This story is the second in a series looking at HIV and AIDS in Zambia.
LUSAKA, Zambia -- Press visits can be a boon for journalists. If done well, they allow what is most needed for good reporting: access to people willing to talk.
So it was recently when I visited Zambia on a media tour sponsored by the Global Fund to Fight AIDS, Tuberculosis and Malaria, a Geneva, Switzerland-based international financing institution that has provided $632 million in funding to battle the three diseases in southern Africa nations. Zambia is one of 150 countries in which the Global Fund allocates funding.
In the case of AIDS, funding has gone to various programs, many of them run by a network of Catholic and Protestant church institutions called Churches Health Association of Zambia.
The trip was a rich, full experience, allowing a group of journalists based in France, South Africa and the United States a chance to talk to a wide spectrum of Zambian society on the eve of the recent XIX International AIDS Conference, held July 22-27 in Washington.
Those we spoke to included doctors, clinicians, prisoners, gay rights activists, one-time sex workers, administrators of Catholic-supported health programs, traditional healers (key players in the life of Zambia), tribal chiefs, women religious, and those being treated for HIV.
One of those I met, Collins Mulenda, a 33-year-old peer Roman Catholic counselor who works at Our Lady's Hospice in Zambia's capital of Lusaka, acknowledged that adjusting to the reality of living "a positive life" is not easy.
However, he said, the stigma attached to having HIV has been declining in recent years.
"It's on the radio, it's part of life," he said with a shrug -- though he pointed out "I am stigmatizing myself" if he does not tell others of his status.
The idea that there is a double meaning to the phrase having "positive life" -- that one can live with HIV and lead a rich, full life -- is catching on.
In the southern city of Livingstone*, nurse and midwife Angela Maseka, tending to a pregnant mother who was HIV-positive, said given the number of patients she sees who have the virus (perhaps as many as seven out of 10), the era of stigma is in the past.
"Nowadays, people have come to accept it," she said. "There is no stigma."
Maybe so. But at the end of our trip, the other journalists and I spoke among ourselves about how interviewing so many people in a week's time who are HIV-positive and are open about it can itself be something of a distortion. This is because in some circles, having the virus does remain a stigma.
One group in particular comes to mind here: men who have sex with men.
That has become the accepted term of usage in the circles of international AIDS response because many men in the world who engage in same-sex relations do not identify themselves as gay or bisexual.
And in a country like Zambia, where the practice of same-sex relations is not only officially verboten but also illegal, reaching out to such men in hopes of providing them with information about safe-sex practices, HIV treatment or even trying to determine how many such men live in Zambia is notoriously difficult to do.
There are a host of reasons why this is so. Religion, social mores and willed political silence all play into the problem, said Zambian gay rights activist Lundu Mazoka, who met with our group.
Silence by the nation's political leadership has been particularly difficult to address, Mazoka said.
"There has been an absence of political push, and we're not where we want to be," he said of a nascent gay rights movement.
That is hardly surprising. Only Mazoka, 33, and a handful of friends are publicly "out" as members of a small Zambian gay rights group. Among the group's goals is to try, in alliance with Zambian human rights groups and others, to change Zambia's constitution and decriminalize same-sex sexual relations.
That won't be easy. Call-in radio and television shows routinely field callers who suggest that gays "should be stoned," he said. As fellow journalist Linda Villarosa, writing for The Huffington Post, described our interview with Mazoka, Mazoka's family sought to "drive the homosexuality out of him," calling on traditional healers to rid him of what they thought was a demon.
"The first day, they cut my skin in 200 places and rubbed herbs and ash in the cuts. The second day, they tied me to a tree in the bush and left me there overnight," Mazoka told us. "On the third day, they put me in a shallow grave wrapped in a white shroud. I know I don't have a disease, I know I'm not demon-possessed, but this is how things are done."
He added: "I have friends who have been beaten, raped and left for dead."
When he spoke to us, Mazoka didn't dwell on these personal horrors. Instead, he kept returning to the theme that more attention has to be paid to male-to-male transmission of HIV. That requires open and honest discussion about unsafe sexual practices between men. He also argued that it is simply not possible that a mere 1 percent (the official but murky figure) of HIV transmission in Zambia is occurring through sexual contact between men.
Both Mazoka, who was brought up as a Jehevoh's Witness, and Dr. Manasseh Phiri, a Roman Catholic physician and AIDS activist, said networks like Churches Health Association of Zambia deserve praise for the work they do.
But the health association still adheres to traditional views of homosexuality as sin, they point out. The activists argue that traditional church teaching about homosexuality -- writ large, Catholic and Protestant, they said -- has hurt the cause of gay rights in Zambia. It has made it difficult for the problem of HIV transmission between men to be discussed, much less treated.
"It's easily the biggest problem," Phiri said of the wider church's stance on homosexuality. "It's even more problematic than the law."
What do the two activists see as steps toward a solution?
"Preach HIV prevention," Phiri said.
"Preach love to us," Mazoka said.
Being Christian, Mazoka said, is living with a sense of grace and security. That means accepting yourself. "It is being who you are," he said. Mazoka said he wishes the wider church had the courage to affirm that notion for gays and lesbians, saying that would mark a substantial bit of healing for him and others.
"The church has so much power," Mazoka said. "But they won't change what they could change."
A day later, officials I spoke to from the health association did not seem particularly comfortable when I asked them about the activists' remarks. They essentially said their hands are tied on the issue of dealing with male-to-male sexual transmission of HIV while the country debates constitutional changes about decriminalizing homosexual relations.
Dr. Clement Chela, the newly appointed director general of Zambia's National HIV/AIDS/STI/TB Council, was less circumspect, and gave a nuanced answer.
Chela said studies are now under way to determine the extent of male-to-male transmission, and that such studies are needed. Overall, he said, given the legal prohibitions against same-sex sexual relations and societal views of it, the issue of male-to-male transmission has not been an easy issue to address in Zambia. He said he believes there are segments of society that are more tolerant of homosexuality than one might imagine.
Chela, a Protestant, said he does not personally disagree with traditional church teaching, including Catholic teaching, on homosexuality. But he also made clear that the government needs to "and will" provide HIV and AIDS services to everyone, and that counseling should be specifically provided to, and targeted for, men who have sex with men. Any violence attached to sexual orientation, practice or HIV status should not be tolerated, he said. Chela called stigma a "human rights issue."
"Yes, stigma is a great disservice. And a great injustice," he said.
But unfortunately, for an unknown number of those in Zambian society, it is also not something that lurks in the past.
* The location was incorrectly identified in an earlier version of this story.
- Zambia pushes for continued education, medication for HIV/AIDS patients
- HIV stigma, while declining, still a stark reality for some in Zambia
[Chris Herlinger, a New York-based freelance journalist and frequent contributor to NCR on humanitarian issues, writes often about Africa. He was a member of a journalists' delegation that visited Zambia on July 9-13, sponsored by the Geneva-based Global Fund to Fight AIDS, Tuberculosis and Malaria.]