Lusaka — "The more HIV/AIDS, the less justice - but the more justice, the less HIV/AIDS."

That clear statement is the provocative thesis of an important report launched last week by the Jesuit Centre for Theological Reflection (JCTR). It sums up the argument of Michael J. Kelly, S.J., in his report entitled "HIV and AIDS: A Justice Perspective." I was struck by the observation made by one person in the audience for the launch after hearing Kelly's presentation: "This is not the usual message we get on this topic!"

What was not so usual in this report is the strong challenge to look at the spread and persistence of the HIV/AIDS pandemic - in Zambia and elsewhere -- from the perspective of four forces of injustice. These are the forces of poverty, gender disparities and power structures, stigma and discrimination, and exploitative global socio-economic structures and practices.

According to Kelly - a distinguished Jesuit priest and educationist with over fifty years in Zambia - these unjust forces contribute to the spread of AIDS and in turn the presence of the pandemic strengthens these forces.

But we don't always talk about this structural situation of injustice, at least not in its fullest sense and its most far-reaching consequences. Indeed, we tend to focus more narrowly on sectoral approaches that deal primarily with medical diagnosis and response or behavioural critique and change.

But is not a more holistic response needed if we are to move beyond concentration on the immediate causes and effects of HIV/AIDS to deal with the underlying and structural environment of the epidemic?

Let me briefly mention here only three obvious points developed in Kelly's report. They are indeed "obvious"-- but they are all-too-often ignored in the programmes of government, international donors, church leaders and members, medical professionals, NGOs, families and individuals.

POVERTY AND HIV/AIDS

Several years ago, President Thabo Mbeki of South Africa shocked many of us by publicly asserting that AIDS was caused not by the HIV virus but by poverty. I remember being attracted to his argument but at the same time confused by its implications.

Would not a focus on poverty distract from the emphasis on behavioural changes and divert attention from provision of the new medical drugs like ARVs? Mbeki has clarified his position some, but his argument remains puzzling for many. Kelly's thesis is clearer.

According to Kelly, there is no simple equation between HIV/AIDS and a country's national wealth or poverty status. But when the majority of people are poor (as is the case in Zambia), then the situation is ripe for the spread of HIV and AIDS.

The economic and social circumstances of the poor put them at risk of transmission of the disease. Malnutrition, micronutrient deficiencies, malaria, TB, etc. depress immune systems in a way that an individual can become more easily HIV-infected and an infected individual can become a more potent transmitter of HIV.

Similarly, the poor may feel a hopelessness about the future and thus fail to take steps to protect themselves against possible HIV infection.

Of course, we also know how HIV/AIDS increases the presence of poverty. Loss of managerial and productive capacities because of sicknesses, diversion of scarce resources at both governmental and household levels to meet medical needs, care of orphans limiting family abilities to provide education opportunities, etc. - all these and many more factors contribute to Zambia's low rank on the UNDP "Human Development Index" - 166 out of 177!

This close link between poverty and AIDS makes me ask: how central to Zambia's Poverty Reduction Strategy Paper (PRSP) and it successor, the Fifth National Development Plan (FNDP), is the response to HIV/AIDS? Surely our government and our cooperating partners should be paying much greater attention to the socio-economic environment within which HIV/AIDS is contracted and spread.

To talk enthusiastically about "wealth creation" can lead us to be distracted from a people-centred development approach that will deal directly with HIV/IADS in a just and equitable fashion.

WOMEN AND THE AIDS EPIDEMIC

Kelly's report does not break new grounds on the topic of women and AIDS. But it strongly reinforces the shocking facts that in Africa this disease has disproportionably higher cause and effect links with the situation of women.

Physiologically women are at greater risk of infection; culturally they are subject to more unequal power relationships; economically, they experience greater burdens of care for others and have fewer chances of treatment for themselves.

The words Kelly uses could not be clearer: "Responding to the AIDS epidemic, in terms of prevention, treatment and impact mitigation, will only succeed when robust, sustained and specific action is taken to reduce and ultimately eliminate the prejudice, discrimination and unjust treatment that women experience. Without a frontal attack on the injustice of gender inequality, the dominance of the epidemic will continue."

But I wonder whether our church groups take that message really seriously in our preaching about AIDS? And do NGOs that are not primarily women-oriented put out that message? Are women empowered in this country in ways that will effectively and equitably deal with AIDS in a just fashion?

YOUTH, ELDERLY AND AIDS

Surely orphans and vulnerable children (OVCs) get a lot of attention these days when we talk about HIV and AIDS. Kelly himself has done considerable research and is involved in many action programmes dealing with OVCs. But in his report he also focuses on the vast numbers of young people below 25 who are most susceptible to circumstances conducive to HIV infection.

He asks whether teen-agers and young adults have access to correct information and youth-friendly services, whether they see opportunities for economic security and prospects for development and whether they are really free for behavioural change?

I believe that we should ask whether five years from now we will be able to say that the 40 billion Kwacha set aside in the 2006 GRZ Budget for youth empowerment has made a significant contribution to curbing the spread of AIDS.

I would suggest that in all the talk about how that money will be spent this year, its impact on the prevention and treatment of HIV/AIDS should be a major point for evaluation. This is especially necessary when faced with fears (realistic or not?) that it might be more supportive of Ruling Party cadres in the upcoming elections than in support of positive socio-economic development programmes for all youth.

The impact on the elderly of the AIDS pandemic also raises critical justice issues. Care for orphans and for those suffering from HIV/AIDS falls largely on the elderly - mostly poor women who are often themselves in bad health Kelly mentions two justice questions: how can these elderly care-givers be enabled to cope with the demands made on them, and who will care for them when they are no longer able to care for themselves or their dependants?

CONCLUSION

I've only briefly touched on some of the many cogent points raised in Kelly's report. He emphasises that responding to HIV/AIDS is intimately connected with the practice of justice. Whether nor not we take that seriously here in Zambia will determine not only how we design prevention and treatment programmes but also how we deal with societal forces normally not addressed by HIV/AIDS efforts.

The ultimate lesson to be learned is Kelly's thesis: "The more HIV/AIDS, the less justice - but the more justice, the less HIV/AIDS." (Copies of the report are available through the JCTR office.)