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zimbabwe_hiv_aids_2007

VIEWS: 150 PAGES: 23

									                    A survey on HIV/AIDS in




                               Zimbabwe




The Internet has been consulted between: March and July 2007

This report is based on the literature from the Internet. The views
expressed are not necessarily the point of view of the assigning
organizations




                                                                      1
Survey on HIV/ AIDS in Zimbabwe                  September 2007


                            Table of contents

Abbreviations

   1. Demographic Situation HIV/AIDS        5

   2. National Policies                     6

   3. HIV/AIDS and Government Policies      15

   4. National Structures                   16

   5. Law and Legislation                   17

   6. Financial Issues                      19

   7. Local Situation                       19

   8. Treatment                             20

   Conclusion                               21


Appendix




                                                          2
Survey on HIV/ AIDS in Zimbabwe                                                  September 2007


Abbreviations
ABC   Abstain, Be faithful, Condomise
AIDS Acquired Immuno-Deficiency Syndrome
ANC Ante-Natal Care
ART   Antiretroviral Treatment
ARVs Antiretrovirals
ASOs AIDS Service Organizations
BC    Behaviour Change
BEAM Basic Education Assistant Module
BFHI Baby Friendly Hospital Initiative
CBD Community Based Distributor
CBO Community Based Organization
CCM Country Coordinating Mechanism
CHBC Community Home-based Care
CRIS Country Response Information System
CSO Central Statistical Office
CSWs Commercial SexWorkers
C&T   Counselling and Testing
CTX   Cotrimoxazole
CZI   Confederation of Zimbabwe Industries
DAAC District AIDS Action Committee
DCT   Data Collection Tool
EMCOZ Employers Confederation of Zimbabwe
FBO   Faith Based Organization
FP    Family Planning
GBV Gender Based Violence
GFATM The Global Fund to fight AIDS, Tuberculosis and Malaria
HBC Home-based Care
HIV   Human Immunodeficiency Virus
ICASA International Conference on AIDS and Sexually Transmitted Infections in Africa
IDU   Injecting Drug Users
IEC   Information, Education & Communication
M&E Monitoring and Evaluation
MCH Maternal and Child Health
MDGs Millennium Development Goals
MIPA Meaningful Involvement of People living with HIV and AIDS
MNCH Maternal Neonatal and Child Health
MoESC Ministry of Education, Sport and Culture
MoHCW Ministry of Health and ChildWelfare
MoPSLSW Ministry of Public Service, Labour and SocialWelfare
MSM Men who have Sex with Men
MTP1 First Medium Term Plan
MTP2 Second Medium Term Plan
NAC National AIDS Council
NACP National AIDS Control Programme
NAP   National ART Programme
NATF National AIDS Trust Fund
NBTS National Blood Transfusion Service
NGO Non Governmental Organization
NPA   National Plan of Action
NPA-OVC National Plan of Action for Orphans and Other Vulnerable Children
NPF   National Partnership Forum
NSF   National Strategic Framework
OI    Opportunistic Infections
OVC Orphans and Other Vulnerable Children
Survey on HIV/ AIDS in Zimbabwe                                      September 2007

PAAC Provincial AIDS Action Committee
PCCs Primary Care Counsellors
PEP   Post Exposure Prophylaxis
PER   Public Expenditure Review
PLWHA People LivingWith HIV and AIDS
PMTCT Prevention of Mother To Child Transmission
PSI   Population Services International
SADC Southern African Development Council
SRH Sexual and Reproductive Health
STD   Sexually Transmitted Disease
STIs  Sexually Transmitted Infections
STP   Short Term Plan
TB    Tuberculosis
TBAs Traditional Birth Attendants
UNAIDS United Nations Programme on HIV/AIDS
UNDP United Nations Development Programme
UNGASS United Nations General Assembly Special Session on HIV/AIDS
UNICEF United Nations Children's Fund
UNFPA United Nations Population Fund
VAAC Village AIDS Action Committee
VCT   Voluntary Counselling and Testing
WAAC Ward AIDS Action Committee
WASN Women and AIDS Support Network
YAS   Young Adult Survey
ZAN   Zimbabwe AIDS Network
ZBCA Zimbabwe Business Council on AIDS
ZCTU Zimbabwe Congress of Trade Unions
ZDHS Zimbabwe Demographic Health Survey
ZNASOP Zimbabwe National HIV and AIDS Strategic Operational Plan
ZNASP Zimbabwe National HIV and AIDS Strategic Plan
ZNFPC Zimbabwe National Family Planning Council
ZNHIF Zimbabwe National Health Indicator Framework
ZNNP+ Zimbabwe National Network of People Living with HIV
ZUNDAF Zimbabwe United Nations Development Assistance Framework




                                                                              4
Survey on HIV/ AIDS in Zimbabwe                                                       September 2007


1 Demographic situation HIV-AIDS
Since 1990, HIV/AIDS has slashed the average life expectancy in Zimbabwe from 60 to 37 years
in 2005.1
    • Number of people infected:
    Estimated number of people living with HIV/AIDS (0-49 years): 1.500.000-2.000.000 in 2003

    According to UNAIDS estimates, 58% of Zimbabwean adults living with HIV at the end of
    2003 were female. This gender gap is even wider amongst young people – women make up
    almost 80% of people between the ages of 15 and 24 living with HIV.2

    Women aged 15 and up living with HIV: 890.000 (520.000-1.300.000)

    Children aged 0-14 living with HIV: 160.000 (54.000-340.000)3

    • Prevalence:
    Adult prevalence of HIV/AIDS (15-49years): 21.7-27.8% in 2003

    Adult prevalence of HIV/AIDS (15-49years): 24.6% in 2005
    Each day an estimated 564 adults and children become infected with HIV.
    About 50% of the people living with HIV/AIDS are infected during adolescence and young
    adulthood.

