Against Aids

For a comprehensive presentation of this program, go towww.humana.org/tce

TCE – Total Control of the Epidemic

Only people can liberate themselves from AIDS – The Epidemic

On this simple line HUMANA PEOPLE TO PEOPLE developed a people’s liberation system to be put in place in most parts of Africa to gain – area by area – total control of the epidemic.

Basically it builds upon a group of 50 “locals” employed for the three years it takes to “liberate” an area with 100.000 people under the leadership of Humana People to People.

The idea then is this:

Only the people themselves will be able to set each other free from the threats of the epidemic. It has to become a collective affair. Everyone involved to his or her capacity. Inspired by a possible positive outcome from this effort, by the groups performing in their neighbourhood and by their neighbours.

The time is ripe for this collective effort, for the liberation from the epidemic by the people for the people.

TCE was first started in Zimbabwe in year 2000

Since its start, TCE has reached 2.5 million people in 4 countries in Southern Africa, namely Botswana, South Africa, Mozambique and Zimbabwe.

TCE changes people’s lives. Field Officers themselves have changed their lifestyle and the way of looking at the AIDS epidemic during the whole process of mobilisation. Total Control of the Epidemic is more than dissemination of correct HIV/AIDS information. It goes to the core, where each and every individual has to make a personal plan for how to reduce the risk of infection with HIV.

Fight Against AIDS in East Africa

For the millions of Africans dealing with HIV/AIDS, a beacon of hope has emerged from an unassuming single story clinic, nestled in the hills of this city.

Since its doors were open in 2004, the Infectious Disease Institute (IDI) has been on the forefront of Africa’s response to the pandemic, quietly and methodically conducting scores of clinical trials while treating thousands.

IDI and its staff have proved through their outreach, and treatments that high-quality care can be given without having to build brick-and-mortar infrastructure in every rural area.

And the friends _ as the patients there are called _ are regaining their foothold in society, living healthier, with their heads held high and some even heading back to the workplace after being pull from the brink of death.

“When this clinic started in a small room, a HIV clinic was a specter of a lot of depression and sadness, people laying on the floors. Now as you will see it’s a vibrant population,” said Andrew Kambugu, IDI’s head of clinical services.

“People are well, they are going back to work, they are looking for spouses if they’ve lost their loved ones and they are looking to live life again. For me as a young African professional I think there are fewer places that give more satisfaction,” the doctor, 35, added.

IDI’s success in rolling out anti-retroviral therapies while simultaneously conducting high level research work began as dream. American and African Academicians wondering how to deal with Africa’s AIDS crisis, came up with the idea to open up a state-of-the-art regional center of excellence to serve the continent.

Thus the Academic Alliance for AIDS care and prevention in Africa was born. The Alliance got the Pfizer foundation to pony up funds for the building and operational cost for the first few years and IDI opened it’s doors in 2004. It cost $2 million a year to operate.

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HIV/Aids & the Youth

                                  AIDS was first discovered over 25 years ago. Yet today, 6,800 people will be infected with HIV. Of the 2.5 million people infected yearly, young people ages 15-24 account for 40 percent of new infections. Poverty, unemployment, a lack of education, sexual violence and gender inequality increase the vulnerability of young people to HIV infection.

11.4 million children and adolescents have been orphaned by AIDS and are now heads of households, as we lose an entire generation of parents, teachers, workers and doctors in many regions. Although world leaders committed that by 2005, 90% of young people would know how to protect themselves from infection, currently in the hardest hit countries, currently less than 40% of young men and less than 36% of young women can correctly identify how to prevent HIV.

Despite the debilitating effects of AIDS, young leaders are taking action in their communities to prevent the spread of the disease and to address the devastating consequences of the pandemic. In fact, evidence shows that young people are most effective at changing the risk behaviors of their peers and at shaping a better future for themselves and their families. 

