Fighting cultural HIV ignorance, roots and razors

AIDS experts say the chief's public and regular HIV testing carries a strong message in rural Sinazongwe, a pocket of almost 200,000 people in southwest Zambia.

In Zubadenda Village, Spector Sialukowa sits with his family outside their hut. One of his two wives is HIV positive and he says the diagnosis has brought them all closer together. 

His Royal Highness Chief Sinazongwe has 80,000 subjects, 700 headmen, 160 villages, 14 children and three wives. He also takes a quarterly HIV test to reassure people that all is well at the top.

“My chiefdom is vast and the role I play is very huge,” the 70-year-old chief said. “I have great trust within my chiefdom. I’m in charge of peace and unity. I’m a peace maker.”

Visitors scrape low and clap rhythmically before HRH, a member of the revered “House of Chiefs” and the latest in a line of headmen to protect Sinazongwe’s culture. 

AIDS experts say the chief’s public and regular HIV testing carries a strong message in rural Sinazongwe, a pocket of almost 200,000 people in southwest Zambia.

Improved testing and effective drugs have put the worst of the AIDS crisis behind Zambia, where 1.2 million of a 16.5 million population live with HIV.

About 21,000 people die of AIDS-related deaths a year, down from a peak of 70,000 in 2003, according to UNAIDS data. But a stubborn adherence to superstition and risky traditions persists, hampering efforts to lower the number of AIDS-related deaths and with new HIV infections still high among young people and key groups, said United Nations data.

“Conventional medicines can prolong your life, but our people have a lot of attachment to traditional healers and doctors,” said Martin Chongo, acting health director for the district.

Roots, leaves, bark and indigenous medicines are routinely used in Zambia to treat illness and cure sexually transmitted diseases such as genital warts, herpes and chlamydia.

Healers usually cut patients’ skin with a razor then apply home-made remedies directly to the flesh: a practice that carries a risk of blood sharing and infection. The same razors are used again and again. Chongo said it would be insensitive to discourage traditional medicine but he has summoned traditional healers to a health summit, urging them to stop re-using razors.

“We are not sitting idle but it is a very difficult issue as a health authority,” Chongo said. 

He is typical of officials who must walk a delicate line in Zambia — embracing the best that modern medicine offers to control the epidemic, while tiptoeing around questionable local conventions or challenging risky behavior.

“Unfortunately, in the villages they have their own cultural beliefs,” said Stephen Shajanika, a district health director. “The government does not come into conflict with the people. We try to encourage everyone. It’s a way of life. It’s a democracy.”

Polygamy is common, with multiple partners being the norm for men, and unprotected sex the biggest carrier of the virus. 

Avert, an AIDS education charity, said 90 percent of new Zambian infections follow unprotected straight sex. 

But with many men enjoying multiple partners, and practicing unprotected sex, HIV — and misinformation — continues to spread. The district commissioner of Sinazongwe said it was hard to inform rural areas like his about HIV protection, as people were reluctant to open up to strangers and accept outside advice that flew in the face of traditional values.

With three wives and an open manner, the chieftain says he is both a modern leader and a man of convention.

An academic study published last year by the University of Namibia found that up to 80 percent of Zambians used traditional medicine for their primary healthcare, using trees, shrubs and climbers to treat a range of diseases.

It said most healers were men and 90 percent had inherited their remedies from older family members. 

AIDS, though, said the chieftain, was a foreign import that for now lies beyond the reach of herbal remedies. 

Sex with children was also in his sights. Headmasters must report to the chief each December with a precise tally of pregnancies at their schools in a drive to cut under-age sex and mother-to-child HIV transmission.

“We want a girl child to be in school, not with a baby,” he said. “We had some bad practices and we are still frightened, we are still afraid — but we are very serious when it comes to our children.”

Patricia is one such child.

Three months old, she was born to an HIV positive mother, in a family of two wives, one husband and four children. 

Her HIV status is not yet known so a local NGO, DAPP Zambia, has put the baby on precautionary anti-retroviral treatment to stave off possible infection. Her mother Matilda is on the same drugs.

Matilda, 38, is the only HIV positive person in her village, a handful of thatched huts with a dust track rutted by ox carts.

How did the first wife, 53-year-old Muleya, react to the second wife’s diagnosis? “There is no division ... In fact it united my wives even more,” said Spector Sialukowa, 55, gathered with his family outside their hut in the village of Zubadenda.

“Look at her,” said Sialukowa. “She’s beautiful and looking really quite well now. There is no fear here.”

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