A nation of orphans where one in five adults has HIV

DELEGATES VISITING Lusaka in September for the International Aids Conference will be conducting their deliberations in a society laid waste by a disease whose ravages are comparable with bubonic plague in medieval Europe.

In Zambia, one in five adults is HIV-positive and 80 per cent of families live below the poverty line. But, in perhaps the most chilling statistic of all, 10 per cent of the population are orphans. Around one million children have lost one or both parents.

According to the Unicef representative Peter McDermot, Zambia faces a "tripod of deprivation: poverty, debt and Aids. Each one is a singular crisis producing a downward spiral; taken together the effect is devastating."

Vincent Mukanga, a Zambian health worker, described how he returned home from an overseas posting to find his sister had died and was buried without a decent funeral.

"Our parents had passed away, and my younger sister had also died of HIV," he said. "Of the 12 people in my brother-in-law's family, there was no one left, they'd all succumbed to the disease. There was nobody to care for the funeral. In the mortuary they just lined up row upon row of naked bodies, and then turned on a hose. They no longer even bother to lay out the bodies properly before burial."

A Unicef report, The Progress of Nations, released last week, warns: "The advance of anti-retroviral drugs in industrialised countries has left some with the illusion that the worst of the Aids epidemic has passed. Nothing could be further from reality. In the developing world the silent, voracious epidemic is wiping out the historic gains of the public health and economic developments of the last 20 years."

Last year, according to a recent World Bank document, 1.5 million Africans died of Aids,leaving a trail of devastation in the worst affected countries, such as Uganda, Zimbabwe and Zambia. "Not since the bubonic plague of the European Middle Ages has there been so large a threat to hundreds of millions of people - and the future of entire economies," the World Bank says. "Aids is no longer a problem of medication. It is a problem of development."

A problem of development it may be, but the toll on a personal level is almost unimaginable. One nurse in a Ndola hospital was horrified to hear a woman shouting at her daughter: "Hurry up and die, so I can go and get some rest."

When told she shouldn't address a patient like that, the mother got really angry andsaid: "You don't know what this girl has put me through. I used to beg her not to go out. I got down on my knees and pleaded with her not to go out in the evenings. Night after night I cried and I tried to warn her that she would get sick like the others. I've buried all my other children and I tried to save her, but she wouldn't listen. Now I have no more tears to cry.

"I warned her and I nursed her. Now I'm tired and I just want to rest, so I wish she'd hurry up and die."

Many men believe sex with virgins is a cure for Aids. This, combined with the prostitution bred by poverty, means that female infection rates are four times higher than male. Zambia's social services are virtually non-existent, and orphans are traditionally cared for by extended families.

But the numbers are now overwhelming, resulting in a ten-fold increase in street children and thousands of households headed by children.

Katie Hallows, an outreach worker with the Catholic diocese of Ndola who trains volunteers and grandparents working with orphans, explains: "For these guardians, the orphans often create a tremendous emotional and financial burden. The guardians are not equipped to deal with the psychological trauma faced by the orphans and, in many cases, this results in destructive teenage behaviour which they feel incapable of coping with. This is especially true of the grandmothers who weren't facing the same problems in their communities even 10 years ago."

Martin Chisulu, a co-ordinator with the Positive Living Project who has been living with HIV for seven years, says attitudes to Aids are changing.

"In the past, people had no proper information on HIV and Aids and they thought that once diagnosed people will die in a few days or months," he said. "We are now working to sensitise the communities to end discrimination and give out correct information on positive living, prevention and care."

The tragedy is, that while new attitudes are coming, they are coming far, far too late.