The Global Youth Coalition on HIV/AIDS (GYCA) recognizes the potential of young leaders as the best force to address AIDS in their own communities, and empowers them with the knowledge, skills, resources and opportunities they need to scale up and expand their initiatives. GYCA links young leaders to mentors, funders, scholarships, information, training resources, and political advocacy opportunities to ensure that HIV interventions for young people are relevant and successful

Young people, like adults, contract HIV primarily in three ways—through men and women having sex, through men having sex with men, and through intravenous drug injecting (158). Having other sexually transmitted infections can increase the odds of contracting HIV/AIDS during sex with an infected person from two- to eightfold (96, 126, 148, 173).

HIV can also be transmitted from a woman to her baby, during pregnancy, birth, or through breastfeeding (see HIV Transmission from Mother to Child). While the first generation of babies infected by mother-to-child transmission would now be adolescents, the proportion of such infants still living is probably small (274).

Other means of transmission account for only a small proportion of infections. These include transfusion with infected blood and activities that can break the skin with unsterilized equipment (359).

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Aids in South Africa

South Africa is finalising an ambitious plan to spend as much as R44.9-billion on halving the rate of new HIV infections in the country by 2011 and providing treatment, care and support to at least 80% of people living with HIV/Aids and their families.

A draft of the new five-year National Strategic Aids Plan was discussed by government, business and civil society leaders at a consultative conference in Johannesburg on Wednesday.

The final document is expected to be adopted by the South African National Aids Council, which is headed by Deputy President Phumzile Mlambo-Ngcuka, by the end of March.

Significant departure
The new plan – drafted in close co-operation with some of the country’s top scientists, actuaries, clinicians, health economists and activists – marks a significant change in South African government policy on the epidemic.

The plan places a new emphasis on treatment and prevention, and makes no mention of the dietary recommendations previously cited by the health ministry as key to fighting Aids.

It also spells out clear, quantified targets, and places a high priority on monitoring and evaluation. Business Day reports that a special unit is to be set up in the health department to monitor the implementation of the plan, with a mid-term review scheduled for 2009.

“There is a new mood and energy in government,” Dr Nomonde Xundu, the department’s chief director for HIV/Aids, told Business Day.

Congress of SA Trade Unions general secretary Zwelinzima Vavi told Wednesday’s gathering that, if supported by business and civil society, the plan would be “the boldest, most comprehensive strategic plan on Aids in the world.”

Massive spending
According to Business Day, Treasury calculations contained in the draft plan put the costs at almost R45-billion – far exceeding the R14-billion the government has already allocated to Aids programmes over the next three years – with up to 40% of this earmarked for Aids drugs.

Xundu indicated to Business Day that the government was likely to increase its funding, but would also look to the private sector and foreign donors for assistance.

Speaking at Wednesday’s conference, Xundu emphasised that prevention remained key to South Africa’s fight against HIV/Aids.

“The intention of the plan is to ensure that the large majority of South Africans who are HIV-negative remain negative,” she said, adding that there was a strong focus on reducing the number of new infections among people in the 15- to 24-year age group.

Young people’s choices
“The future course of the HIV/Aids epidemic [in South Africa] hinges, in many respects, on the behaviour young people adopt and the contextual factors that affect those choices,” Xundu said.

The plan also aims to reduce the HIV infection rate among children under the age of five by expanding the prevention of mother-to-child transmission programme and providing antiretroviral therapy for pregnant women.

On treatment, the aim is to increase the reach of the country’s antiretroviral treatment programme from the current estimated one-quarter of HIV-positive people to at least 80% of people living with HIV/Aids as well as their families.

In order to lessen the impact of Aids on familes and communities, the plan also aims to expand community-home-based care and palliative care programmes, as well as social safety network programmes for orphans and vulnerable children.

‘Formidable partnership’ needed
“Nothing less than a formidable partnership between government and civil society can assist us to achieve our goal of reversing the tide of this pandemic,” Mlambo-Ngcuka said on the release of the first working draft of the plan on World Aids Day in December.

“Too many people have been infected and too many have died, but if we work together, Aids can be beaten.”

According to that draft of the document, HIV/Aids is one of the main challenges facing South Africa, which had an estimated 5.54-million people – 18.8% of the adult population – living with HIV in 2005.

“Although the rate of the increase in HIV prevalence has in past five years slowed down, the country is still to experience reversal of the trends,” the document stated. “There are still too many people living with HIV, too many still getting infected.”