     Women are disproportionately affected by HIV/AIDS, constituting 51% of the population and
    53% of the people living with HIV/AIDS in 2003. The estimated number of women living with
    HIV/AIDS has been higher in comparison to men since 1989, and the number of new
    infections among women has exceeded more than among men since 1989.

    •   Mortality rate due to AIDS:

Deaths due to AIDS: 200,000 (2001 est.), 160,000 annually (1999 estimate)4.

Deaths due to AIDS: 180.000 (120.000-250.000) 20065

    •   Number of AIDS orphans:

    At the end of 2003, an estimated 980 000 children younger than 17 years had lost one or
    both parents to HIV/AIDS6.
    Children (0-17 years), 2005 an estimate of 1.100.000 have become orphan due to AIDS.




1
  www.unicef.org/infobycountry/zimbabwe
2
  UNAIDS (2004), UN Secretary-General’s Task Force on women, Girls and AIDS in Southern Africa:
Facing the future together.
3
  www.UNAIDS.org/en/Regions_Countries/Countries/zimbabwe.asp
4
  http://en.wikipedia.org/wiki/Demographics_of_Zimbabwe
5
  www.unaids.org/en/Regions_Countries/zimbabwe.asp
6
  www.who.int/hiv/HIVCP_ZWE.pdf


                                                                                                  5
Survey on HIV/ AIDS in Zimbabwe                                                       September 2007



    •   Trends over time:

    Data (dec. 2005) from the national surveillance system show a decline in HIV prevalence
    among pregnant women from 26% in 2002 to 21% in 2004. Changes in sexual behaviour
    appear to have contributed to the decline. However, infection rates in Zimbabwe continue to
    be among the highest in the world7.

    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. The adult prevalence in 2005 was
    20.1% according to Government figures.8

Five countries will experience negative population growth by 2010. By 2010, Botswana,
Mozambique, Lesotho, Swaziland and South Africa will have negative population growth,
meaning that more people will be dying than babies will be born. In addition, Zimbabwe and
Namibia will experience a population growth rate of close to zero.

Infant mortality rates in some countries are higher than 1990. AIDS mortality has reversed
the declines that had been occurring during the 1980s and early 1990s. For example, in
Swaziland and Zimbabwe, AIDS has nearly doubled the infant mortality rate, compared to what it
would have been without AIDS.

More infants will die from AIDS in four countries in 2010 than all other causes. In Botswana,
Zimbabwe, South Africa and Namibia, more infants will die of AIDS than from all other causes.
Although overall infant mortality rates are projected to decline between 2000 and 2010, infant
mortality due to AIDS is projected to be higher than it would have been it were not for AIDS9.

2 National Policies
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 is a
coordinating body under the Ministry of Health and Child Welfare (MoHCW). NAC 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 paid into a National AIDS Trust Fund (NATF).10

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

7
  www.who.int/hiv/HIVCP_ZWE.pdf
8
  Ministry of Health and Child Welfare,Zimbabwe (2005), Zimbabwe National estimates
9
  www.usaid.gov/press/releases/2002/pr020708.html
10
   annex 1


                                                                                               6
Survey on HIV/ AIDS in Zimbabwe                                                       September 2007

dealing with other issues have led to a situation where the government is unable to adequately
address the crisis11.

The development of the Zimbabwe National HIV and AIDS Strategic Plan (ZNASP) covering the
period 2006-2010 involved the participation of stakeholders at different stages of the consultative
process, following recommendations made at the first national HIV and AIDS Conference in June
2004 that the old strategic framework be reviewed and a new framework be
developed.
The first stage was the review of:
* National HIV/AIDS Strategic Framework (2000-2004).
* Current policies and strategies, including the National HIV/AIDS Policy (1999).
* Behaviour change situation analysis and response analysis.
* HIV and AIDS epidemiology in Zimbabwe.


ZNASP 2006 - 2010


The overall goal of the Zimbabwe National Aids Strategic Plan 2006-2010 (ZNASP) (see attached
file above) is to reduce the spread of HIV, improve the quality of life of those infected and
affected, and mitigate the socio-economic impact of the epidemic in Zimbabwe.

In order to achieve this goal, the following four main strategies have been agreed upon:
    1. HIV prevention to reduce number of new infections, with a focus on behavioural change
         promotion;
    2. Increased access and utilization of treatment and care services;
    3. Improved support for individuals, families and communities, including orphans and other
         vulnerable children infected and affected by HIV and AIDS;
    4. Effective management and coordination of the national HIV and AIDS response
         (including resource mobilization).
In addition, capacity strengthening of national institutions and gender mainstreaming into all
programmes and services have been identified as key cross-cutting themes for the 2006-10
period12.

Gender
This principle provides a framework for integrating gender into the overall HIV and AIDS
response, to ensure all prevention and advocacy strategies and programmes are gender
sensitive in order to reduce vulnerability and risk.
The National Task Force on Women, Girls, HIV and AIDS has already developed a draft strategy
that addresses six key issues, including prevention, equal access to treatment, girl's education,
fighting gender-based violence, women's property and inheritance rights and gender equality in
addressing the burden of care. The ZNASP embraces this work.
Some of the strategies will use a mainstreaming approach, so that girls' education and men's
participation in HBC are fully considered within the education sector and the development and
implementation of HBC strategies and policies respectively. Other areas will require a specific
effort and the mobilization of extra resources, for example the fight against sexual abuse and the
reinforcement of women's property and inheritance rights. The particular relationship between
women's vulnerability to HIV transmission, pregnancy and the well being of newborns will require
continuing research, policy formulation and service development13.

