WHEN they first began to receive sensitisations on HIV/AIDS over a decade ago, the refugees did not believe it really existed. Just like many Zambians, they viewed the effects of HIV/AIDS as a work of witchcraft. They did not believe HIV/AIDS existed.

Due to a deep-rooted belief in witchcraft, for most refugees then, any ailment or death among them was attributed to witchcraft. As a result, in the event of death, someone would be accused of having caused it; in most cases an elderly member of the family would be the scapegoat and usually ended up being ostracised from the community.

However, according to UNHCR national HIV/AIDS technical officer Elizabeth Khosa Nkhoma, through various awareness programmes that were conducted, the refugees now have a better understanding of how one contracts HIV and how to prevent transmission.

Programmes on HIV/AIDS included door-to-door and mass dissemination of messages in the camps and settlements on HIV/AIDS transmission, prevention and care, drama performances, video shows, outreach meetings, debates and quizzes in schools, and sports activities.

As a result of this understanding, the refugees have now become active participants in the fight against HIV/AIDS in the refugee camps and settlements.

“For instance, between October 2008 and September 2009, 27,282 youths received messages about the dangers of teenage pregnancy, the importance of education, HIV transmission/prevention and how to delay sex debut for youths; and 22,602 refugees and Zambians from the host communities were reached with messages concerning the risks associated with having multiple sexual partners in the HIV era, benefits of male circumcision, advantages of family planning, harmful traditional practices in view of HIV.

Youths, refugee volunteers, local and church leaders are trained to spearhead the sensitisations and lead the community’s response to HIV/AIDS. Refugees take part in World AIDS Day and in the 16 Days of Activism against Gender-Based Violence. Youths have been trained in life skills so they can make informed decisions that will reduce their vulnerability to the risk of HIV,” explained Nkhoma.
Nkhoma explained that the overall goal of UNHCR’s HIV/AIDS activities globally is to promote HIV and AIDS policies and programmes to reduce morbidity and mortality and to enhance the quality of life among refugees and other persons of concern.

In this regard, UNHCR strives to ensure that the human rights of refugees are respected and protected and that they have full access to comprehensive HIV prevention, treatment, care and support programmes. Specifically, UNHCR has developed a list of “10 Key Points on HIV/AIDS and the Protection of Refugees, Internally Displaced Persons (IDPs) and Other Persons of Concern”, which explains in further detail what this means in practice. The 10 points are:

1. Non-Discrimination: Persons living with HIV and AIDS are entitled to live their life in dignity, free from discrimination and stigmatisation;

2. Access to HIV and AIDS Health Care: Refugees, IDPs and other persons of concern to UNHCR should benefit as any other individual from the “right of everyone to the enjoyment of the highest attainable standard of physical and mental health.” This right entails non-discriminatory access to services which are equivalent to those available to surrounding host communities. In the context of HIV and AIDS, States need to take steps towards realising access for all to HIV and AIDS prevention, treatment, care and support, including antiretroviral therapy (ART);

3. Access to Asylum Procedures and Protection from Expulsion and Refoulement: The HIV status of an asylum-seeker should not constitute a bar to accessing asylum procedures or be used as an exception to the right to be protected against refoulement; 4. Protection from Arbitrary Detention and Unlawful Restrictions on Freedom of Movement: Detention or restrictions on the freedom of movement of persons living with HIV and AIDS would be in violation of the fundamental rights to liberty and security of the person, as well as the right to freedom of movement, if carried out solely on the basis of a person’s actual or suspected HIV status;

5. Respect for Confidentiality and Privacy: In principle, personal data is confidential and should not be shared without the consent of the individual concerned; this includes data on the health status of the person;
6. Provision of Voluntary Counselling and Testing (VCT): VCT programmes play an important role in preventing HIV transmission by providing people with accurate information about the virus.