According to the document, the “immediate determinant of the spread of HIV relates to behaviours such as unprotected sexual intercourse, multiple sexual partners and some biological factors such as sexually transmitted infections.”

However, the “fundamental drivers” of the epidemic in South Africa “are the more deep-rooted institutional problems of poverty, underdevelopment and the low status of women, including gender-based violence, in society.”

Next going to Published Aids in china

Aids in India

Aids in India

The incidence of AIDS in India is steadily rising amidst concerns that the nation faces the prospect of an AIDS epidemic. By June 1991, out of a total of more than 900,000 screened, some 5,130 people tested positive for the human immunodeficiency virus (HIV). However, the total number infected with HIV in 1992 was estimated by a New Delhi-based official of the World Health Organization (WHO) at 500,000, and more pessimistic estimates by the World Bank in 1995 suggested a figure of 2 million, the highest in Asia. Confirmed cases of AIDS numbered only 102 by 1991 but had jumped to 885 by 1994, the second highest reported number in Asia after Thailand. Suspected AIDS cases, according to WHO and the Indian government, may be in the area of 80,000 in 1995.

The main factors cited in the spread of the virus are heterosexual transmission, primarily by urban prostitutes and migrant workers, such as long-distance truck drivers; the use of unsterilized needles and syringes by physicians and intravenous drug users; and transfusions of blood from infected donors. Based on the HIV infection rate in 1991, and India’s position as the second most populated country in the world, it was projected that by 1995 India would have more HIV and AIDS cases than any other country in the world. This prediction appeared true. By mid-1995 India had been labeled by the media as “ground zero” in the global AIDS epidemic, and new predictions for 2000 were that India would have 1 million AIDS cases and 5 million HIV-positive.

In 1987 the newly formed National AIDS Control Programme began limited screening of the blood supply and monitoring of high-risk groups. A national education program aimed at AIDS prevention and control began in 1990. The first AIDS prevention television campaign began in 1991. By the mid-1990s, AIDS awareness signs on public streets, condoms for sale near brothels, and media announcements were more in evidence. There was very negative publicity as well. Posters with the names and photographs of known HIV-positive persons have been seen in New Delhi, and there have been reports of HIV patients chained in medical facilities and deprived of treatment.

Fear and ignorance have continued to compound the difficulty of controlling the spread of the virus, and discrimination against AIDS sufferers has surfaced. For example, in 1990 the All-India Institute of Medical Sciences, New Delhi’s leading medical facility, reportedly turned away two people infected with HIV because its staff were too scared to treat them.

A new program to control the spread of AIDS in India was launched in 1991 by the Indian Council of Medical Research. The council looked to ancient scriptures and religious books for traditional messages that preach moderation in sex and describe prostitution as a sin. The council considered that the great extent to which Indian life-styles are shaped by religion rather than by science would cause many people to be confused by foreign-modeled educational campaigns relying on television and printed booklets.

The severity of the growing AIDS crisis in India is clear, according to statistics compiled during the mid-1990s. In Bombay, a city of 12.6 million inhabitants in 1991, the HIV infection rate among the estimated 80,000 prostitutes jumped from 1 percent in 1987 to 30 percent in 1991 to 53 percent in 1993. Migrant workers engaging in promiscuous and unprotected sexual relations in the big city carry the infection to other sexual partners on the road and then to their homes and families.

India’s blood supply, despite official blood screening efforts, continues to become infected. In 1991 donated blood was screened for HIV in only four major cities: New Delhi, Calcutta, Madras, and Bombay. One of the leading factors in the contamination of the blood supply is that 30 percent of the blood required comes from private, profit-making banks whose practices are difficult to regulate. Furthermore, professional donors are an integral part of the Indian blood supply network, providing about 30 percent of the annual requirement nationally. These donors are generally poor and tend to engage in high-risk sex and use intravenous drugs more than the general population. Professional donors also tend to donate frequently at different centers and, in many cases, under different names. Reuse of improperly sterilized needles in health care and blood-collection facilities also is a factor. India’s minister of health and family welfare reported in 1992 that only 138 out of 608 blood banks were equipped for HIV screening. A 1992 study conducted by the Indian Health Organisation revealed that 86 percent of commercial blood donors surveyed were HIV-positive

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Aids in Zimbawae

With around one in seven adults living with HIV¹ and an estimated 565 adults and children becoming infected every day (roughly one person every three minutes),² Zimbabwe is experiencing one of the harshest AIDS epidemics in the world.