Vulnerable groups


11
   www.avert.org/aids-zimbabwe.htm
12
   Zimbabwe National HIV and AIDS Strategic Plan 2006 - 2010
13
   Zimbabwe National HIV and AIDS Strategic Plan 2006 - 2010


                                                                                                  7
Survey on HIV/ AIDS in Zimbabwe                                                        September 2007

The framework of 2005 highlighted the needs of specific groups at high risk, such as young
people, sex workers, and prisoners. Recent reviews have further stressed the particular
vulnerability of married women, orphans, the disabled and mobile populations.
Mobile populations in Zimbabwe include sex workers, cross-border traders, uniformed personnel
(soldiers, police, game rangers, the militia, customs and immigration officials), truck drivers, the
internally displaced and the farming community. The vulnerability and risk factors of mobile
populations are caused by long periods of separation from regular partners and social settings,
which may result in casual and commercial sex and/or irregular access to HIV prevention and
care services. Other groups that have been identified as particularly vulnerable to infection
include the disabled (including the mentally challenged), prisoners, illegal immigrants, men who
have sex with men (MSM), and survivors of rape and sexual abuse.
The ZNASP seeks to develop innovative strategies for these groups at high risk, focusing on their
empowerment and inclusion in decision-making, the allocation of resources for programmes that
address their specific needs, and community strategies, especially with regards to orphan
support, ensuring the rights of married women, and prevention of transmission in marriage
settings. The life skills education and HIV prevention and care components of the National Plan of
Action for OVC will be strengthened.
Mobile populations will be reached through intensified programming in specific geographic areas,
further mainstreaming of HIV in sectors such as mining, transport, construction, agriculture,
uniformed services, informal cross-border trade and sex work. In addition, research will be carried
out and specific strategies will be developed for other groups at risk, which are not yet benefiting
from any strategy or programme14.

Orphans and other vulnerable children

The rights of children in Zimbabwe are defined in the UN Convention on the Rights of the Child
and the African Charter on the Rights and Welfare of the Child, both of which Zimbabwe is a
signatory, and more specifically in the Children's Protection and Adoption Act [Chap. 5:06], the
Education Act [Chap. 25:04] the Guardianship of Minors Act [Chap. 5:08], among other statutes.
In Zimbabwe persons under the age of 18 are minors according to the Legal Age of Majority Act
[Chapter 8:07]. World Health Organisation (WHO) defines those between the ages of 15 and 24
years as young people. The provisions of these national and international instruments apply to all
children including those living with and affected by HIV/AIDS.

The rights of children and young people will be upheld in regard to protection from HIV infection.
If children have HIV/AIDS, these rights must extend to freedom from discrimination in all spheres
of life and the right to full access to health care, education and welfare support. Children of both
sexes must be brought up in ways that develop responsible behaviour and a sense of
responsibility towards themselves and others. Children-and young people should have access to
knowledge and life skills needed to avoid HIV infection.

In response to the crisis of 1.1 million orphans per 2005, the Government of Zimbabwe has
endorsed the urgent need for coordinated, expanded interventions to strengthen existing work
being undertaken by government ministries, nongovernmental organisations (NGOs), community-
based organisations (CBOs), faith-based organisations (FBOs) and United Nations (UN)
agencies. With support from the Social
Services Action Committee of the Cabinet (SSACC), a national stakeholders' conference
was held in Harare in June 2003 to widen the consultative process and secure broad-based
support for a National Plan of Action (NPA) for Orphans and other Vulnerable Children (OVC)
(See attached file below).




14
     Zimbabwe National HIV and AIDS Strategic Plan 2006 - 2010


                                                                                                  8
Survey on HIV/ AIDS in Zimbabwe                                                        September 2007



  NPA for OVC -
  Zimbabwe.pdf
The vision and goal for 2005 used the following objectives:
• Strengthen the existing coordination structures for OVC programmes and increase
resource mobilisation by December 2005;
• Increase child participation where appropriate in all issues that concern them from
community to national level, considering their evolving capacities;
• Increase the percentage of children with birth certificates by at least 25% by
December 2005;
• Increase new school enrolment of OVC by at least 25% by December 2005, while
ensuring retention of OVC in primary and secondary schools;
• Increase access to food, health services, and water and sanitation for all OVC by
December 2005;
• Increase education on nutrition, health, and hygiene for all OVC by December 2005;
and
• Reduce the number of children who live outside of a family environment by at least
25% by December 2005 (this includes children living without adult guidance, children
living on the streets, and children in institutions).

Since 2005 no further information was available on particular policies on OVC.

 Over the years health professionals have observed an increasing number of young people below
the age of consent (16 years) who are seeking advice on and/or care for Sexually Transmitted
Infections (STIs).

According to research that has been conducted in Zimbabwe a number of young people are
sexually active before the age of 16 years. This therefore means that these young people are
vulnerable to HIV infection. Their visit to a health facility for advice and/or care should present a
special opportunity to health professionals to provide them with education, information and
counselling about HIV/AIDS/STIs, and the advantage of behaviour change ("secondary virginity")
and deferment of further sexual adventurism.

Because of the serious risks of pregnancy, and HIV/STI, that these sexually active young people
face, health workers should counsel them appropriately and use their professional judgement to
advise them on available means for the prevention of HIV/STI depending on each client's specific
circumstances, with special emphasis on abstinence and preparation for a life time commitment
to mutually faithful partnership.

