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  Poverty: The Driving Factor in the Spread of AIDS  
                 
   
  Gold Divider Rule
 

The African Church's Response
to Disease and Poverty

Anderson M Kamwendo
(New York: October 24 -27, 2002)

THE CHURCH'S RESPONSE TO POVERTY AND DISEASES IN MALAWI

Introduction

Since its introduction in Malawi the Church has played a major role in the socio-economic, political and development arena. This has been possible because the missionaries identified themselves with the oppressed and the poor. In carrying their work the missionaries endeavored to minister to the body, soul and mind. To this effect they established industrial missions where holistic needs so people were met.

The Church today is responding to the needs of the sick and the poor because of three basic reasons and these are: historical (following the footsteps of the missionaries), responding to the call and commissioning of Jesus Christ and on ethical grounds. When looking at the work of the Church it is important to understand these three reasons because they influence the type of projects that are implemented and more so the approach, or better still the whole reason why the Church is involved in the Social Ministry.

The Church's work and approach is unique because other service organizations only concentrate on the physical needs of people while the Church takes a holistic view. The Church believes mankind shall not gain anything if he conquers the world and loses his life after death. Further the Church understands that the fall of mankind was the beginning of problems, hence the need to address sin and all its consequences. The ties that the Church has with its partners abroad influences its work through the presence of mission co-workers, financial and material support that it receives.

This paper attempts to expand on these reasons, explore a few examples of the kind of interventions that the Church is implementing and the methodology that is used. The paper will not focus on the health work of the Church because this was will be discussed in detail in another presentation. The paper poses a few questions on issues that are affecting the Church and how it is working with the communities.

Historical Reason

The Church's response to the needs of the poor can be traced back to the work of the missionaries. Although major adjustments have been made in the past fifty years the foundation that was laid by the missionaries greatly influences the work of the Church to this very day. A closer look in history, especially the Blantyre and Livingstonia Synods, reveals the following:

Social justice

The church opposed slave trade and other evils that dehumanized people. When the political wind started blowing across Africa the Blantyre and Livingstonia Synods encouraged a number of debating groups to unite and form the Nyasaland African National Congress (Forty- five years of turmoil, Ross A.C. Ross, pg. 55) . The African population resented the Federation of Rhodesia and Nyasaland was instituted in 1953. The Blantyre Synod supported this move and appealed to Christians of all races to strive by every means in their power, to help build understanding between races and to build a peaceful, righteous society. The Synod also urged people in Scotland through the Church of Scotland to remember their ties with people in Nyasaland show solidarity with the people and reject the federation (2 K.R. Ross 1996).

Malawi become independent in 1964 and for sometime the church was seen to be under the armpit of the government. Things changed on March 8 1992 when the Catholic Bishops released a Pastoral letter, Living Our Faith, which criticized the excesses and injustice of the one-party system. The Catholics Bishops were supported by the two Synods on June 1992, which in collaboration with the World Alliance of Reformed Churches called late Dr. H. K. Banda to appoint a broad based commission with the mandate to among other things check government powers and put in place a mechanism to empower the people ( WARC 1992:2 ).

Eight years into the current democratic dispensation, the church has stood up again and is praying and sensitizing the community not to accept the governments plan to amend the constitution and allow the President to stay in office for three terms.

Education

The Livingstonia Missions opened the first school in Malawi in 1875 at Cape Macclear and the second followed in Blantyre in 1876, barely a few weeks after the arrival of the missionaries. Apart from primary and secondary schools the Presbyterain church trained and encouraged local leaders, for instance Reverend David Kaunda, who later became a missionary in neighboring Zambia (Forty - five years of turmoil, Ross A.C. Ross, pg. 53). The Church also provided technical training in carpentry, building and other crafts. The Blantyre Synod discontinued this service in 1956 when the government Apprenticeship Training School was opened at Soche.

The Church also provided technical training in carpentry, building and other crafts. The Blantyre Synod discontinued this service in 1956 when the government Apprenticeship Training School was opened at Soche.

Agriculture

Malawi has a poor mineral resource base and the missionaries recognized this earlier on. Today Malawi exports tea and coffee some of whose direct descendants were planted by the missionaries on Blantyre mission in 1878. Crops grown on the Blantyre Mission station were watered using the countries' first irrigation system. While pupils learned concepts of agriculture in class they also had the opportunity to try things out in a laboratory, which has been dubbed as the first agriculture research station in Malawi in the booklet entitled, "Blantyre Mission with Prayer and Praise".