In a country with such a tense political and social climate, it has been difficult to respond to the crisis. President Robert Mugabe and his government have been widely criticised by the international community, and Zimbabwe has become increasingly isolated, both politically and economically. The economy is suffering from a rapidly growing rate of inflation that was around 2,000% in November 2006, making goods twice as expensive as they were in May 2006.^{3 4} In January 2008, inflation was reported to have reached 100,000%.⁵ This economic decline is fuelling food shortages at a time when poverty is already rife, leading to a desperate situation where HIV and AIDS are in danger of being overlooked in the face of more immediate survival concerns.

In many cases, as one Zimbabwean doctor explained to reporters, the reality is that AIDS can now be counted amongst such concerns:

“Put simply, people are dying of AIDS before they can starve to death” – ⁶

The situation in Zimbabwe is now so bad that:

• Between 2002 and 2006, the population is estimated to have decreased by four million people.⁷
• Infant mortality has doubled since 1990.⁸
• Average life expectancy for women, who are particularly affected by Zimbabwe’s AIDS epidemic, is 34 – the lowest anywhere in the world.⁹ Officials from the World Health Organisation have admitted that since this figure is based on data collected two years ago, the real number may be as low as 30.¹⁰
• Zimbabwe has a higher number of orphans, in proportion to its population, than any other country in the world, according to UNICEF. Most of these cases are a result of parents dying from AIDS.¹¹

Pattern of the HIV/AIDS epidemic so far

The first reported case of AIDS in Zimbabwe occurred in 1985. By the end of the 1980s, around 10% of the adult population were thought to be infected with HIV. This figure rose dramatically in the first half of the 1990s, peaking and stabilising at 29% between 1995 and 1997. But since this point the HIV prevalence is thought to have declined, making Zimbabwe one of the first African nations to witness such a trend. According to government figures, the adult prevalence was 24.6% in 2003,¹² and fell again to 15.3% in 2007.¹³ The United Nations and WHO have accepted these revised figures.¹⁴

Yet although survey results do indeed indicate a fall in Zimbabwe’s adult HIV prevalence, caution should be taken when interpreting the data available; it is not yet known whether the trend is a sign of long-term change or merely a temporary movement. Given the large number of homeless and displaced people living in Zimbabwe who are not likely to have been surveyed, the results cannot be taken as wholly representative of the situation. A rise in the number of people dying from AIDS is thought to have played a role in the decline, as well as an increase in the number of people (HIV positive or otherwise) who have migrated to other countries.

Brian Nyathi, a Zimbabwean health practitioner in South Africa, is among those questioning the official statistics:

“Many people have left Zimbabwe and the ones that are left are so struck down by poverty and the collapse of the health delivery system such that they can not access hospitals. We wonder if these figures can be trusted.” – ¹⁵

Nonetheless there is evidence of positive changes in sexual behaviour.¹⁶ Condom use has increased, a higher number of young people are delaying first sex and many people have reduced their number of sexual partners. It is thought that an increased awareness of HIV and AIDS has influenced these changes. In many cases, people may have changed their behaviour after witnessing the effects of the epidemic first hand, through the deaths of friends or relatives.

One young Zimbabwean recently told reporters:

“I’m not sure if sexual attitudes are changing altogether, but I tell you around the streets of Harare you will see lots of used condoms on the ground”. – ¹⁷

While it is encouraging that sexual behaviour change has helped to reduce HIV prevalence, there is a long way to go. As the WHO country representative, Dr Custoda Mandlhate, has pointed out:

“a sero-prevalence rate of 15,6 percent remains high and this is not the moment for relaxing”. – ¹⁸

The Government’s response

When AIDS first emerged in Zimbabwe, the government was slow to acknowledge the problem and take appropriate action. Discussion of HIV and AIDS was minimal and President Mugabe rarely addressed the subject in speeches. When he did, it was considered newsworthy.

