“We are like a person on a dark night, hunting frantically for a lost key under a light. Not because that is where the key was lost, but because that is where we are able to see.”

The first day of our #ZambiaHealth trip was a real eye-opener to the many complexities and difficulties of fighting HIV in Zambia. Issues we had read about and researched before coming to the country were brought up time and time again, but so too were new developments and matters which aren’t yet widely talked about in the public arena.

The trip began with an overview of HIV/AIDS from retired physician, journalist and HIV activist Dr Manasseh Phiri. If ever anyone was going to give you a true picture of the problems this country faces, it’s this man. His no-nonsense approach means that he gets straight to the heart of the matter which, in his own words, “isn’t always pretty”.

Dr Phiri began by describing the problem as being like a well known African animal. He said: “The African elephant commands a huge amount of resources. It eats 250kg and drinks 200l of water a day and it spends 18 hours a day eating. The virus behaves very much like an elephant. Even now, almost 10 years into treatment, 200 to 250 people die every day from HIV. It commands a lot of lives, it commands a lot of human resources and it commands a lot of financial resources.”

The prevalence of HIV in adults in Zambia is 14.3%, although in some areas, such as Livingstone, it’s as high as 30%. More women are infected than men and the number of infections is significantly higher in urban areas.

Of the key drivers of the Zambian epidemic, the biggest one is multiple and concurrent sexual partnerships. In this country it is acceptable to have more than one sexual partner at the same time. This makes the spread of infection much more likely, as for the first month after catching the virus it is very infectious. So a husband with a girlfriend can easily and quickly pass the infection on to his wife.

Other factors include low and inconsistent condom use, low levels of male circumcision, mobility and labour migration, mother-to-child transmission and vulnerable and marginalised groups (such as sex workers, men who have sex with men – which is illegal in Zambia, prisoners and the disabled).

Each of these could generate an entirely new post in itself, the issues are so complex and according to Dr Phiri, that is part of the problem. People want to shy away from controversial topics in order to find an easy answer. After reciting the quote at the top of this post, he said: “We wasted a lot of time trying to find the easy answer.” This included working with specific groups of people like sex workers and truck drivers, rather than recognising that the country’s behaviour as a whole needed to change.

Dr Phiri also expressed a lot of concern at the country’s reliance on international aid, using a Zambian proverb: “If you borrow another man’s legs you have to go in the direction he wants to go.”

However, he did describe this decade as “the decade of hope” and added: “The answer to the HIV epidemic is women. If we can empower women we will sort this problem out.”

That’s what I like to hear!

Using the example of the reduction made in mother-to-child transmission, thanks to HIV testing programmes during pregnancy, Dr Phiri explained what women can do when they are given the facts. He believes that if the status of women can be raised in Zambia they can help to lead the HIV response in areas including men having sex with men, testing and encouraging the uptake of male circumcision.

This, of course, comes with its own challenges, which includes changing cultural practices in a country where, in the doctor’s words, the belief is: “A woman is born to make her man happy.”

But, alongside other important areas like planning a programme which is sustainable beyond donors and having the political will and leadership, Dr Phiri believes women can and should be empowered which, in all areas of life, can only be a good thing.

Telling it like it is: Dr Phiri