The Prevention Convention

Prevention logoThis week will go down as one of the highlights of my time in Zambia, in fact it will probably remain a highlight of my entire professional career. For the last 4 months I have been part of a small team working day and night to deliver a large scale conference on HIV prevention – “The Prevention Convention” and I am proud to say that this week – deliver it we did – and in some style!

Over 250 delegates came for three days to listen and debate as more than 40 international and national experts presented the latest evidence on the Zambian epidemic and how best we might try to stem the flow of new infections. We were honoured that the President himself opened the meeting – I even managed to have a little bit of a ‘West Wing moment’ as a few of my lines sneaked their way into his speech.

A Presidential Opening

to a full house

To a full house

Our agenda was extremely ambitious: we had priests talking about condoms, government ministers talking about men who have sex with men, police commissioners talking about human rights. Most importantly, we had a room filled with policy makers and ex Presidents on the last day to hopefully ensure that all the talking turned into something a little bit more than hot air.

KK - Father of the Nation and in 1986 the first African leader to admit loosing a son to HIV

To their credit, almost everyone we asked to talk or attend did so, but the work involved in agreeing and coordinating such a large and diverse faculty through an organising committee that included many parts of government, multiple UN agencies as well as few NGO types like myself was immense. As somebody who regularly attends scientific congresses but never has to organise them, I walk away with a  new-found respect for the level of work involved behind the scenes in pulling such an event off.

It might surprise you to learn that this was the first convention of its type in Zambia.This might be due in part to the huge focus that treatment roll out has received at the expense of prevention in the last years but it also reflected a lack of basic data on exactly where the next 100 infections were coming from. Thankfully this academic gap has now been filled and the newly produced Zambian Modes of Transmission report became the cornerstone of all our discussions.

Alarmingly for a country of only 12 million, 220 Zambians will become infected this very day, and tomorrow, and the day after. In fact if current trends continue this will rise to 270 per day within 3 short years. The Zambian epidemic has matured and spread in such a way that there are now 6 distinct drivers of the epidemic:

1. Multiple concurrent partnerships – jargon for sleeping with several people at the same time. Multiple partners, particularly for men, are widely held to be culturally acceptable putting both them and their girlfriends and wives at risk. Interestingly, it is not that Zambians have more sex or even more partners over a lifetime than those of us from Europe or the US, simply that they have more than one partner at the same time and it is this that drives the high rates of infection.

2. Low and inconsistent condom use – this is an old problem but still nowhere near resolved. Although there seems to have been an increase in the use of condoms when men perceive their partners to be ‘risky’ (e.g. when they sleep with sex workers), the rate of consistent use amongst steady partnerships is dismally low. Putting on my old marketing hat, it is clear that the positioning of condoms in the average Zambian’s mind is all wrong. It is still viewed primarily as an anti-HIV device with all the guilt and suspicion that using it entails rather than a more innocent tool for general sexual health and family planning.

3. Low rates of male circumcision – As we have discussed previously on the blog, this is a relatively recent addition to the HIV prevention arsenal and with only a few tribes traditionally practising it, the focus of much activity to bring it to the masses.

4. Labour and mobility –  Zambians have to travel a lot for whatever work they can find. Be it seasonal movements to pick cotton, long periods of time down the mines or on the lakes fishing or even amongst wealthy business travellers – 5 or more trips away from home in a year is now recognised as a significant risk factor to contract HIV.

5. Vulnerable populations – Both prostitution and homosexuality are proscribed by Zambian law with the latter having a penalty of 15 years hard labour. Life within Zambian prisons, regardless of how you ended up there is indescribably hard. Providing services to protect those who live within these populations is a specific challenge

6. Mother to child transmission – Despite the drugs being available for over a decade to prevent infected mothers passing it on their newborns, sadly Zambia has as yet not managed to protect all their newest citizens.

Make no mistake, this country faces huge challenges in turning round some fundamental beliefs and behaviours that continue to put large portions of its population at risk. The road to reducing the rate of new infections will be a long and hard one. However, I am immensely proud to have been part of a team that has shared the very latest evidence with the political, religious, traditional and community leadership and hopefully empowered them with the knowledge to go out and face the challenge head on.

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  1. […] Having a day, every now and then, when you feel like you might have contributed to something really important […]

  2. […] Council (NAC). It was in this final capacity that I worked briefly with him during last year’s Prevention Convention. In fact the last time I saw the gentleman, he was at the podium presenting the Vice President with […]



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