Without proper standards, however, there may be breaches of confidentiality resulting in other protection problems. UNHCR supports the use of VCT programmes as long as international standards are met and promotes equal access for persons of its concern to existing VCT programmes, or the establishment of such programmes in cooperation with governments and partners;
7. Freedom from Mandatory Testing: UNHCR strictly opposes mandatory HIV testing of asylum-seekers, refugees, IDPs and other persons of concern as this is at variance with relevant human rights standards;

8. Access to Durable Solutions: The attainment of a durable solution should not be jeopardised by the HIV status of a refugee or a family member;
9. HIV-related protection needs of women, girls and boys: Women and girls are disproportionately affected by HIV and AIDS and gender inequality can play a significant role in the protection problems they face, including increased exposure to violence. Appropriate measures need to be taken to ensure their protection against sexual or physical violence and exploitation. Special attention must also be paid to children affected by HIV, including those orphaned or otherwise made vulnerable by HIV;

10. Access to HIV information and education: The right to health includes access not only to HIV treatment, but also to HIV-related education. States and UNHCR should ensure the widespread provision of information about HIV and AIDS to refugees, IDPs and other persons of concern, particularly with regard to HIV-related prevention and care information as well as information related to sexual and reproductive health.

Nkhoma disclosed that the HIV/AIDS prevalence rate among refugees in Zambia is lower than the national average.

“The HIV/AIDS prevalence rate among refugees in Zambia is around 3.0 per cent,” according to the 2007 antenatal Sentinel Surveillance revealed Nkhoma.

Each refugee site has an established community-based response spearheaded by the Community AIDS Task Force (CATF). They oversee and lead all HIV/AIDS activities. This gives credence to the sustainability of community-led interventions in HIV/AIDS.

Youth-friendly corners have been established where youths receive counseling and information in various languages through posters, fliers and booklets on HIV/AIDS. Youth-friendly centers use various games to woo and sustain greater participation. The camps and settlements have anti-AIDS clubs equipped with games to enhance information-dissemination and keep members occupied with constructive activities.

Between October 2008 and September 2009, 5,314 people tested and received their results. Refugees now voluntarily turn up for testing. Increasing turnout for Voluntary Counselling and Testing (VCT) is a positive indication of the level of awareness and understanding among the refugees. All refugees who need Anti-Retroviral Treatment (ART) receive this. Sero-positive mothers have access to prophylactic Anti-Retroviral drugs (ARVs). As a result, ten babies born in Meheba to HIV-positive mothers tested negative. People living with HIV/AIDS actively participate in the various interventions that include counseling for those who are HIV-positive. For example, in Kala camp situated in Luapula’s Kawambwa District, the engagement of a person living with HIV/AIDS as a facilitator led to an increase in the number of persons availing themselves of VCT. In Mwange, teenage pregnancies decreased from 179 in 2007 to 72 in 2009.

Doreen Namasiku, the HIV/AIDS Co-ordinator in the Ministry of Community Development and Social Services (MCDSS) at the Mayukwayukwa Refugee Settlement in Kaoma explained that her team has been focusing on the youth and single persons and provided guidance on the benefits of being faithful to your partner and other preventive measures such as male circumcision and change of lifestyles.

“We have set up various HIV/AIDS taskforce committees in all the zones of the settlement. Then we have the overall settlement taskforce. These members are actively involved in the sensitisations”, explained Namasiku.

The Mayukwayukwa refugee HIV/AIDS taskforce chairman Chitondo Kasoka explained that the refugees have fully embraced the concept of HIV/AIDS prevention and are now in the forefront, through various committees, sensitising their colleagues on issues of prevention.

“The refugees are now aware of HIV/AIDS. Even the consumption of condoms in the settlement has gone up as a result of the messages we are giving the refugees,” said Kasoka.
UNHCR representative to Zambia James Lynch said the agency would endeavor to make issues pertaining to HIV/AIDS as inclusive as possible among the refugees.

“The High Commissioner has reiterated his commitment to HIV/AIDS as his policy priority and asked all of us to be equally committed. We want to ensure that all the refugees are involved in one way or another because HIV/AIDS affects everyone,” said Lynch.

Since 2006, most of UNHCR’s HIV/AIDS activities have been funded by the American President’s Emergency Plan for Aids Relief (PEPFAR) through the annual budget support of US$250,000. In addition, UNHCR has received support from its internal basket, including that from the Zambian Government by way of ARVs and food supplements from the World Food Programme (WFP).

Zambia currently hosts a total of 65,429 refugees consisting of Congolese, Angolans, Rwandans, Burundians, Somalis and Ugandans, in two camps and two settlements as well as in urban areas.