        Guiding principle 29: Children and young people below the age of 16 years who have
        concerns about and/or have an STI have the right to appropriate counselling and care
        services and advice on means to prevent HIV/STI. The counselling and professional
        advice given should depend on each young person's circumstances and potential risk of
        HIV/STI.

        Guiding principle 31: Apply the most effective policies and strategies to deal with
        commercial sex work in order to reduce the transmission of HIV and STIs and deal
        appropriately with legislative provisions and revise those which do not comply with
        current community concerns.

Prisoners

Overcrowding in Zimbabwe's prisons is acknowledged as a problem by the Ministry of Justice.
Legal and Parliamentary Affairs. HIV/AIDS levels among prisoners is high. Homosexuality and
sodomy are known too occur in prisons worldwide. Improved surveillance and supervision is not


                                                                                                   9
Survey on HIV/ AIDS in Zimbabwe                                                          September 2007

sufficient to prevent consensual and forced ,sexual activity in crowded prisons. Prisoners have
the right to information about HIV/AIDS. It is in the prisoners' interests and the community into
which prisoners will be released that the risk of HIV/STIs in prisons be reduced.

Guiding principle 33: Prisoners have basic rights that must be respected and protected
including the right to HIV/AIDS/STI information, counselling and care.

                   Strategies
                   1. Ensure that all prisoners and detainees have access to HIV voluntary
                       counselling and testing on admission to custodial remand or imprisonment.
                   2. Give all prisoners access to accurate, clear and relevant information, in the
                       appropriate language, throughout their period of detention and on release to
                       assist them to avoid HIV/STIs.
                   3. Provide appropriate information, education and training on HIV/AIDS/STI
                       prevention, control and care to prison staff.
                   4. Explain clearly the risks of HIV and STI transmission to prisoners and prison
                       staff in relation to all forms of sexual activity. Prisoners should have access
                       to information and advice on ways to prevent HIV and sexually transmitted
                       infections.
                   5. Initiate and promote peer education programmes for the prevention of
                       HIV/STIs in prison.
                   6. Promote the development and implementation of measures to reduce
                       chances of sexual abuse within prison cells.
                   7. Allocate additional resources to the prison services to improve the quality, of
                       prison care.


Prevention

While treatment, care and support will have to significantly expand by 2010, prevention of new
HIV infections will remain the cornerstone of the national HIV response. With infection levels
declining, HIV prevention in Zimbabwe can build on already existing successful programmes.
Behavioural change approaches will be further refined, and C&T and PMTCT services and their
utilization further increased. STI management will be adapted to new realities, and blood safety
maintained.
As compared to the previous framework 2000-2004 and the national response so far, the ZNASP
promotes the re-focusing and intensifying behavioural change (BC) approaches and programmes
in several ways15.
In the ZNASP on page 25 & 26 the government plans on prevention are elaborated.

Sexually Transmitted Infections (STIs)

Sexually Transmitted- Infections (STIs) increase the risk of sexual transmission of HIV
significantly. Effective control of STIs has been shown to decrease the transmission of HIV.
Women are particularly vulnerable to STIs because of biological and socio cultural factors.

STIs on their own are a major cause of illness among young and middle aged adults as
evidenced by the high number of sexually transmitted diseases reported annually throughout the
country.

Complications of STIs can lead to chronic lower abdominal pain and ectopic pregnancy in women
and infertility in both men and women. STI can also be transmitted to the unborn child causing
neonatal infections or death.

15
     Zimbabwe National HIV and AIDS Strategic Plan 2006 - 2010


                                                                                                   10
Survey on HIV/ AIDS in Zimbabwe                                                         September 2007


Guiding Principle 6: Quality STI care services should be made available and accessible at all
levels of the health care delivery system and in the community.

                  Strategies
                  1. Ensure availability of appropriate technical capacity and drugs for effective
                      treatment of STIs in all health facilities.
                  2. Upgrade STI management skills of health personnel at each level including
                      community workers.
                  3. Strengthen integration of STI management skills into training curriculum of
                      health personnel at both undergraduate and postgraduate levels.
                  4. Strengthen contact tracing and treat partners for STIs.
                  5. Address barriers faced by women and young people in seeking treatment for
                      STIs and their complications. These barriers include lack of information,
                      education, stigma and negative cultural norms.
                  6. Improve diagnosis and treatment of STI by developing, implementing and
                      evaluating cost-effective management guidelines on STIs and their
                      complications, backed by research and appropriate training.
                  7. Educate the community and especially young people on STI health seeking
                      behaviour.
                  8. Provide information to everyone attending any level of, the health system for
                      reproductive or sexual health care about STIs and advise them on their
                      prevention.
                  9. Enhance the relationship between health care providers and. patients by
                      undertaking systematic review and research and implementing research
                      results.
                  10. Provide information on STIs and related conditions in a gender sensitive and
                      integrated manner.
                  11. Ensure that every pregnant woman has access to screening for STIs which
                      are vertically transmittable16.

HIV is transmitted through infected blood and blood products to a very high degree of risk. In
Zimbabwe, the risk of HIV transmission through blood transfusion is virtually non-existent as all
blood and blood products are screened for HIV before transfusion.

Guiding Principle 8: Safety of all blood and blood products should be ensured before any
transfusion. Male and-female condoms, when properly and consistently used, highly reduce the
risk of HIV transmission and other sexually transmitted infections.

Guiding Principle 9: To limit HIV transmission through sexual intercourse, condoms should be
made available, accessible and affordable to all sexually active individuals17.


