Designing appropriate intervention strategies for HIV/AIDS in southern Africa

Abstract

Zambias estimated 190 population was 8.1 million of whom 43% resided in cities. 1000 health care facilities are spread throughout 9 provinces and comprise village and district health clinics as well as provincial hospitals and the University Teaching Hospital (UTH) in Lusaka. A national sexually transmitted disease (STD) control program was launched in 1980 by the Ministry of Health to initially assess the extent of diseases on the basis of sample surveys and ultimately make preventive and curative interventions. The 1987 annual incidence of STDs in the adult population was 18/1000 with the male: female ration of 1.7:1. Genital ulcers due to syphilis or chancroid comprised more than 50% of new STD cases with the remainder resulting from gonorrhea chlamydia or trichomonias vaginalis. HIV seroprevalence surveys among antenatal women delivering on labor wards at the UTH show an increase from 8.6% to 22% over the period 1985-90; the level of male HIV seroprevalence increase is probably the same or greater. Risk factors among sexually active male adults are blood transfusions travel outside of Zambia and positive serological tests for syphilis; while blood transfusion and history of venereal disease are risk factors for female adults. Adults having had more than 50 sex partners are at highest risk for HIV infection; circumcised men have a significantly lower prevalence of HIV compared to uncircumcised men; and the female practice of removing vaginal secretions with a cloth to increase penile-vaginal friction increases the risk of transmission. Studies indicate however that condoms used alone or with spermicides are not effective in preventing the sexual transmission of HIV except in highly motivated couples. The cost and availability of condoms limit their use while the importance of their need is poorly recognized by health agencies. It is estimated from blood tests and interviews that 2.6 million Zambians between ages 15-34 years are at risk of HIV infection. Constrained by the lack of available resources to provide condoms on mass scale Ministry of Health programs reach out to diagnose and treat STD patients and partners and provide them with condoms. Primary and secondary syphilis and chancroid are the 2 most important STDs which may increase the risk of HIV transmission. Both can usually be cured with single doses of antibiotics.