Zimbabwe's National Aids Council (NAC) on Tuesday said it was only ableto provide anti-retroviral (ARV) drugs to one in every 12 HIV/AIDS patients because there is no money to buy adequate supplies. Being the result of funds raised through an aids tax on workers having to be spread out to cover other social sectors requiring support leaving little money to pay for drugs or HIV/AIDS prevention programmes, the article further describes the impact of this news.
Equity and HIV/AIDS
Zimbabwe Aids council says only one in 12 patients getting anti-retroviral drugs
SAFAIDS, 29 March 2006
Zimbabwe gets funding for HIV-positive mothers and babies
Plus News: 22 February 2011
A US$45 million five-year grant has been awarded to the Elizabeth Glaser Paediatric Foundation (EGPAF) to fund various child HIV interventions in Zimbabwe. Some of this funding is intended for the country’s prevention of mother-to-child transmission (PMTCT) programme, which, according to this article, is performing poorly, as more 150,000 children are estimated to be HIV positive and more than 90% of childhood HIV infections can be attributed to mother-to-child transmission. USAID blamed the high figure on the fact that most children were ‘getting lost in the system’ because their mothers did not return to clinics for additional maternal and child health services after the initial visit to the antenatal clinic. Financial constraints and lack of knowledge about the importance of registering for antenatal services were identified as major barriers, while long distances from health facilities prevented many women from accessing treatment for their infants. In the article, Plus News argues that the government should implement the 2010 World Health Organisation guidelines on PMTCT, which recommend that all HIV-positive pregnant women begin anti-retroviral treatment at 14 weeks of pregnancy and continue until they stop breastfeeding.
Zimbabwe HIV and AIDS subaccounts 2005
Cambridge MA, Bethesda MD, Chicago IL, Durham NC, Hadley MA and Lexington MA: UNAIDS: 2005
Total HIV and AIDS expenditure in 2005 in Zimbabwe was around 20.9 trillion Zimbabwe dollars, an equivalent of US$209.4 million, which represents about US$150.50 per adult living with HIV, according to an assessment of HIV and AIDS spending. The largest contributors to this expenditure were donors at 49% of the total HIV and AIDS expenditures. This is similar to that found in studies undertaken in other countries prior to the surge of external targeted funds for HIV and AIDS, such as in Kenya, Malawi, Rwanda and Zambia. From this analysis, it can be concluded that most of the funds from Ministry of Health and Child Welfare, local NGOs, UN agencies and international NGOs were used for the provision of prevention and public health programmes for HIV and AIDS, whereas spending by people living with HIV went directly to health facilities for treatment and care of opportunistic infections. The Ministry of Health and Child Welfare and PLWHA through direct out-of-pocket payments were those principally responsible for paying for treatment and care of opportunistic infections. Donors, international NGOs and Local NGOs, on the other hand, were mainly responsible for the payment of provision and administration of prevention and public health programmes for HIV and AIDS and for Anteretroviral treatment in 2005.
Zimbabwean government to double number of people on HIV treatment
Plus News: 22 January 2010
The Zimbabwe Minister of Health and Child Welfare, Dr Henry Madzorera is reported to have announced plans to increase the number of people on anteretrovirals from the current 180,000 to 300,000 (or 60% of the 500,000 adults estimated to need treatment) using resouces from the Global Fund, the United States President's Emergency Plan for AIDS Relief (PEPFAR), and a basket funding mechanism to which donors contribute for various HIV and AIDS interventions, known as the Expanded Support Programme on HIV/AIDS (ESP).
Zimbabwe’s adult HIV prevalence rate down
Plus News: 29 September 2009
Zimbabwe's adult HIV prevalence rate is continuing its downward trend, showing a drop from 14.1% in 2008 to 13.7% in 2009, according to new estimates released by the Ministry of Health and Child Welfare. The 2009 Antenatal Clinic (ANC) Surveillance Survey, based on blood specimens collected from 7,363 pregnant women anonymously screened at 19 clinic sites throughout the country, estimated that 1.1 million Zimbabweans in a probable population of around 11 million were living with HIV. The prevalence rate is expected to continue decreasing; investigations have shown that the decline ‘most likely resulted from a combination of an increase in adult mortality and a decline in HIV incidence, resulting from adoption of safer sexual behaviours’, said Douglas Mombeshora, Deputy Minister of Health and Child Welfare. ‘When prevention programmes achieve heightened awareness, significant changes in behaviour will occur, and one of the main outcomes is the significant reduction in the need for PMTCT [prevention of mother-to-child transmission] services, as well as a reduced number of new HIV infections,’ he noted.
‘Antwerp in Geneva’ workshop on the AIDS response and health systems strengthening in sub-Saharan Africa, 28 May 2008
Ford N, Ooms G, Laga M, Pirard M, van Damme W and Loewenson R
On 28 May 2008 the Institute of Tropical Medicine (Antwerp, Belgium) hosted a meeting at the World Health Organization (Geneva, Switzerland) to review the evidence on the effects of AIDS programmes on Health Systems, particularly in high HIV prevalence settings, and discuss the way forward. Over 30 participants attended from a range of backgrounds (implementers, activists, academics and funders) and HIV-affected countries. The report summarizes the main issues that were discussed at the workshop, including the harms and benefits of HIV programmes for health systems and primary health care, debates around continued AIDS exceptionalism, and considerations and policy options for HIV programmes
to maximise their potential to contribute to health systems strengthening.