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



16
     www.youth-policy.com/Policies/Zimbabwe_National_Policy_on_HIV_AIDS.cfm
17
     www.youth-policy.com/Policies/Zimbabwe_National_Policy_on_HIV_AIDS.cfm


                                                                                                   11
Survey on HIV/ AIDS in Zimbabwe                                                            September 2007

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 people18.

Use of condoms:

Condom distribution, marketing and consumption have steadily expanded since the 1990s, and
are the highest in the region, adjusted to size of the population. More than 85 million male
condoms were freely distributed and/or sold in 2004, 37 million within the public sector, and 48
million in the social marketing sector. Furthermore, 353 600 female condoms were distributed
(ZNFPC 2004) and 750,000 female condoms were sold (PSI 2004) in various outlets such as
liquor stores, hair salons, supermarkets and service stations19.

Attention for harm reduction:

     Look at strategies above.

Multi-sectoral approaches

Since the development of the first strategic framework there has been an increased recognition of
the importance of a multi-sectoral response to HIV and AIDS. However, some sectors in
Zimbabwe have yet to become fully engaged. As mentioned a number of sectoral strategies and
policies have been developed while other strategy developments are still underway. Several
existing sector policies have remained incomplete and do not address the increasing need for
care, support, impact preparedness and mitigation.
This ZNASP will further guide strategic development in the various sectors and assist them to
address any deficiencies and encourage the implementation of the policies and the elaboration of
specific programmes.
In addition, this strategic plan specifically recognises the important role NGOs, FBOs, the private
sector and PLWHA should play in the national response to the HIV and AIDS epidemic in the next
five years20.

While initially conceived as a coordinating body, NAC has also played a role in implementing
AIDS interventions. NAC funds the purchase of ARV drugs, supports the Zimbabwe National
Family Planning Council’s HIV/AIDS activities, Ministry of Health and Child Welfare, as well as
directly funding program proposals submitted by NGOs, as well as the education sector (e.g.,
through the Basic Education Assistance Module (BEAM) for the payment of school fees), army,
prison services and churches, and directly distributing food, blankets, home-based care kits, as
well as conducting Information Education Communication (IEC) programs.

Sexual and Reproductive Health

Culturally, female ignorance of sexual matters is considered a sign of purity and, conversely,
knowledge of sexual matters and reproductive system is viewed negatively.

The equating of ignorance with innocence may inhibit some women from seeking information that
is critical to their well-being. The lack of vital information among women and girls limits their ability
to adopt risk-reducing behaviour and identify early abnormal symptoms that could signify a
sexually transmitted infection. The risks associated with sexuality in the cultural context should be
reviewed.


18
   www.avert.org/aids-zimbabwe
19
   Zimbabwe National HIV and AIDS Strategic Plan 2006 - 2010
20
   Zimbabwe National HIV and AIDS Strategic Plan 2006 - 2010


                                                                                                      12
Survey on HIV/ AIDS in Zimbabwe                                                       September 2007

Guiding Principle 36: Men and women need to understand and respect their own and each
others’ sexuality.

                Strategies
                1. Promote wide debate on the sexual rights of women and men.
                2. Educate women, men, girls and boys about male and female sexuality,
                    HIV/AIDS and other sexually transmitted infections and the consequences of
                    high-risk behaviour.
                3. Educate individuals to refrain from high-risk behaviour such as multiple
                    partners, unprotected sex, alcohol and drug abuse.
                4. Provide opportunities to women and men for individual counselling and group
                    interactions to enable them to discuss openly sexual issues and the benefits
                    of either adopting or negotiating risk-reduction options and thus share
                    personal experiences.
                5. Educate women and men about the risks related to certain practices that
                    may facilitate transmission of HIV, e.g., the adverse physical effects of herbs
                    and chemicals which some women insert in the genital area.

Guiding principle 37: All HIV/AIDS/STI programmes should be gender sensitive and include
gender-related issues.

                   Strategies
                1. Review objectives and content of all HIV/AIDS/STI programmes to ensure
                   that they address the gender perspective.
                2. Improve the information and education of men and women about
                   HIV/AIDS/STI. Better understanding of the risk of HIV/STI is the critical first
                   step towards behaviour change.
                3. Provide explicit information and guidelines regarding men and regarding
                   women living with HIV/AIDS because society accords each gender a different
                   status.

Linkages with family planning:

HIV can be transmitted from mother to her child during pregnancy, delivery and through breast
milk. The risk of HIV transmission from mother to child is significant. Many children with HIV
related illness develop AIDS early in life and die before they reach the age of five years. Child
bearing is a very important event-for-every Zimbabwean-yet the desire of the couple with HIV
infection to have children needs to be balanced with the possibility of having an HIV infected baby
who has a high risk of dying within the first five years of life.

Guiding Principle 10: Individuals and couples considering marriage or bearing children should
have access to accurate information about HIV infection and pregnancy and Voluntary
Counselling and Testing.

                Strategies
                1. Encourage women and couples considering pregnancy to seek voluntary
                    testing and counselling for HIV.
                2. Increase the availability, accessibility and acceptability of voluntary
                    counselling and testing services throughout the country.
                3. Give information and offer counselling to HIV-positive women and their
                    partners in order to enable them to make informed decisions about planning
                    pregnancy.
                4. Increase the general public's access to information, education and
                    communication about options for HIV-positive women to reduce the risk of
                    mother to child transmission of HIV.