Although the National AIDS Co-ordination Programme (NACP) was set up in 1987 and several short term and medium term AIDS plans were carried out over the following years, it was not until 1999 that the country’s first HIV and AIDS policy was announced. This policy began to be implemented the following year by the newly formed National AIDS Council (NAC), which took over from the NACP. At the same time, the Government introduced an AIDS levy on all taxpayers to fund the work of the NAC.

While these measures have had a positive impact, the Government’s response to HIV and AIDS has ultimately been compromised by numerous other political and social crises that have dominated political attention and overshadowed the implementation of the national AIDS policy. The NAC has also been constrained by poor organisation and a lack of resources.

The government should not be presented as innocent victims of inevitable problems, though; many of the struggles facing the country stem from their mistakes and failures. While political commitment towards fighting AIDS is apparent in Zimbabwe, the decisions made by Mugabe in dealing with other issues have led to a situation where the government is unable to adequately address the crisis.

Political issues in Zimbabwe

The Government of Zimbabwe, led by President Mugabe since 1980, has attracted intense international criticism in recent years. Mugabe’s rule has been marked by corruption, human rights abuses and media repression, all of which have had an impact on the AIDS epidemic.

Land reforms

Although Zimbabwe gained political independence from British rule in 1980, the majority of the country’s land remained in the hands of non-indigenous white farmers, despite the fact that they made up just 1% of the population. This was a source of tension in the years that followed, and in 1999 the Government began to forcibly evict white farmers from their land.

The land redistribution campaign that followed is thought to have contributed to the AIDS epidemic in several ways. As farming communities were disrupted, the economy deteriorated, leading to increased poverty and reduced access to education and healthcare. Many farm workers were forced to move to different areas and in some cases families were separated: both factors that are likely to have widened sexual networks and increased the risk of HIV transmission. Violence against farmers was practically encouraged, a climate of lawlessness ensued in many areas and rape became increasingly common, making women more vulnerable to HIV infection.

Operation Murambatsvina

Operation Murambatsvina, which translates to ‘operation drive out trash’, was initiated in May 2005 with the aim of redistributing people from urban to rural areas. Large numbers of homes and businesses were demolished and their tenants forcibly removed, leaving thousands homeless, unemployed and starving. The Government claims that this was a response to increases in illegal housing, crime, and the spread of sexually-transmitted diseases in urban areas, while critics (such as the UN) have claimed that the campaign was a direct attack on the poorer sections of society that represent the main opposition to President Mugabe. Mugabe himself labelled it an ‘urban beautification’ programme.

 

Before the destruction of Porta Farm, Zimbabwe (22nd June 2002)

 

After the destruction of Porta Farm, Zimbabwe (6th April 2006), trees have replaced houses (photos courtesy of Amnesty International)

By July 2005, it was estimated that Operation Murambatsvina had displaced some 700,000 people, including over 79,500 adults living with HIV.¹⁹ A number of these people had previously been receiving antiretroviral drugs (ARVs) to delay the onset of AIDS, but now had no access to them as treatment centres and clinics had been demolished. The interruption of ARV treatment can lead to drug resistance, declining health, and in some cases death.

Other HIV and AIDS-related services such as home-based care and prevention programmes were also disrupted. Several home-based care programmes for people living with HIV indicated a 15-25% reduction in the number of patients accessing their services.²⁰

One year after Operation Murambatsvina, Lynde Francis – co-ordinator of The Centre, an HIV and AIDS non-governmental organisation (NGO) with 4,500 clients that was disturbed by the campaign – described the difficulties her organisation was facing in re-establishing connections with people living with HIV:

“We still haven’t traced some clients … they’ve vanished as far as we’re concerned. Others disappeared for weeks and were homeless and incomeless, which means they were not eating, and that’s a problem when taking [ARVs]” – ²¹

As well as affecting people who were already living with HIV, the campaign may also have contributed to the spread of infection. Factors such as increased population mobility, the separation of couples and an increased number of women turning to sex work in order to survive are likely to have increased the frequency of unsafe sex in many areas. Access to education and information about HIV decreased, and nationwide sales of condoms fell: between May and June 2005, sales of male and female condoms dropped by over 20% and 40% respectively.²²