Responding to the call

The book of Genesis tells us that God was happy with what he created. On Seven occasions he said, "it was good," (Gen. 1: 1-31) but the fall (Gen.3: 6-7), darkened the mind of humankind, evil and rebellion replaced holiness. This was followed by loss of power over nature, love, harmony, freedom from suffering and the grace of God. Jesus Christ reversed the curse and commissioned the Church to minister to God's people as he did himself. In John 20:21 the Bible says, "Jesus said to them again, "Peace be with you. As the Father sent me, so I send you." (NRSV) The Church knows what Jesus Christ came to do because a summary of this work is spelt out in the Word of God, John 10:10 and Luke 4:18-19.

By being involved in meeting the needs of the poor the Church is responding favorably to the great commission, helping people to see God's love and to realize that God Almighty has answers to all mankind's problems.

Ethical Response

William Stanley writes, "we as Christians have an ethical response; the Church should seek policy changes through advocacy and promote alternatives that address sustainable initiatives both in the Church and outside the Church" (Religion and Development pg. 3). Natural and man-made disasters, poor policies and world economic systems drive many people into destitution. The Church has the duty to respond and render a helping hand to those that are affected.

Interventions that are implemented by the Church

Today the Church is assisting to the needy through the following interventions:

Child Survival (Care of orphans and other vulnerable children)
The HIV/AIDS pandemic is taking the lives of adults who are primarily in the productive and child bearing age group (National AIDS Control Program). One of the most troubling consequences of the pandemic is the enormous number of children who are orphaned and affected. The Church is using a number of approaches to help the children, namely: typical orphanages where children are admitted for a number of years, transitional homes, day care centres and home-based care using the outreach components.

Through this service orphans and other vulnerable children are provided with food (nutrition), clothing, shelter (including building or repair of their own houses), education, skills training, counseling and basic medical attention (growth monitoring and treatment).

In most day care centres orphans learn together with non-orphans in order to reduce stigma but also accord them opportunities to learn from each other. The non-orphans pay token fees, for instance those who are with the Projects Office of the Blantyre Synod pay about $2 per month.

Education
In Malawi more men are literate than women, 72% and 49 % for men and women, respectively (Malawi Demographic and Health Survey 2000). This has adverse effects on people's desire to achieve sustainable livelihoods. Education is key to poverty alleviation as it helps broaden one's scope and opens opportunities in life. The Church is responding to this need by running literacy centres where people, mostly women, learn to read, write and count using the functional literacy and REFCLECT models. Apart from meeting the needs of adults Churches play a vital role in the provision of education to children both at primary and secondary levels.

Agriculture Development
Malawi has a poor mineral resource base and as a result agriculture is the mainstay of the economy. The sector contributes 37% of the Gross Domestic Product, employs 80% of the country's labor force and accounts for over 90% of Malawi's foreign exchange earnings. Most Malawians are subsistent farmers and 90% of the people reside in rural areas (Kabambe D. The Food Insecurity Situation for Malawi and the Measures Towards Mitigation. Background Paper, Blantyre synod Strategic Planning Meeting, October 2002.). The Church runs agriculture programs through which villagers are taught low input farming techniques, for instance use of organic manure and conservation the soil by making contour ridges using the A Frame, an A-shaped level that is made using locally available materials.

In addition to training and extension services the programs provide seed and livestock on loan basis to the farmers.

Provision of Safe Drinking Water
Although the government has programs that seek to provide clean water to the communities through the sinking or boreholes, many Malawians do not have access to the commodity. Women wake up early and walk for miles to go and fetch water. Realizing that safe drinking water is a major contributing factor to livelihood security, the Church has programs that work with communities to sink boreholes and dig shallow wells.

The community, which requests for the service, is responsible for the provision of quarry stones and sand, molding bricks, digging the well, building the walls inside the wall, and maintaining the pump. They purchase spare parts using their own maintenance fund and pay a local person in cash or kind to fix the pump. Each zone has a trained person who fixes the pumps.