The report is organised around the major issues/debates that have been raised around AIDS programmes and health systems, particularly the financing, organisation and delivery of health systems. The discussions were informed by country experiences presented from a number of high-burden countries in sub-Saharan Africa and evidence and experience from
meeting delegates.
‘It's her responsibility’: Partner involvement in prevention of mother to child transmission of HIV programmes, northern Tanzania
Falnes E, Moland K, Tylleskar T, de Paoli M, Msuya SE and Engebretsen IM: Journal of the International AIDS Society 14(21), 26 April 2011
In this study, the authors explored acceptability of child transmission (PMTCT) programme components and identified structural and cultural challenges to male involvement in pregnancy and childbirth in rural and urban areas of Moshi in the Kilimanjaro region of Tanzania. Mixed methods were used, including focus group discussions with fathers and mothers, in-depth interviews with fathers, mothers and health personnel, and a survey of 426 mothers bringing their four-week-old infants for immunisation at five reproductive and child health clinics. Routine testing for HIV of women at the antenatal clinic was found to be highly acceptable and appreciated by men, while other programme components, notably partner testing, condom use and the infant feeding recommendations, were met with continued resistance. Very few men joined their wives for testing and thus missed out on PMTCT counselling. The main barriers reported were that women did not have the authority to request their husbands to test for HIV and that the arena for testing, the antenatal clinic, was defined as a typical female domain where men were out of place. The authors conclude that deep-seated ideas about gender roles and hierarchy are the major obstacles to male participation in the PMTCT programme. Empowering men to participate by creating a space within the PMTCT programme that is male friendly should be feasible and should be highly prioritised for the PMTCT programme to achieve its potential.
‘Just like fever’: A qualitative study on the impact of antiretroviral provision on the normalisation of HIV in rural Tanzania and its implications for prevention
Roura M, Wringe A, Busza J, Nhandi B, Mbata D, Zaba B and Urassa M: International Health and Human Rights, 9 September 2009
As part of a broader initiative to monitor the implementation of the national antiretroviral therapy (ART) programme, this qualitative study investigated the impact of ART availability on perceptions of HIV in a rural ward of north Tanzania and its implications for prevention. A mix of qualitative methods was used including semi-structured interviews with 53 ART clinic clients and service providers. Four group activities were conducted with persons living with HIV. People on ART often reported feeling increasingly comfortable with their status reflecting a certain ‘normalisation’ of the disease. Overcoming internalised feelings of shame facilitated disclosure of HIV status, helped to sustain treatment, and stimulated VCT uptake. However ‘blaming’ stigma – where people living with HIV were considered responsible for acquiring a ‘moral disease’ – persisted in the community and anticipating it was a key barrier to disclosure and VCT uptake. As long as an HIV diagnosis continues to have moral connotations, a de-stigmatisation of HIV paralleling that occurring with diseases like cancer is unlikely to occur.
‘SADC, put your money where your mouth is’
SATAMo: December 2008
The Treatment Barometer, a survey by SATAMo on access to AIDS treatment within Southern African Development Community (SADC) countries, calls on regional leaders to keep the promises they made towards the provision of HIV treatment by committing much-needed resources. It’s the first regional treatment monitoring research to be carried out by community-based treatment activists, who noted that more than 80% of SADC governments have not honoured the Abuja Declaration more than seven years after the commitment, barriers to treatment still exist, reports of stigma and discrimination by health care workers remain high, stock-outs of drugs are common in more than 80% of the countries surveyed and most countries are struggling to provide first-line treatment to those who need it, with eight countries in SADC below 35% coverage and only two exceeding 75% coverage.
‘The mercurial piece of the puzzle’: Understanding stigma and HIV/AIDS in South Africa
Gilbert L: Journal of Social Aspects of HIV/AIDS Research Alliance (SAHARA-J)13(1) 8-16
Although stigma and its relationship to health and disease is not a new phenomenon, it has not been a major feature in the public discourse until the emergence of HIV. The range of negative responses associated with the epidemic placed stigma on the public agenda and drew attention to its complexity as a phenomenon and concept worthy of further investigation. Despite the consensus that stigma is one of the major contributors to the rapid spread of HIV and the frequent use of the term in the media and among people in the street, the exact meaning of ‘stigma’ remains ambiguous. This paper re-visits some of the scholarly deliberations and further interrogates their relevance in explaining HIV-related stigma evidenced in South Africa. In conclusion a model is presented. Its usefulness – or explanatory potential – is that it attempts to provide a comprehensive framework that offers insights into the individual as well as the social/structural components of HIV-related stigma in a particular context. As such, it is argued by the authors to have the potential to provide more nuanced understandings as well as to alert us to knowledge-gaps in the process.