                                                                                                13
Survey on HIV/ AIDS in Zimbabwe                                                       September 2007

                  5. Adopt interventions to reduce the risk of mother-to-child transmission of HIV
                     based on results of research considering acceptability, affordability and
                     sustainability of such initiatives.
                  6. Emphasise the importance of primary prevention of HIV transmission among
                     all young people through appropriate behaviour change.
                  7. Ensure full information is available to all couples contemplating pregnancy.


Breastfeeding

Over the years breastfeeding has been encouraged to improve child survival. Breastfeeding is
universally affordable, uniquely nutritious, offers protection, from most serious infant infections,
ensures bonding between mother and baby and acts as contraception. Breastfeeding remains a
key preventive measure against infant morbidity and mortality. HIV can be transmitted to the baby
through breastfeeding.        HIV positive women need to make informed decisions about
breastfeeding. Such decisions should be based on correct information. A decision not to
breastfeed may raise questions in the family. Women making this decision will need considerable
support from their families and health professionals. In addition, if they cannot safely replace
breastfeeding, they will increase the risk of infant and childhood illnesses and mortality. Latest
statistics indicate that exclusive breastfeeding for the first 3 months by HIV positive mothers does
not increase the risk of vertical transmission. The need to protect breastfeeding must be
paramount in any advice given to the mother.


Guiding Principle 1l: Breastfeeding should continue to be encouraged unless. there are viable
options to ensure appropriate in Lint and child feeding for women who know they are HIV
positive.

                  Strategies
                  1. Encourage all breastfeeding women, whether HIV positive or not, to use
                      barrier protection methods to, prevent early conception and HIV infection, or
                      reinfection.
                  2. Provide appropriate information and counselling to enable an HIV infected
                      woman to make an informed decision about breastfeeding.
                  3. Support women with HIV infection who choose not to breast-feed with
                      information on appropriate, safe and affordable alternatives.
                  4. Provide the family and the community with education and information in order
                      to reduce stigma which may be faced by women who decide not to
                      breastfeed because of their HIV status.
                  5. Incorporate accurate information on HIV transmission into breastfeeding
                      guidelines. These guidelines should be standardised, updated and made
                      widely available.
                  6. Make breastfeeding and adequate nutrition for mother and child the subject
                      of intervention or action research.

Attention for the effects of HIV-AIDS

Besides the ZNASP the Zimbabwean government developed a National Behaviour Change
Strategy (for the complete document see below)



National Behavioural
 Change Strategy




                                                                                                 14
Survey on HIV/ AIDS in Zimbabwe                                                     September 2007

This Behavioural Change Strategy therefore provides guidance to all stakeholders on
their contributions to behavioural change promotion over the period from 2006 to
2010. It spells out key expected outputs and areas of focus necessary for achieving
results. It strengthens successful elements of the past response like promotion of
condom use, but also focuses on new key aspects. Epidemiological evidence shows that
reducing multiple partnering through promotion of faithfulness in marriage and
other stable relationships has to be in the centre of behavioural change promotion.
Underlying root causes of risk behaviours like imbalanced gender relations and
stigma associated with HIV will be addressed. Decentralized behavioural change
planning and involvement of leadership at district and community levels are core elements of the
Strategy.


3. HIV/AIDS and government policies
Poverty Reduction Strategy Papers (PRSP):
Zimbabwe has not yet developed a PRSP but has the following policy frameworks that will serve
as building blocks for a PRSP:
    • Millennium Economic Recovery Plan: which sets the platform for Government initiatives
         in macroeconomic stabilisation, economic reform and social development;
    • Land Reform Policy that seek to address land ownership imbalances and equity.
    • Indigenization Policy that seeks to economically empower the majority of Zimbabweans.
    • Other policies such as Gender Policy, Orphan Care Policy, Population Policy, etc. that
         seek to promote equitable access, improved service delivery, protect the rights of
         disadvantaged groups.
    • A NSPS and an Employment Policy have reached advanced stages of development

Zimbabwe has realised the gravity of the HIV/AIDS pandemic, esp. its effect on human capital. As
a result it has put in place a unique and sustainable funding mechanism through taxation which
raises Z$1 billion a year.
•Arrangement administered by NAC at the national level. Implementation at local level is through
multisectoral District Action AIDS Committees.
•Emphasise of assistance is in the area of prevention, community approaches to care and
mitigation

Over the last decade Zimbabwe experienced macroeconomic instability despite implementation
of economic reforms. This has resulted in increased poverty levels.
The country, therefore, has decided to address the issue of poverty through the political economy
approach while appreciating the need for macroeconomic stability in the long run.

In this context the following programmes, which are in sync with the MDGs are being
implemented:
•Land Reform and Redistribution Programme: Aims at increasing asset creation and ownership
by the poor as well as enhancing gender equity.
•Indigenisation of the economy through access to investment resources and wider participation of
the majority in the mainstream of economy.
•Improved health delivery services esp. focusing on preventive
rather than curative thus safeguarding the human capital base of the
country21.




21
 http://info.worldbank.org/etools/docs/library/77905/HQWorkshop/smafrica/hq/pdfppt/cppt/zimba
bwe.pdf


                                                                                              15
Survey on HIV/ AIDS in Zimbabwe                                                           September 2007

Social/ welfare policies

The public assistance scheme under the government’s Social Welfare Assistance Act is
specifically designed to provide assistance to:

-    Persons over sixty years of age;
-    Persons who are handicapped physically or mentally; or
-    Persons who suffer continuous ill health;
-    Dependants of a person who is destitute or otherwise incapable of looking after himself; or
-    Otherwise has need of social welfare assistance.