Small Enterprise Development
Malawi's socio-economic indicators are very poor and the situation is compounded by the HIV/AIDS pandemic. Dalitso Kabambe argues that poverty is the most pervasive problem in Malawi, in a country where 65% of the population lives below the poverty line. These people consume less than $0.34 per day (Integrated Household Survey, 1998.). To help uplift the lives of the poor, more so orphans, caregivers and the rural poor, the Church has micro credit and savings programs that provide loans to beneficiaries. The loans that attract interest, at lower than commercial bank rates, for instance 15% for programs that are run by the Projects Office Blantyre Synod, have enabled some participants to send their children to school, purchase food and clothing for the families.

People who receive loans are trained on how to manage their business so as to maximize profit margins. Orphans and other vulnerable members of the community are trained in carpentry and joinery (including how to make cane furniture), tinsmith, tailoring, baking (to run bakeries) and brick laying. The aim of the training is equip them with skills so that they may start their own business and to seek employment elsewhere. The graduates are occasionally given loans (financial and material) but due to lack of funding sometimes they go away empty handed and thus fail to utilize skills that they gained during training.

Relief
Floods and droughts have on a number of occasions hit the Southern Africa region. The disasters coupled with mismanagement, HIV/AIDS and other factors like the lack of improved agriculture inputs have made many people to be food insecure.

A combination of floods and droughts hit Malawi in the 2001/2002 farming season such that over three million people are at risk of starving this year. During the past twelve years Malawi has only been food self sufficient in four years ( Ministry of Agriculture and Irrigation — appendix 1). The Church has responded to this crisis by providing relief maize, maize flour, powdered milk, beans, cooking oil and likhuni phala (a maize meal that is fortified with Soya and vitamins. In situations were floods swept away everything, including tools and houses, the Church has distributed polythen sheets, blankets, clothes, cooking utensils and agriculture tools such as hoes and watering cans.

Famine has very negatives effects on children, especially those that are under five years since they become malnourish and start wasting away quickly in times of hunger. In his report to the Blantyre Synod Dalitso Kabambe pointed out that malnutrition is one of the major reasons why the infant mortality rate is high in Malawi (Kabambe D. The Food Insecurity Situation for Malawi and the Measures Towards Mitigation. Background Paper, Blantyre synod Strategic Planning Meeting, pg. 10). In an effort to help the vulnerable and undernourished children the Church provides likhuni phala and initiates wet feeding and growth monitoring programs. A medical component is also added to primarily assist the children.

The Church believes that relief is not sustainable on its own and as such that relief interventions are followed by development efforts that are aimed at building the people's capacity to produce their own food. This has included distribution of agriculture inputs and extension services.

Advocacy work
For over a century the Church has been working with the needy but the living standards of the people have not risen as expected. Some of the causes of this problem are poor policies and mismanagement on the part of government. The Church realized that trying to meet the needs of the poor on its own is like treating somebody who has toothache with painkillers. There is need to find out the cause of the toothache and treat it if the patient is to feel better. To this affect some Churches have established advocacy programs, for instance the Catholic Commissions for Justice and Peace (CCJP) and Church and Society programs (Livingstonia and Blantyre Synods). The programs work with the community to help raise people's awareness in issues that affect them, including the Republican Constitution (so that people may understand it and know their rights) and their role in governance (by voting and participation in decision making processes through the local government). There is also a call to start working in development through the Rights-Based approach.

They also advocate for and with the people when certain things are not gone well by government. Knowing that rights go hand in hand with responsibilities, the programs do sensitize the community on the role they are supposed to play in governance and in meeting their own needs. People are not passive players in a democratic dispensation.

In the late 90s Churches formed the Church Development Coordination Committee (CDCC) with the view to strengthen their work through sharing knowledge and experiences. Knowing that there is strengthen in unity and that advocacy work can be dangerous especially when one is working on issues that may seem to threaten those that in authority, the Churches decided to set up an advocacy desk within the CDCC. The aim of the unit is to be a secretariat that would receive issues identified by the Churches, investigate them and pass the findings to Church leaders who would then meet government officials or whoever may be concerned. The unit is also charged with the duty of advocating with or on behalf of government if there are issues that the people are supposed to sort out. Currently the unit has organized three interdenominational prayers aimed at seeking God's interventions on issues that are and may affect the people, for instance the desire by the ruling party and government to extend the Presidents term of office.

