HIV and AIDS are present in Zambia in a way that is unimaginable in Europe, even though being openly HIV positive is still rare. My first encounter with it was when another friend was explaining how her friend's husband was sick and how his CD4 count was very low. CD4 count didn't ring any bells with me, so she had to explain what it actually means.
After this discussion, I realized how little I knew about HIV. It could all be summarized with the sentence: “Use condom!”. I had never wondered why HIV has spread so widely in many African countries but I also quickly realized that it's not just about information. Everybody here knows about HIV because everybody has lost friends and relatives because of AIDS.
According to my favorite source, 2007 Zambia Demographic and Health Survey, 14 % of adults aged between 15-49 are HIV positive. In urban areas the HIV prevalence is 20 % compared to 10 % in rural areas. The highest peak in the data is urban women aged 30-34. Over 40 % of them are HIV positive. (These numbers are not very reliable though, as 20 % of those interviewed refused to give blood samples.)
The same source shows also data on HIV/AIDS knowledge. You can look into it in many ways and decide how you want to portray the situation. A pessimist would say that only 35,9% of Zambians have comprehensive knowledge on HIV/AIDS. Optimist would point out that over 80 % know that also a healthy looking person can have HIV and that almost 90 % know that having sex with only one HIV-negative partner reduces risk of contracting HIV. Among the wealthiest and the most educated ones, the level of knowledge is even higher but HIV-prevalence is also highest among them. Obviously, there is a lot of room to improve the knowledge level but no amount of information will solve the whole problem.
Instead, the biggest problem is in behavior. It's very common for men to have several girlfriends, even if they are married. I could tell you amusing stories of married or engaged men trying to hit on me except that they are not really amusing because that is exactly how HIV spreads here. This behavioral difference makes it more likely for HIV to spread here than in the north. Another factor related to this is that HIV is particularly infectious when the infection is new and cannot even be detected in the test. So when the husband gets it from one of his girlfriends in unproected sex, he will soon also transmit it to his wife (and other girlfriends as well.) This is also how HIV is linked to wealth. The poorest cannot afford to have many girlfriends, since the guy is supposed to pay girl's expenses.
(If you think the reason is only condom usage, just have a look at the data on chlamydia in Finland. Chlamydia spreads a lot easier than HIV and is really widespread in Finland. It is actually quite unlikely to contract HIV during one sexual intercourse, though according to statistics, the probability is higher in low-income countries, such as Zambia.)
Another problem is that people prefer not to know about their status. Very few have actually been tested. Women are more likely to be tested ever since many pregnant women get tested, so that the risk of HIV transmission to the baby can be reduced. The ARV treatment is already quite widespread and the coverage is increasing all the time. This brings also hope for more people getting tested when there is actually something that can be done.
What's there to be done? A glimpse of hope comes from that half of Zambians are under 18 and only few of them are HIV positive. Then again, the pressure for them is high. Who doesn't do stupid things as a teenager? For the adults, the requirements are even higher. How does a wife force her husband to use a condom every time? Getting tested sounds simple but how many of us has ever been tested for HIV? And how many would do it yearly?
Based on your choice of statistics, you can decide whether you are pessimistic or optimistic about the HIV situation in Zambia.
(These pics are from the UN Epidemiological Fact Sheet on HIV and AIDS)
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