Thanks to the drastic drop in prices of antiretroviral drugs, the government has initiated a programme to provide ARV treatment through the public health facilities. The programme is targeting 10,000 people. Currently over 40 health professionals have been trained and more people will be trained in the near future. As much it is important to train medical staff, experts in the field of HIV/AIDS agree that for the programme to succeed there is need to prepare the communities in terms of information provision, mobilisation of people living with HIV/AIDS, and mobilisation of existing structures on the issue of ARV treatment.

Community consultations

In order to support the government's ARV programme, the International HIV/AIDS Alliance carried out community consultations in Zambia in 2002. This exercise in Lusaka and Ndola involved the Network of Zambian People Living with AIDS (NZP+) and other AIDS service organisations. The consultation aimed to develop an understanding of community perceptions, knowledge and experience about ARV treatments, and encourage the involvement of people living with HIV and communities in the planning, development and implementation of ARV treatment programmes.

Approximately 200 people were consulted, including PLWHA, equal numbers of women and men, children and adolescents, older people, people with low incomes or not formally employed, professional and business people, church and other community leaders, and the military. Confidentiality was maintained at all times. The key tools used were in-depth interviews (IDIs), focus group discussions (FGDs) and some informal conversations.

Participants discussed the following needs: for correct information; increased co-operation between community structures and health systems; scaling up of VCT services; education of relatives; more community mobilisation on HIV/AIDS issues and antiretroviral treatment. They also expressed several worries related to: uncertainty about medicine supply; selection criteria for treatment and transparency of the process; less access of women to information; and the role of stigma in preventing people to access ARV treatment.

Mobilizing existing community structures

The consultation clearly showed that communities in Zambia are keen to be involved in supporting delivery and use of ARV treatments. Mobilizing existing community structures and increasing community involvement in ARV treatment will reduce the burden of public care and will support systems that will be under pressure to provide additional HIV testing, monitoring and counselling as well as treatment. Community involvement will contribute to the reduction of stigma by encouraging people to come forward for services. It will also support safe and effective delivery and use of treatment. Co-ordination of different levels of the community is essential, and organisations like NZP+ should play an important part in this process.

In the final analysis, it is evident that safe and effective ARV treatment and community preparedness (including the involvement of PLWHA) will form two sides of the same coin of improved health for people infected with HIV.