Congregational work
The Church through the congregations and individual members is also responding to the needs of the poor through some of the interventions mentioned above, although at a small and irregular scale. The major thrust of the congregation or what we may call Church proper here, is through bringing hope and comfort. This is done through prayers, visitations, counseling and preaching. This ministry which is part of stewardship (focusing within the congregation) and evangelism (external focus) is what could be referred to as the spiritual side of the ministry. It is intended at meeting the spiritual needs of people and helping them look to God as the source of help.

In the statement that is found in Mathew 11: 28, Jesus Christ is calling all those that are heavy laden to come to him and he is assuring them that he will not judge or condemn them. The Church uses this, and other messages to assure people that there in hope in Jesus Christ and that he went to prepare a place for all of us. This work is done through Sunday services, women's, men and youth groups. Individual members take it upon themselves, as a special ministry, to pray and assist the needy.

Although the word of God is used to comfort people it has also been used as a tool to condemn those that are sick, especially those that suffer from HIV/AIDS. Some preachers say that AIDS is a curse and have used Deuteronomy 28 as the backing chapter. This portrays the picture that all those that are HIV positive are sinners, disregarding the fact that sexual intercourse is not the only way through which the virus in transmitted. Some people have been faithful all their lives only to get infected while they are in marriage. Such teachings perpetuate stigma and myths that surround the pandemic.

Another aspect that continues to bring controversy is the issue of condoms. The Church is preaching that chastity before marriage and faithfulness within marriage are the tools for HIV prevention (AIDS A Christian Response) while the government (Malawi National HIV/AIDS Strategic Framework 2002-2004) and other stakeholders include the condom as the last resort, for those that cannot abstain. At a recent HIV/AIDS seminar for Clergy and other leaders of the Blantyre Synod, the majority of the participants stood their ground and said that condoms will only promote promiscuity. This is debatable because the use of a condom is a mater of choice and those that do not want to use it they can still go ahead and have unprotected sex even if they are not Christians.

Methodology
Most Churches have established development departments (see appendix 2) through which they minister to the needs of people. Initially the departments where usually run by mission co-workers but over time Malawians have taken over leadership position.

The presence of mission co-workers is still strongly felt and this should be encouraged as it helps cement the relationships and also improve the quality of the ministry. Although they are not independent units, the departments have some form of autonomy such that they have their own conditions of service, accounting systems and vehicle running and other policies. External auditors who in most cases come from firms that also audit Church books look departmental books annually.

This semi independence may seem to be a threat but it is necessary as the staff in these departments has a different calling from that of the Clergy and hence need better remuneration or else the Church will become a training ground and staff may be snatched by other Non Governmental Organizations (NGOs). The level of operations and the demands from the donors/partners is intense and there is need therefore to hire qualified and competent staff. The other benefit is that because the books are kept separately, funds are spent as per the budgets.

External Church partners and other Para-church organizations like Interchurch Aid for Development Cooperation (ICCO), Christian AID and Kindernothilfe, have traditionally funded the departments. However, the scale of activities has expanded rapidly and this coupled with reduced inflow of funds from some of the traditional partners, the departments have been compelled to seek assistance from governments, government development agencies, for instance USAID and Department for International Development (DFID) and United Nations agencies such as UNCEF. Although this is a solution to immediate funding needs it posses a threat to the approach and reasoning behind the work of the Church. For instance a partner cautioned one of the development departments against evangelizing while doing its work. Even issues of praying at meetings are things that some partners question.

The departments do realize that government has the duty to meet the needs of its citizens and that the responsibility of improving the people's living standards lies with the central and local governments, particularly now that the government system has been decentralized. To this effect the departments work closely with civil servants in all their endeavors. The program participants are also part and parcel of all the development process; they help by rendering voluntary services as members of support groups, teachers at preschools, Extension Multipliers, Functional Literacy Facilitators and committee members for various activities.

The work that is being done by the Church is highly appreciated by government and civil society in general. Although the departments are part of the Church, they are still treated as NGOs due to the quality and scale of the operations. In Malawi both government and the Council for Non Governmental Organizations (COMGOMA) have called upon staff from the departments to serve at various regional and national capacities.

