The Zambian parliament passed an AIDS bill this week which establishes a national council and secretariat to coordinate the previously fragmented fight against the epidemic.
"We did not have a single coordinated body that could marshal effectively the responses being initiated by the various actors. It is necessary that all communities throughout the country be mobilised in a collaborative manner to take part in the fight against HIV/AIDS/STI and TB [sexually transmitted infections and tuberculosis] which are all inter-related," Health Minister Brian Chituwo said while presenting the bill to parliament.
The focus of the council and its secretariat would be to advise, evaluate, identify gaps, mobilise resources, initiate activities and produce guidelines on how HIV/AIDS, STI and TB infections can be curbed. The council would be composed of members from the medical profession, government, people living with AIDS (PWAs), civil society and religious bodies.
While there were cheers over the adoption of the bill, there was also some disquiet over perceived "gaps" in the government's strategy to tackle the epidemic in a country where 21.5 percent of adults are HIV positive.
Guy Scott, a former minister of agriculture and now a member of the opposition said the bill did not address the parallel realities in Zambia. One where AIDS drugs cannot be sold without a license, and the other where anyone can make a concoction and sell it under the banner of alternative medicine. And while medical doctors had to be licensed and undergo scrutiny, non-professionals operated without regulations as traditional healers.
There was also the issue of accessing antiretrovirals (ARVs). Scott argued there was one rule for Zambian politicians and another for the general public. "The politicians access ARVs and get medical treatment, at government expense in South Africa, the public are not accorded the same treatment no matter what the merit of their case is."
Axwell Zulu, secretary for the Network for People Living with HIV/AIDS, told IRIN that although the bill was a leap forward, he was "a little disappointed" that it was silent on issues of regulation.
He said he had expected provisions for sanctions against doctors for breaches of confidentiality, or punitive measures for people knowingly infecting others with HIV. "These are the issues that affect us and we have been trying to work around them ... what we are getting is a top heavy council and secretariat which will enable the status quo to continue, albeit under the law."
Though none of the members of parliament (MPs) objected to the bill in principle, there was concern that the government appeared to have introduced it as a condition to access funding from the World Bank. A pledge by the Bank in May of US $42 million hinged on the introduction of a national AIDS policy.
"We are in a hurry to pass this bill to access money, which takes away something from an otherwise very good thing. We are now doing the right thing for the wrong reasons. PWAs have been crying for something like this since 1999. We should learn to do things by ourselves, not wait for instructions from Washington," opposition MP and former commerce minister Dipak Patel said.
Other MPs saw the bill as an opportunity for an African-orientated policy approach that could challenge traditional practices such as wife inheritance and polygamy that encouraged the spread of HIV.
"The West is preoccupied with drug addicts and gays. They formulate their advocacy plans along those lines and then transfer them wholesale to us. But they fail here because that is not our problem, we have our own practices that we should interrogate," MP Sipula Kabanje said.
For the government, the easy part after the lobbying of MPs by President Levy Mwanawasa and Vice-President Enock Kavindele, was to get the bill passed. The test now comes over how to source long-term funding to make the council financially sustainable, analysts said.
Health minister Chituwo said a good chunk of the money would come from the Geneva-based Global AIDS fund, the rest from the treasury. However, 70 percent of Zambia's national budget is financed by donors, who in the past have withheld funding over policy differences with the government.
"I hope the council is a success, it is an opportunity for us to reach the levels of Uganda in mitigating the impact of AIDS," Zulu said. "This is our only shot at regressing HIV/AIDS infections."