International aid

While campaigns to prevent and treat HIV in other African nations benefit from international aid, the political situation in Zimbabwe has caused some foreign donors to either decrease aid for the country or halt it altogether. The government has been increasingly hostile towards foreign non-governmental organisations (NGOs), to the extent where they threatened to pass a law that would prohibit organisations from working on human rights, and would give the government the power to interfere with how NGOs are run.²³

Despite this hostility, Zimbabwe is still receiving international aid, and the main donors are the UK and the US departments for international development (DFID and USAID), and the European Commission (EC). Since 2002, DFID has provided Zimbabwe with over £35 million to help tackle HIV/AIDS and health priorities.²⁴ At the beginning of 2008 USAID donated US$12.5 million to increase women and children’s access to HIV prevention services.²⁵

However, these donations are not as much as other sub-Saharan African countries are receiving. Put into context, the neighbouring nation of Zambia, which has a similar HIV prevalence rate, was reported in 2005 to receive around US$187 per HIV positive person annually from foreign donors; in Zimbabwe, the figure was estimated to be just US$4.²⁶

HIV prevention in Zimbabwe

Efforts to prevent the spread of HIV in Zimbabwe have been spearheaded by the NAC, NGOs and religious and academic organisations. Although HIV prevalence has probably fallen, indicating a change in sexual behaviour, it is difficult to say how significant the role of prevention programmes has been in achieving this trend. Prevention schemes have been significantly expanded since the turn of the millennium, but remain critically under-funded.

There has also been conflict between the messages promoted by different programmes; for instance, some religious or traditional campaigns discourage the use of condoms and place emphasis on abstinence, contrasting with the strategies of some other organisations. This has led to confusion about how it is best to prevent HIV infection, particularly amongst young people.

Education

Children in Zimbabwe are currently taught about HIV and AIDS in schools from the age of eight, and the Government has recently suggested that there are plans to make students take an exam on the subject.²⁷

Outside of school, efforts to educate and inform people about HIV and AIDS (which are often organised by NGOs) have used a number of different means to convey prevention messages, including television and radio, drama, and community groups.

With around 50% of the people living with HIV in Zimbabwe becoming infected during adolescence or young adulthood,²⁸ education campaigns have primarily targeted young people. Knowledge about HIV and AIDS among young people is higher than the average for sub-Saharan Africa. 55.2 percent of people aged between 15-24 in Zimbabwe correctly identified ways to prevent HIV.²⁹ This is compared to only 19.15 percent in Nigeria, 26.5 percent in Mozambique and 40.5 percent in Kenya.

A greater understanding and awareness of HIV and AIDS is thought to lead to changes in sexual behaviour, which has been shown to reduce the number of new HIV infections. A study carried out in 2006 suggested that the adoption of safer sexual behaviours was one of the reasons why HIV prevalence in Zimbabwe has declined.³⁰

Voluntary counselling and testing

The Government emphasised the importance of voluntary counselling and testing for HIV (VCT) with its National AIDS Policy in 1999, which highlighted VCT as a central part of Zimbabwe’s AIDS prevention strategy. Between 2004 and 2005 the total number of VCT sites increased from 292 to more than 430, with every health district now containing at least one site that provides the service.³¹

Despite these advances, there is still a strong reluctance to access testing amongst much of the population. People living with HIV face a particularly high level of discrimination in Zimbabwe, and many people fear that if they are found to be HIV-positive they will be victimised. In places where there is little access to ARVs, some see testing as pointless, as one HIV-positive women described to reporters:

“I said [to the doctor]: “Why have you tested me – you have just put me on a death sentence because I’m scared now because I know I am HIV positive. If you test me, it was to give me tablets.” Here in Zimbabwe we don’t have something like that. We don’t have tablets” – ³²

In 2007, the Government shifted focus from voluntary testing to provider-initiated testing, meaning that whenever a person visits a healthcare facility, they will be offered HIV testing as part of the hospital service. Dr Mugurungi, Head of the AIDS and TB Unit in the Ministry of Health and Welfare, believes that the new testing regulation will mean that a greater number of people will know their status, which will help “both the service provider and the infected person to plan effectively on either living positively or maintaining a negative status.”³³

Mother-to-child transmission

In 2006 UNAIDS estimated that only 4.4 percent of pregnant women were receiving treatment to reduce mother-to-child transmission.