The Church believes that programs cannot bring about meaningful change if the community is not involved. To this effect community members are mobilized and trained in various areas such as leadership, resource mobilization and management and group dynamics. The committees that are formed work hand in hand with traditional leaders and other stakeholders. The process helps the beneficiaries to participate actively in their own development. This is vital as it ensures ownership of the work and leads to sustainability of some of the activities. (see appendix 3)

Conclusion

For over a century the Church has been carrying out a holistic ministry. Apart from preaching the Good News, effects to been made by the Church to ensure that there is justice and fair play in all areas of human endeavor. At times the Church has appeared to be dormant and collaborating with powers that be but thankfully the body of Christ has stood and taken its rightful role in society, by raising its prophetic voice. The journey has not been smooth because in its effects to stand by the Word Of God, the Church may have stepped on people's toes. This is the whole essence of being salt and light. However, the Church ought to examine its role and how it has performed in the past with the view to equip itself even better. Some of the areas that need to be looked at are the schools that belong to the Church but are essentially run by the government. Education standards have gone down and so has student and staff discipline. The health infrastructure is under immense pressure and the standards; especially in government institutions are very poor. HIV/AIDS is probably the biggest challenge the nation is facing at moment. The Church should harness all the resources that it has and play a strong role in the fight against the pandemic.

For the past 50 years massive amounts of dollars have been spent, funding development work, and different theories have been tried in the name of assisting the needy and yet many people are poorer today in Malawi than they were years ago. Life expectance continues to fall and problems like HIV/AIDS, natural disasters, corruption and economic mismanagement still pose a threat to millions of Malawians. Like what Paul said in the letter to the Philippians (Philippians 3:13-14) the Church should not look back and become contented with its marvelous record. Instead it should engage the powers that be and take a lead in advocacy work to ensure that there is good governance and that people of God achieve sustainable livelihoods.

When Paul was traveling to Rome the boat was rocked by a storm and for days the people did not eat anything such that all hope of being saved was lost. In the midst of this suffering the word of God came to His servant Paul. He spoke, prayed and demonstrated his faith by eating bread before them all. This encouraged the others and they took bread and ate. (Acts 271-31) This is what the Church should be today, a living testimony, real salt and light. It should be practical in order to be relevant to society today.

Questions

  • Needs of the people are increasing while resources from within the Church circles are either stagnant or diminishing. While this is happening Church development departments are seeking assistance from non-religious institutions. Should Church development departments seek funding from secular institutions? Will this comprise our Christian faith?

  • Some Church procedures and policies, like reconciling after a couple has been on separation for sometime and the fact that the Church does not condone divorce even when it is clear that one of the partners has been unfaithful, may encourage the spread of HIV/AIDS. Should the Church stick to this teaching or should it start accepting divorce under such grounds?

  • The Church says that condoms may be used in families and yet the pandemic is taking even those that are not married. What should the Church's position be on the issue of condom use?

Reference

National AIDS Control Program and Ministry of Health and Population. Malawi National HIV/AIDS Strategic Framework, 2002-2004.

Kabambe D. The food Insecurity Situation For Malawi and The Measures Towards Mitigation, October 2002.

Ross A.C. Ross. Forty- five years of turmoil, 1994, pages 53-56, 58-60

Stanley W. Religion and Development.
www.daga.org/ds/dsp00/d13m-I-htm /21/2002

Cornel W.du Toit. Empowerment of the Poor: Changing our Minds on Affluence and Poverty.
www.geocities.com/Athens/Parthenon/8409/poverty.htm 3/21/2002

Kenneth R.R. Crisis and Identity - Presbyterian Ecclesiology in Southern Malawi.
www.geocities.com/Athens/Parthenon/8409/poverty.htm 2/21/2002

Shaker R. Religion and Development, No, 01 1997.
www.acdi-cida.gc.ca/xpress/dex/dex9701.htm

CCAP Blantyre Synod. Blantyre Mission with Prayer and Praise.