In determining whether a person qualifies for public assistance, the Director of Social Welfare, or
social welfare officers consider the degree of financial hardship of the applicant, the availability to
the applicant and his dependents of any assistance financial or otherwise from any source and
the state of health, educational level and the level of skills for purposes of the employment
prospects of the person applying for financial assistance. Those receiving assistance may be
given a letter from the department of social welfare that exempts them from paying for health care
and treatment22.

In September 1998, the Minister of Public Service Labour and Social Welfare enacted Statutory
Instrument 202 of 1998, the Labour Relations (HIV and AIDS) Regulations. The regulations were
introduced under the Labour Relations Act [Chapter 28:01]. They are also based on the
provisions of the Constitution of Zimbabwe. As they are under the Labour Relations Act they
currently cover only workers in the private sector and parastatals, but give an indication of the
intention of the tripartite parties on what should apply across all sectors of employment.

The regulations are a product of the Intersectoral Committee on AIDS and Employment, chaired
by the Ministry of Public Service, Labour and Social Welfare, and involving the Employers'
Confederation of Zimbabwe, the Zimbabwe AIDS Co-ordination Programme and non-government
organisations with expertise on HIV/AIDS. The drafting of the regulations involved three years of
consultations and review of draft legal provisions by over 300 organisational representatives
nationally. The legal provisions were adopted by the National Tripartite committee.

The regulations aim to ensure non-discrimination between individuals with HIV infection and
those without; and between HIV/AIDS and other comparable life-threatening medical conditions.

In relation to employment, they establish that HIV-infection is an infection with a virus that by itself
does not affect an employee's ability to perform the functions for which he/she will be or has been
assigned in employment.



4 National structures
National AIDS Council (NAC) has also set up Provincial, District, Ward and Village AIDS Action
Committees, which coordinate the HIV/AIDS response through local government structures.
These participatory structures involve communities in identifying people infected and affected by
HIV/AIDS, including orphans to enable them to access resources from NAC. Provincial governors
and traditional leaders are involved in these structures. Within the government all ministries are
included in the committees, including the Ministry of Health and Child Welfare, the Ministry of
Education, Sports and Culture, the Ministry of Higher and Tertiary Education, Ministry of Youth,
Gender and Employment Creation, Ministry of Local Government and National Housing as well


22
     http://www.hrw.org/reports/2006/zimbabwe


                                                                                                     16
Survey on HIV/ AIDS in Zimbabwe                                                          September 2007

as the Ministry of Public Service, Labour and Social Welfare (MPSLSW). NGOs and faith based
organizations are involved at all levels of the NAC23.

Several websites describe the different actors who play a role in Zimbabwe, concerning HIV. For
more details go to: http://www.unaids.org.zw/zim_resourcelinks.php or
http://www.plusnews.org/profiletreatment.aspx?Country=ZW&Region=SAF# .

5 Law and legislation
The law establishes rights and responsibilities of both employers and employees with regards to
the prevention and management of HIV/AIDS and its employment consequences It is hereby
notified that the Minister of Public Service, Labour and Social Welfare, in terms of, section 17 of
the Labour Relations Act [Chapter 28:01], has made the following regulations:-

1.        These regulations may be cited as the Labour Relations (HIV and AIDS) Regulations,
          1998.

Interpretation
2.       In, these regulations:
         AIDS means acquired human immuno-deficiency syndrome and includes the AIDS-
         related complex;
         HIV means human immuno-deficiency virus;
         Testing, in relation to HIV, includes:
                   (a) any direct analysis of the blood or other body fluid of a person to determine
                   the presence of HIV or antibodies to HIV; or
                   (b) any direct method, other than. the testing of blood or other body fluid, through
                   which an inference is made, as to thee presence of HIV
         Related communicable disease means any communicable disease whose transmission
         may be linked with HIV due to its transmission through body fluids or, whose risk of
         clinical disease may be increased due to the presence of HIV;
         Medical practitioner means a person registered as a medical practitioner in terms of the
         Medical, Dental and Allied. Professions Act [Chapter 27:08]

Education of employees on HIV and: AIDS

3.        (1) Every employer shall cause to be provided for the benefit of every person employed
          by him, and at such place and time during normal working hours as he may appoint,
          education and information relating to:
                  (a) the promotion of safe sex and risk-reducing measures in relation to sexually
                  transmitted diseases; and
                  (b) the acquiring and transmission of HIV; and
                  (c) the prevention of the spread of HIV and AIDS; and (d) . counselling facilities
                  for HIV and AIDS patients.

          (2) Education and information shall be provided in terms of subsection (1) by persons
          who have proven sound knowledge and expertise in matters relating to HIV and AIDS,
          and who are able to communicate information with consistency and accuracy.

          (3) The design of the education programmes shall be in accordance with guidelines
          approved by the relevant employer and employee organisations, in consultation with the
          Ministry of Health and Child Welfare and any other organisation with expertise in HIV and
          AIDS-related matters.

23
     http://www.hrw.org/reports/2006/zimbabwe


                                                                                                    17
Survey on HIV/ AIDS in Zimbabwe                                                        September 2007


         (4)      The provision of the education referred to in subsection (1) shall be at such
         intervals as the relevant employer and employee organisations may agree.

Medical testing on recruitment

     4. (1)       No employer shall require, whether directly or indirectly, any person to undergo
     any form of testing for HIV as a precondition to the offer of employment.

         (2)     Subsection (1) shall not prevent the medical testing of persons for fitness for
         work as a precondition to the offer of employment.