In Zimbabwe, more than 17,000 children are infected with HIV every year³⁴, the majority through mother-to-child transmission. As with VCT, the provision of services to prevent the transmission of HIV between mothers and their children during pregnancy is gradually being scaled up. The prevention of mother-to-child transmission (PMTCT) pilot programme was launched at four sites in 1999 and today the programme is nationwide. It aims to provide pregnant women with free VCT and give them access to nevirapine, a drug that significantly reduces the chances of transmission occurring.

The provision of drugs to prevent MTCT rose from 4% in 2006 to 29% in 2007. Although this is an encouraging scale-up, the provision of PMTCT services remains severely limited by a lack of funding, and access to nevirapine remains low. ³⁵ Around 120,000 children are living with HIV in Zimbabwe, most of whom became infected through mother-to-child transmission. AVERT is calling for rapid improvements in PMTCT in our Stop AIDS in Children campaign.

Read more about Mother-to-child-transmission of HIV worldwide.

Condom use

 

“What smart guys are wearing” condom poster in Zimbabwe

Increased condom use has been recognised as a major factor in the recent decline in Zimbabwe’s HIV prevalence. The number of free condoms distributed by the Government, NGOs and social marketing campaigns tripled during the 1990s, and further increased in subsequent years. The number of condoms sold through the private sector has also increased dramatically, and most condoms are now purchased rather than acquired for free, suggesting that condom use has become more accepted in Zimbabwean society.³⁶ It has also been reported that Zimbabwean women use more female condoms than any other country.³⁷

HIV and AIDS treatment in Zimbabwe

Largely as a result of Zimbabwe’s declining economy, there has been a shortage of antiretroviral drugs (ARVs, which are used to treat HIV). The government has responded to this shortage by taking various measures to expand the provision of ARVs. In 2002 it declared that the treatment shortage was a national emergency, allowing Zimbabwe to produce and purchase generic AIDS drugs locally under international law, thereby reducing their cost.

However, in October 2005 it was reported that the cost of ARVs had quadrupled in the previous three months.³⁸ The increasing cost of ARVs has led to a number of problems, such as the selling of fake drugs at flea markets.³⁹ An article published in 2006 even reported that government officials who were HIV positive had been given priority access to ARVs. While doing so, they had intercepted drugs for their own use that were actually meant for public hospitals.⁴⁰ More recently there has also been the severe threat brought about by interruptions of regular supplies of ARVs. Reports of breakdowns in drug delivery and theft of drugs by government officials, as well as physicians switching patients on established regimens due to lack of drug availability could all lead to drug resistant HIV strains developing.⁴¹

Women who live in rural areas are reported to find it very difficult to obtain ARVs. As the income for rural households tends to be low, and rural women often rely upon husbands working in urban areas for financial support, the women cannot afford the cost of the drugs.⁴² They also have to travel long distances to health centres in order to receive ARVs, which is another financial burden. Even at sites where treatment has been made accessible, a severe national shortage of healthcare workers has led to long waiting lists and administration problems.

Other reports have revealed that people living with HIV/AIDS in Zimbabwe have crossed the border into Mozambique in order to receive ARVs, which Mozambique provides for free.⁴³

In 2007 the government aimed to increase treatment provision through public health sector facilities, with the aim of reaching at least 140,000 people in need of ARVs by the end of the year. In October 2007, the government claimed that they were on track with the target, and had reached close to 90,000 people already.⁴⁴ WHO figures for the end of 2007, however, put treatment figures at an estimated 98,000, somewhat short of the target. Approximately 472,000 people  in need of treatment are not yet receiving antiretroviral drugs⁴⁵.