 
                 
  APPENDIX 1
FOOD SUPPLY AND DEMAND SITUATION FOR MALAWI
(Metric Tones)
 
                 
  Year
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
  Supply
1,600,000
1,700,000
2,500,000
2,993,242
2,540,454
2,280,600
1,986,394
1,328,000
819,000
2,033,000
656,650
1,38,000
  Demand
2,200,000
2,100, 000
2,100,000
2,367,152
2,793,043
2,398,600
2,160,000
1,800,000
1,698,066
1,700,000
1,572,714
1,496,016
  Balance
-600,000
-400,000
400,000
626,270
-184,061
-118,000
-173,606
-322,000
-870,066
333,000
-916,064
141,984
 
                 
  Source: Ministry of Agriculture and Irrigation  
                 
  APPENDIX 2
EXAMPLE OF CHURCH DEVELOPMENT DEPARTMENTS
  • Relief and Development Department (CCAP Livingstonia and Nkhoma Synods)
  • Catholic Development Commission
  • Catholic Relief Services
  • Evangelical Lutheran Development Commission
  • Projects Office Blantyre Synod
  • Adventist Development and Relief Agency
  • AIDS and Relief Program (Word Alive International)
 
                 
 

APPENDIX 3
DEVELOPMENT APPROACH

The Departments:

  • Recognize that staff members have no answers to people's problems;
  • Realize that members of staff and program participants have knowledge that when combined can propel programs to greater heights. No person is an empty slate;
  • Act as facilitators to communities as they: identify their problems, make decisions, implement activities, monitor and evaluate outcomes; and
  • Promote: Transformation, Participation, Ownership and Sustainability.
 
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  Gold Divider Rule
  Declines in casual sex in Lusaka, Zambia:
1996-1999 (AIDS 2002;16:291-93)

Sohail Agha, PSI

This study examines whether changes in reported sexual behavior in Lusaka, Zambia, are consistent with the evidence of declining HIV prevalence levels reported elsewhere. A comparison of findings from two cross-sectional surveys implemented in Lusaka between 1996 and 1999 show statistically significant reductions in casual partnerships among men and women. Respondents with higher socioeconomic status were more likely to reduce casual sex. Condom use increased but the change was not statistically significant.

Zambia has one of the highest levels of HIV prevalence in the world, with an estimated one-fifth of men and women between the ages of 15 and 49 years infected with HIV [1]. Recent research has shown declining HIV levels among 15-19-year-old women across Zambia and for 20-24-year-old urban women [2]. Because of issues related to the measurement of HIV levels [3-7], it is important to have evidence of behavioral changes that support findings of declining HIV prevalence [8]. This study uses data from two serial cross-sectional surveys on sexual behavior to determine whether changes in casual sex and condom use were reported in Lusaka between 1996 and 1999.

The two surveys were representative of 15-49-year-old men and women living in Lusaka. Both surveys used three-stage probability samples (806 respondents were interviewed in 1996; 1211 in 1999), with 100 standard enumeration areas randomly selected in 1996, and 120 in 1999. The samples were drawn by the Central Statistical Office of Zambia. For both surveys, the response rate was 98%.

The questionnaire used was based on the Partner Relations and Knowledge Attitude Behavior Practices Surveys implemented by the World Health Organization's Global Program on AIDS [9]. Experienced field supervisors from the Central Statistical Office were used, and enumerators were trained for one week before survey implementation. Same-sex interviews were conducted. Data were collected in October 1996 and June 1999.

To determine socioeconomic status, an index of assets was created on the basis of the ownership of nine assets, including a bicycle, motorcycle, car, video player, radio, television, refrigerator, farm, and house. To measure sexual behavior, respondents were asked to describe their relationship with their last sexual partner. The response was coded as marital, regular, or casual. Respondents were then asked whether they used a condom in their last sexual intercourse. The survey also included questions on exposure to condom advertising carried out by the social marketing program. For example, respondents were asked if they had seen or heard advertising for Maximum brand condoms, and if so, through what sources.

Weights were attached to match the age distributions of the two samples. Data from the two surveys were pooled and the chi-square test of independence [10] was used to determine statistical significance. All results presented in the Table 1 are weighted, but the number of cases shown are unweighted. [ Download Table 1 in printable Adobe PDF format ]

Sample characteristics

There were no significant differences in the socio-demographic characteristics of the 1996 and the 1999 samples. In each year, 51% of the respondents were men, 51% were married, and 19% had some primary education. Approximately one-third of respondents in each year came from households with up to one asset (not shown).

Changes in casual sex

Table 1 shows the percentage of sexually experienced women and men who reported that they had last sex with a casual partner in 1996 and 1999, by various independent variables.

