Whether or not to marry an HIV positive person - the students debate

I enjoy reading the works of the students, whom my wife teaches here at Chikankata Higher Secondary School. Here are compositions by two of the Class XI students when they are asked to write a letter encouraging or discouraging their brother who has decided to marry an HIV positive woman. One can learn about the awareness level of the students on HIV/AIDS, and their attitudes towards the disease. These works of the students clearly depict the extent of impact HIV/AIDS on the household economy and the community life. Thanks to the effective community coping strategy the Zambians developed, the disease, however, fails to disrupt the strong social cohesion pattern of the Zambian society.

This letter discourages marrying an HIV positive person:

Dear brother,

First of all, I would like to greet, hope you are fine that side. As for me I am just okay and the family here is just okay.

Coming to the main point of writing this letter to you is that, I heard that you are marrying next year. It’s good to hear that, but the woman you want to marry is HIV positive. I just want to tell you that you can’t marry a woman who is HIV positive because, you won’t even stay with her for a long time. She may die or yourself may die soon. And another thing is that you will also get the virus which causes AIDS. That will make you die fast, as you know men die faster than woman if they have the virus. When you die, you may leave your children; those children may suffer financial problems. As you know that in our family we are not rich enough to help your children to let them go to school, they will just end up loitering in the streets and may become thieves and prostitutes. The other thing is that when you die it will be a great loss for the family. You know that you are the only one who can help us in financial problems for you are the only one who is educated.

In conclusion, I would like to advise you not to marry that woman, because she will just bring us problems. Actually she is not the only girl in this world. If you don’t mind I will help you to look for someone else and not that one. So if you want to die fast, go ahead. But just know that your marriage will not be blessed because our parents are not happy about your idea. So stop it before it is too late for you.

Tusela Kooma

I personally like the following letter more for it is full of hope and life.
Dear Martin,

How are you and the family there in Chooma? Chikankata is just fine, only the coldness.

My main purpose of writing is to congratulate you on the issue I heard. I heard that you want to marry and that the woman you want to marry is HIV positive. But I would encourage you that if you really love the woman from deep down your heart and she really loves you, go ahead and marry her. Even if people talk and talk just go ahead, at last they will get tired of talking.

But when you get married there are some conditions which are: you should be faithful to each other; you or she should not have other partners. Whenever you have sex please use a condom. When she becomes pregnant by chance please advise her to go to the hospital or nearby clinic for more information on how she can prevent the baby from HIV/AIDS. Please when she is sick, care for her. Show her love because when people who are positive are not taken care of or shown love, they feel underrated. Please before you get married go to the hospital and get more information on how you are to live your marriage life. Remember that there are also some sexually transmitted infections which can be easily transmitted, so be careful brother! I also wanted to attend your wedding but it’s just that I am preparing for my mock exam. Send my regards to Aunt Rose, Sister Linda, grandma, grandpa and the rest of the family. See you when I come. All the best in life.

With lots of love.

Mwangala Liswaniso

Of course, whatever is our HIV status, positive or negative, we all deserve to have the best in life. These three things will abide with us forever: faith, hope and love!

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