Art in the fight against HIV in an African country

Africa

Africa is known for its many problems, to mention a few: poverty, corruption, political turmoil, wars and diseases. One should remember that there are strong differences between the countries in Africa, but the majority of the sub Sahara countries  still have a long way to go, in spite of a predicted economic growth of  6% for the continent in the years to come. Especially the burden of HIV in Southern Africa remains a serious problem. Billions and billions of USD are pumped into the AIDS programs. The solution to HIV, we now know, will not be brought by money alone. In Zambia a fascinating initiative was started to increase motivation and awareness. Let’s have a closer look at this country and its HIV/AIDS problem and the interesting way people over there cope with it.

 Zambia and HIV

Zambia a land locked country in Southern Africa is one of the countries most severely affected by HIV/AIDS. The adult HIV prevalence rate at this moment stands at 14,3%.¹ At current levels of HIV prevalence, young  persons in Zambia face a 50% life-time risk of dying of AIDS in the absence of treatment.² This is the setting of the Zambian national anti retroviral treatment or ART programme.³ Since its start in 2004, a total of  310.000 Zambians started with the life saving drugs.⁴ This in itself is an impressive achievement. At the same time there is no time for complacency, the challenges that the program is facing are enormous. 

Approximately 1.7  Million Zambians (of a total population of about 12 million) are estimated to be infected with the HIV virus. The antiretroviral drugs need to be provided over a lifetime and without a cure in time all infected Zambians will need ART. The numbers of people that are infected with HIV are actually increasing at a rate that outpaces treatment: for every two people who receive HIV treatment, five are newly infected.⁵

A large part of the African ART programme is paid for by foreign aid. The US government President’s Emergency Plan for Aids Relief (PEPFAR) has spent USD 25 billion on the fight against HIV/AIDS in Africa between 2003 and 2008.⁶ In Zambia the US government is one of the major contributors to the national ART programme alongside support from other international donors and institutions. The Zambian Ministry of Health at the same time faces many challenges: human resources, supply chain management and not least financial mismanagement; USD 5 million was unaccounted for in May 2010 and  investigations are going on at time of writing.

The apparent lack of political dedication is echoed in the lack of commitment to the ART programme by the Zambian population. Knowing one’s HIV status through testing provides an important link to HIV/AIDS treatment and care and is considered to be a key motivating factor for behaviour change.⁷According to the 2007 Zambian Demographic and Health Survey (ZDHS) only 16% of Zambians have gone for testing and are aware of their HIV status. Research data in Africa show that two years after starting treatment, on average 40% of Africans have defaulted: they are no longer taking treatment.⁸This is confirmed by what is observed in the Zambian ART clinics.⁹

In Lusaka, the capital of Zambia,  the majority of the AIDS awareness campaign adverts have disappeared over the past 10 years. Social life and especially sexual behaviour remains unchanged in spite of millions of USD that have been spent on behaviour change communication initiatives.

The picture described is called normalisation: a determined effort to reconstruct a ”normal” social and moral order in the midst of an epidemic.¹⁰ This can be seen at the family and community level and in the way national politics is managed. Its causes are multiple and complex. The main reasons have to do with stigmatization, the way in which this sexually transmitted epidemic is incompatible with the African and Zambian Christian identity, poor governance and  governments benefitting from the epidemic, in combination with poor understanding of the drivers of the epidemic.

Art4ART

The author of this article is one of the founders of the Zambian NGO art4ART (www.art4art.com). Art4ART is an example of the way in which the visual arts can be used to clarify or promote discussion about social  issues of any sort. Although the name art4ART suggests a focus on issues related to HIV/AIDS and its treatment, we want to use this forum as a platform for engaging in a range of social issues. For example, many of the challenges in addressing the prevention and treatment of HIV/AIDS are linked to underlying problems of stigmatisation, discrimination, empowerment, issues of gender equality and so on. All these challenges have a direct relationship with AIDS and (the acceptance) of Anti Retroviral Treatment. The visual arts can be a strong platform for promoting discussion, involvement, education and interaction on all of the above issues. Art4ART seeks to make use of this powerful approach to social engagement in Zambia.

In February 2010 art4ART organised a Black History Month exhibition in the National Museum of Zambia. Black History Month has its roots in the celebration of important black individuals and events. This was the first time that the Black History Month was celebrated on this scale in Zambia. The exhibition was opened by Zambia’s first President of the Republic and hero of the liberation struggle, his Excellency Doctor Kenneth Kaunda. In December 2010 during World Aids Day, art4ART organized an exhibition on HIV related stigma in the Alliance Francaise, Lusaka. The exhibition comprised of  9 interactive artworks, printed  t-shirts and booklets on the subject, focus-group discussions and performances by theatre groups. The exhibition was opened by the famous Zambian AIDS activist and current director of the Society for Family Health Dr. Menassah Phiri.

Jack Menke jr.

Medical Director Kara ART clinic & Laboratory, Lusaka, Zambia.

References

1. ZDHS 2007 Zambia p. 235.
2. MOH report 2009.
3. ART or Anti retroviral treatment aims at slowing the progression of HIV disease into AIDS. At this moment more than 310.000 Zambians are receiving this treatment.
4. ART update meeting , November 29 –  December 2, 2010 at Intercontinental Lusaka,  Zambia.
5. WHO/UNAIDS/UNICEF, Scaling up Priority HIV/ AIDS Interventions in the Health Sector, Progress Report, 2007.
6. No deed goes unpunished, Foreign Affairs, July august 2010,  p. 74-84.
7. ZDHS 2007 Zambia.
8. Rosen S, Fox MP, Gill CJ (2007) Patient retention in antiretroviral therapy programs in sub-Saharan Africa: A systematic review. PLOS Med 4(10): e298. doi:10. 1371/journal.pmed.0040298.
9. 12 months patient retention percentage in Lusaka urban clinic 2, 76%. Kelly McCoy, Maria Kankondo, Joshua Kasimba, James Lungu, Phil Seidenberg, Victor Mukonka, and Sydney Rosen, Cost of First Line Antiretroviral Therapy Using Tenofovir.
10. Aids and Power, why there is no political crisis-yet, Alex the Waal, 2006, p.9.

Dr. Kenneth Kaunda (center), dr. Jack Menke (right) and another viewer (left) look at the painting of South Africa’s former president Nelson Mandela at the Lusaka National Museum during the opening of the Black History Month exhibition of heroes and heroines on February 5, 2010. Photo Post of Zambia Newspaper.

 

The counseling process  by Kilarenz Albert Zulu (1x1m acrylic on canvas ) The picture depicts the four stages of the voluntary testing for HIV infection and counselling process. The artist was trained as an HIV/AIDS counsellor by art4ART.

 

This is a detail of the “Modern Family”,  a work exhibited during the Deconstructing Stigma exhibition . It shows the nature of Zambian sexual relationships (multiple concurrent sexual partnership)