Overall, there was a significant reduction in reported casual partnerships among both women and men: approximately 7% of women reported having had last sex with a casual partner in 1996, compared with 3% in 1999; approximately 27% of men reported having had last sex with a casual partner in 1996, compared with 19% in 1999. Declines in casual sex were especially large for respondents who reported not having a partner at the time of the survey: 41% of women with no current partner reported having last sex with a casual partner in 1996, compared with 13% 1999; 73% of men who did not have a current partner in 1996 reported having last sex with a casual partner, compared with 49% in 1999. Significant declines in casual sex also occurred among those with higher socioeconomic status, including women with secondary or higher education, men with some secondary education, women with four or more assets, and men with two or three assets.

Changes in condom use

Table 1 also shows the percentage of sexually experienced women and men who reported that they had used a condom in last sex, by various independent variables.

Women reported 17% condom use in 1996 and 21% in 1999, but the increase was not statistically significant. Men reported 24% condom use in 1996 and 28% in 1999, but the increase, again, was not statistically significant. There were, however, significant increases in condom use among women with a regular non-marital partner (from 33 to 50%), among men aged 30-34 years (from 7 to 20%), and among men who had been exposed to social marketing condom advertising through three or more media channels (44% in 1999, up from 30% in 1996).

Our analysis of data from two rounds of representative household surveys of Lusaka has shown that there was a significant reduction in casual sex among both women and men between 1996 and 1999. Although condom use in last sex with any partner increased during this period, the increase was not statistically significant. Because casual sex has tended to be concentrated among Zambian men and women who are not in stable partnerships [11,12], these declines in casual sex reflect a substantial reduction in high-risk sexual activity in Lusaka between 1996 and 1999.

Respondents with higher socioeconomic status backgrounds were more likely to reduce casual sex, a finding that is consistent with recent research showing a declining HIV prevalence among more educated Zambians [2]. These findings indicate the importance of intensifying efforts to promote behavior change among those with low socioeconomic status in Lusaka.

Acknowledgements

The author would like to thank Dominique Meekers, Muyiwa Oladosu, Kerry Richter and Nils Gade who commented on an earlier version of this paper, and Megan Klein and Cheryl Kolwicz who helped to edit it.

Sohail Agha, Population Services International, 1120 19th Street NW, Suite 600, Washington DC 20036, USA.

Sohail Agha is the Senior Research and Evaluation Coordinator, AIDSMark/PSI, and an affiliate of the Department of Demography, the University of Zambia.

Sponsorship: This study was made possible through financial support by USAID Zambia and AIDSMark/USAID.

Received: 26 October 2000; revised: 13 July 2001; accepted: 23 July 2001.


References

  1. Central Statistical Office (Zambia). Zambia sexual behavior survey 1998. Chapel Hill, North Carolina: Central Statistical Office and MEASURE Evaluation; 1999.
  2. Fylkesnes K, Musonda RM, Sichone M, et al. Declining HIV prevalence and high risk behavior in Zambia: evidence from national surveillance and population-based surveys. In: XIIIth International AIDS Conference. Durban, 9-14 July 2000 [Abstract ]. &aq;1&\aq;
  3. Nunn AJ, Wagner HU, Kamali A, Kengeya-Kayondo JF, Mulder DW. Migration and HIV-1 seroprevalence in a rural Ugandan population. AIDS 1995, 9:503-506.
  4. Wawer MJ, Serwadda D, Gray R, et al. Trends in HIV-1 prevalence may not reflect trends in incidence in mature epidemics: data from Rakai population-based cohort, Uganda. AIDS 1997, 11:1023-1030.
  5. Fylkesnes K, Ndhlovu Z, Kasumba K, Musonda RM, Sichone M. Studying dynamics of the HIV epidemic: population-based data compared with sentinel surveillance in Zambia. AIDS 1998, 12:1227-1234.
  6. Gray R, Wawer MJ, Serwadda D, et al. Population-based study of fertility in women with HIV-1 infection in Uganda. Lancet 1998, 351:98-103.
  7. Zaba B, Boerma T, White R. Monitoring the AIDS epidemic using HIV prevalence data among young women attending antenatal clinics: prospects and problems. AIDS 2000, 14:1633-1645.
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  11. Agha S. First report. The Lusaka sexual behavior and condom use survey 1996. PSI Research Division. Washington DC: Population Services International; 1997.
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