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Medical Journal of Zambia

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Gaps in the Implementation of Anti-Retroviral Treatment: A Case for Addressing Gender and Mental Health Consequences of HIV Positive Individuals

JA Menon, MPS Ngoma, T Nkumbula, R Paul, S Sichimba

Abstract


This paper looks at the current status of HIV infection in Zambia. The results show that Zambia is among the worst affected with a prevalence of 14.3% in the age group of 15-49 (ZDHS, 2011). Further it is noted that Prevention and control of HIV and AIDS has been a priority of the Zambian Government however only 63 percent of those eligible have access to ART. We also found that women are more susceptible to HIV infection than men. This could be due to a number of socioeconomic and cultural factors such as loopholes in enforcement of laws regarding property ownership, economic opportunities and autonomy, inheritance, marriage and sexual negotiations with their husband or partners that have yet to be fully addressed. These inequalities have the potential to cause negative psychosocial problems. In rural communities due to long distances to health posts it is still difficult for people to access treatment for psychosocial concerns. This further compromisesthe immune functioning of HIV positive individuals. In the some regard we report that there is a paucity of professionals to provide neuropsychological support. There is need for evidence-based and action-oriented approaches in addressing gender and mental health concerns of PLWHA to score successes in ensuring adherence to ART as well as reducing new HIV infections.

Zambia is among the worst affected countries in Sub-Saharan Africa in terms of HIV infection, with a prevalence of 14.3% in the age group of 15-49. Each year about 1.6 percent of the adult populationget infected of HIV. The country first reported AIDS diagnosis in 1984, and this was followed by a rapid rise in HIV prevalence. While Zambia's national prevalence rate has remained high, the country has made significance strides in increasing antiretroviral treatment access which has been made possible with donor funds such as PEPFAR and supported by the national HIV and AIDS strategic plan.

Prevention and control of HIV and AIDS has been a priority of the Zambian Government. Emphasis was placed on promoting care for those infected and affected, and need to devise measures for reducing the personal, social and economic impact of the pandemic. The National HIV/AIDS/STI/TB policy, formulated in 2005, provided monumental turnaround for patients infected by HIV and AIDS, as during the same year, a decision was taken to provide Anti-Retroviral Treatment (ART) free of charge to all those in need of treatment. The target was to provide ART to 1, 000 HIV positive individuals by the end of 2005 in the first instance.

Other challenges to providing ART include lack of established clinical infrastructure, negative social stigma and the cost effectiveness of HIV prevention programmes. While there has been a scaling up of ART with about 75,000 on ART, this only represents about 63% of people in Zambia who need them. Although provision of ART has been a major stride in the mitigation of HIV and AIDS in Zambia, how proactive has the structure been in meeting the challenges of providing ART as well as addressing other consequences of being HIV positive?




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