 tested). The situation changed for the better in 2006, when for the first time, a fewer number of people (37.93%) tested positive for HIV as against the negatives, from the huge total of 2175 (so far the largest Chikankata Hospital has in one year). The situation remains constant in 2007 (38.22% HIV positive) when 1724 were tested and in 2008 (37.76% HIV positive) when 1533 people were tested.

Antenatal versus population-based HIV prevalence rates, Chikankata Hospital:
When HIV prevalence rates among 15 – 39 years group each from pregnant mother antenatal attendee (considered the best representative sample of the general population) [3] and the actual general population (VCT attendee) are compared, there is a huge difference. While the antenatal HIV prevalence rates of Chikankata Hospital (12.97%) closely follows that of the Zambian national antenatal prevalence (12.50%), the prevalence among general population attending the VCT at Chikankata Hospital (44.08%) is so high that in no way can it represent the general population of the area, let alone that of the nation (15.2%). [4] This high prevalence of infection among VCT attendee of Chikankata Hospital is likely due to the sampling bias as majority of the people tested are either in-hospital patients or outpatients who already had certain medical problems at the time of arrival at the hospital.

These reductions in the prevalence/incidence of HIV are, of course, a welcome shift. However, the dynamics of epidemic prove that reduction in the prevalence or incidence of infection is not a consequence of a single factor alone. Hence the following questions arise:
1. Are the observed changes a reflection of the natural progression of the epidemic? Because the HIV prevalence will not grow indefinitely, it will saturate at some level. [5]
2. Are the observed changes a product of interventions or changes in behaviour? Considering the extent of interventions being carried out by Chikankata Hospital and the resultant behaviour change visible within the community, one can be compelled to answer this question with the affirmative.

The fact that HIV prevalence within Chikankata catchment area levels off or decreases from 2006 through 2008, paints a bright picture on the wall. It gives the idea that the rate of new HIV infection per year (incidence) has also decreased, as a fall in incidence always precede the fall in prevalence. It will be wise and more accurate to agree, that the natural saturation of the HIV epidemic coupled with VCT services and behaviour change interventions carried out by Chikankata Hospital, both contribute to the fall in the incidence and prevalence of HIV in Chikankata catchment area.

References:
1. Silomba, Weddy. Manager of AIDS Management & Training Services, Chikankata, Zambia. HIV/AIDS and Development: The Chikankata Experience. March 2002
2. Dixon, Dr. Patrick. AIDS and You. 2005
3. UNAIDS. Trends in HIV incidence and prevalence: natural course of the epidemic or results of behavioural change? June 1999
4. UNAIDS. Latest epidemiology data. http://www.unaids.org/en
5. UNAIDS. Trends in HIV incidence and prevalence: natural course of the epidemic or results of behavioural change? June 1999