Other major issues

Stigmatisation

Despite a high level of awareness, HIV and AIDS remain highly stigmatised in Zimbabwe. People living with HIV are often perceived as having done something wrong, and discrimination is frequently directed at both them and their families. Many people are afraid to get tested for HIV for fear of being socially alienated, losing their partner or losing their job. Those who do know their status rarely make it publicly known, which often means that they do not have access to sufficient care and support.

There is a feeling in Zimbabwe that the stigma surrounding HIV is gradually diminishing, although it remains a significant problem. Various attempts have been made to improve the situation, such as the 2005 “Don’t be negative about being positive” campaign. Organised by PSI-Zimbabwe, this campaign encouraged people to reveal their HIV-positive status and to share their stories. The organisers won the 2005 Global Media Award for their work.⁴⁶

Gender inequalities

There are large social and economic gaps between women and men in Zimbabwe, and these inequalities have played a central role in the spread of HIV. Constrictive attitudes towards female sexuality contrast with lenient ones towards the sexual activity of men, resulting in a situation where men often have multiple sexual partners and women have little authority to instigate condom use. Sexual abuse, rape and coerced sex are all common, and as the economy deteriorates more women are turning to sex work as a means of survival.

Prevention campaigns that emphasise safe sex and abstinence often fail to take into account these realities, and are more applicable to the lives of men than those of women. Women are likely to be poorer and less educated than men, predisposing them to HIV infection and making it harder for them to access treatment, care and information.

According to UNAIDS estimates, almost 60% of Zimbabwean adults living with HIV at the end of 2006 were female. This gender gap is even wider amongst young people – women make up around 77% of people between the ages of 15 and 24 living with HIV.⁴⁷

Human resources

With an unemployment rate of around 80%, Zimbabwe is suffering from a severe lack of human resources. In many cases this problem is a direct result of the HIV epidemic, as workers are either caring for family members with AIDS or suffering from it themselves.

In the healthcare sector, the deficiency of workers has hindered efforts to treat and care for people living with HIV. The Zimbabwe Doctors for Human Rights say that there is now only one doctor for every 12,000 people.

Zimbabwe’s health professionals are working under intense pressure and stress. They have too much to do, poor pay, a critical lack of supplies. What they are meant to do as doctors is just impossible - Peter Iliff, a doctor who has been working in Zimbabwe for 20 years

Additionally, large numbers of health personnel migrate to other countries once they are trained, and many of those who remain in the country are affected by HIV themselves.

Famine and malnutrition

As the economy deteriorates and farming communities struggle to recover from Mugabe’s land reforms, food shortages have escalated. Sickness and death from AIDS has caused a reduction in agricultural output, especially since women (who form the bulk of agricultural labour in Zimbabwe) are so vulnerable to HIV infection. Women are also expected to care for relatives who are infected with AIDS, forcing many to abandon their agricultural work.

As Zimbabwe’s workforce has deteriorated, the resulting food shortages have increased the number of deaths from AIDS. Malnutrition has caused people living with HIV to develop AIDS faster, and is likely to have decreased the effectiveness of ARVs for those who are receiving treatment.

While it is essential that those on ARVs are recieving adequate nutrition for the drugs to work effectively, there are reports of HIV positive patients in such desperation that they are actually selling their ARV medication in order to buy food.⁴⁸

The way forward for Zimbabwe

Most people feel that the Zimbabwean Government’s response to the AIDS crisis has been relatively good in comparison with their performance in other areas. Prevention and treatment initiatives have been scaled up and the national HIV prevalence seems to have declined. Yet in the context of such a fragmented political and economic background, the fight against AIDS has been unable to make substantial progress. The collapse of the economy – which is perhaps the most prominent of Zimbabwe’s interrelated problems – has been a direct result of the Government’s disastrous land reforms policy, as farming output has deteriorated and the unethical nature of the campaign has led to international sanctions and the withdrawal of aid.

Ultimately, there is only so much that can be done with such low levels of funding, human resources and international support. While Zimbabwe has one of the lowest life expectancies in the world at just 37 years for men and 34 years for women⁴⁹ (due in large part to the AIDS epidemic), President Mugabe is now 84 years of age. Many people feel that a change of Government is long overdue and is indeed necessary if an effective response to the epidemic is to be formed.