The care of AIDS patients in rural Zambia: a case study in the North Western Province

Abstract

In 1992 the Ministry of Health estimated that there were 250000 persons infected with HIV in Zambia. The AIDS epidemic has now taken hold in Zambias rural areas. In the North Western Province one-third of prenatal patients at government hospitals are HIV-infected. A number of factors enhance the risk of HIV transmission in Zambias rural areas: a tendency for tuberculosis patients to discontinue treatment once they leave the hospital a failure to diagnose AIDS in many tuberculosis patients high rates of polygamy cultural practices such as ritual intercourse and scarification untreated sexually transmitted diseases and a general lack of medical knowledge. Hospitals in rural Zambia have resources to test only blood donors high-risk pregnant women and high-risk surgical cases leaving many HIV cases undetected. In Zambia as in other African countries mission hospitals are playing a pioneering role in the care of AIDS patients. In the North Western Province there are 6 mission hospitals and only 3 government hospitals. Mission hospitals tap into the rural tradition of reciprocal responsibility are trusted by villagers and have more direct access to outside funding. A program being introduced to the North Western Province with funding from the Canadian International Development Agency will train counselors to work with AIDS patients. Concerns remain however that steadily increasing numbers of AIDS cases and AIDS orphans will overwhelm the traditional reciprocal care arrangement between relatives. Coordination between providers and the community will be essential to make the most effective use of dwindling resources.