IX. Conclusion

Before ARVs became freely available to all in Zambia, receiving an HIV-positive diagnosis was the equivalent of a death sentence.  By introducing a policy of universal access to free ART, the Zambian government proved its seriousness in attempting to combat the HIV pandemic and save the lives of many Zambians living with HIV/AIDS, including women.  But there are still life-threatening barriers to the success of ART programs and some of these, such as domestic violence and insecure property rights, affect women disproportionately.  The government of Zambia should urgently address and remove these barriers. 

Zambian women living with HIV/AIDS suffer persistent constraints to accessing HIV information, testing, and treatment, and to adhering to ART.  The accounts of women interviewed for this report reveal the excruciating effects of gender-based violence and insecure property rights, not only as abuses in their own right, but as major factors that delay women’s access to lifesaving ART, compel them to hide their HIV status and medicine, and eventually impede adherence to ART.   The consequences are potentially disastrous since adherence to ART must be close to perfect (95 percent) to achieve proper suppression of HIV.  Lack of adherence can also lead to the emergence of new, resistant strains of HIV that can both be transmitted to others and lead to drug failure.

Zambia’s health system and legal frameworks are ill-equipped to respond to gender-based abuses and their effects.  In healthcare facilities HIV treatment adherence counselors and other healthcare providers do not generally probe for, discuss, or respond to gender-based violence and other abuses, thus missing vital opportunities to support women’s treatment.  HIV treatment counselors also do not receive specialized training to help them detect or respond to gender-based violence.  There is no government protocol that instructs counselors on the practical steps to detect or address gender-based violence.  Although Zambia has expanded its clinics substantially to accommodate the increasing need for and supply of ART, in most clinics there is inadequate private, confidential space for counseling.  Most of healthcare facilities also lack appropriate settings for women to be able to disclose their experiences of violence or other abuses.

With respect to legal protections, there is currently no specific law to address gender-based violence, and the Penal Code has limited application in cases of domestic violence.  It also does not appear to cover psychological abuse or marital rape.

Widowed and divorced women who are living with HIV/AIDS suffer impoverishment as a result of their inability to exercise and enforce their property rights, and this affects their ability to access and adhere to ART.  The Intestate Succession Act is not properly enforced, and property grabbing still occurs.  Widows who experience property grabbing and many women divorced under discriminatory customary law often sink into deep poverty and fail to start or adhere to treatment as a result of their inability to afford food or the transportation necessary to attend clinic appointments to collect their ART.  

Zambia still has a long way to go to fulfill its international and regional obligations in relation to women’s human rights, including the right to the highest attainable standard of health.  As a priority the Zambian government should immediately take the necessary steps to integrate detecting and responding to gender-based violence into the work of healthcare facilities providing ART.  As a prerequisite the government should build the capacity of healthcare facilities and providers so they can respond to the gender-based abuses described in this report, particularly violence against women.   There are several useful guidelines developed by international and regional organizations that could help the healthcare sector in its response to gender-based violence.

The Zambian government should act immediately to introduce constitutional and legal reform as a critical measure to eliminate discrimination against women, including under customary law.  The government should make sure that the new constitution affirms equal rights for all Zambians, including women.  It should enact a law that addresses gender-based violence without delay, and as a necessary step towards the prevention of gender-based violence and effective prosecution of perpetrators.  The Zambian government should also enforce the Intestate Succession Act.  It should further ensure that the Matrimonial Causes Act provides for equal property rights for women upon divorce.   

In the long run it is essential that the Zambian government, UN agencies, and donors work in collaboration with women’s rights organizations to transform the unequal power relations between women and men, and the social, economic, political, and cultural factors that maintain gender-based abuses and inequality in Zambia.

In 2000 the Zambian government, along with other world leaders, made firm commitments, in the Millennium Development Goals, to promote gender equality and combat HIV/AIDS.  This political commitment and the availability of resources—inadequate as they may be—could help Zambia set an example in the Southern Africa region by removing the overwhelming barriers to HIV treatment and support that some women face.  Otherwise, gender-based abuses will continue to shatter the lives of countless Zambian women in acute need of ART and contribute to avoidable losses of health and lives.