Testing of employees for HIV and confidentiality
5.      (1)     It shall not be compulsory for any employee to undergo, directly, any testing for
        HIV.
        (2)     No employer shall require any employee, and it shall not be compulsory for any
        employee, to disclose, in respect of any matter whatsoever in connection with his
        employment, his HIV status.
        (3)     No person shall, except with the written consent of the employee to whom the
        information relates, disclose any information relating to the HIV status of any employee
        acquired by that person in the course of his duties unless the information is required to be
        disclosed in terms of any other law.


Job status and training

6.       (1)    No employer shall terminate the employment of an employee on the grounds of
         that employee's HIV status alone.
         (2)    No employee shall be prejudiced in relation to:
                (a) promotion; or
                (b) transfer; or
                (c) subject to any other law to the contrary, any training or other employee
                    development programme; or
                (d) status; or
                (e) in any other way be discriminated against on the grounds of his HIV status
                    alone.


Eligibility for employee benefits

7.       (1)      Subject to any other law to the contrary, the HIV status of an employee shall not
         affect his eligibility for any occupational or other benefit schemes provided for employees.
         (2)      Where in terms of any law the eligibility of a person for any occupational or other
         benefit scheme is conditional upon an HIV or AIDS test, the conditions attaching to HIV
         and AIDS shall be the same as those applicable in respect of comparable life-threatening
         illnesses.
         (3)      Where any HIV testing is necessary in terms of subsection (2), the employer
         shall ensure that the employee undergoes appropriate pre- and post-HIV test counselling.
         (4) Where an employee who opts not to undergo an HIV testing for the purposes of
         subsection (2), no inferences concerning the HIV status of the employee may be drawn
         from such exercise by the employee of the option not to undergo the testing.
         (5) Where an employee undergoes an HIV testing for the purposes of subsection (2), the
         employer shall not, unless the occupational of other benefit scheme concerned is



                                                                                                  18
Survey on HIV/ AIDS in Zimbabwe                                                        September 2007

          operated by the employer, be entitled to information concerning the HIV status of the
          employee concerned.


Sick and compassionate leave

8.        Any employee suffering from HIV or AIDS shall be subject to the same conditions relating
          to sick leave as those applicable to any other employee in terms of the Act.
9.        (1) Where a person is employed in an occupation or is required to provide services .
          where there may be a risk of transmitting or acquiring HIV or AIDS, the employer shall
          provide appropriate training, together with clear and accurate information and guidelines
          on minimising the hazards of the spread of HIV or AIDS and related communicable
          diseases.
          (2)      The working conditions and procedures in relation to occupations referred to in
          subsection (1) shall be designed to ensure optimal hygienic precautions to prevent the
          spread of HIV or AIDS and related communicable diseases to employees and members
          of the public
          (3)      Personal protective devices shall be issued, free of charge, by the employer to
          persons employed in occupations referred to subsection (1).


Copy of regulations for each employee

10.       An employer shall provide every employee with a copy of these regulations.


Offences and Penalty

11.     Any person who contravenes any provision of these regulations shall be guilty of an
offence and liable to a fine not exceeding five thousand dollars or to imprisonment for a period not
exceeding six months or to both such fine and such imprisonment24.

6 Financial issues
In February, NAC disbursed more than Z$210 billion (US$2,100,000) to the country’s more than
90 district AIDS action committees and the purchase of ART (NAC reportedly spends
US$250,000 every month on ARVs (US$3,000,000 or Z$300 billion annually)25.

7 Local Situation
Thousands of PLWHA are unable to access HIV/AIDS-related treatment and care services
because they cannot afford the high costs of user fees for health services. The government has
established a system of exemptions or waivers for health user fees to assist in equitable access
to health care for the poor and vulnerable. However, lack of information on the criteria and
availability of the exemptions, combined with a failure to have an enforceable and standardized
assessment process by which all social welfare officers administer the exemptions, leads to their
subjective and ultimately arbitrary application. The result is unnecessary obstacles for vulnerable
and poor PLWHA who urgently need access to healthcare, leaving them at risk of fatal
deterioration in their health.


24
     http://www.youth-policy.com/Policies/Zimbabwe_National_Policy_on_HIV_AIDS.cfm
25
     http://www.hrw.org/reports/2006/zimbabwe0706/2.htm


                                                                                                 19
Survey on HIV/ AIDS in Zimbabwe                                                        September 2007

A lack of public information on antiretroviral therapy (ART) policies also restricts access to
treatment for thousands of people in desperate need of life-saving antiretroviral drugs. Failure to
provide sufficient information to public sector physicians, AIDS service organizations and
networks of PLWHA on national standards for ART , and specifically on the necessity and role of
CD4 tests (a marker of immune system function) in the eligibility criteria for ART, has led to
thousands of people being turned away unnecessarily from access to ART26.

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.27

8 Treatment
Many Zimbabweans face significant obstacles in accessing health services even where these are
widely available. In the midst of high unemployment rates and a declining economy, the high cost
of user fees for health services means that the majority of Zimbabweans who can no longer afford
user fees are therefore unable to access treatment. Those living with HIV/AIDS find it even more
difficult to cope with the extremely high costs of AIDS treatments, tests and hospitalizations.

Zimbabwe has long had user fees as a part of its health system. User fees are often promoted by
governments as a means for rationalizing health care use and for increasing resources to the
health sector. Zimbabweans pay a user fee— ranging from 250,000 (US$2.50) for children to
500,000 (US$5) for adults to 7,500,000 (US$75) for pregnant women (per visit) — to get a
consultation at a government run hospital or clinic.133 In addition, they are required to pay for any
treatment they receive as well as any tests that are undertaken at clinics or hospitals. Patients
seeking to go onto the government ART programs are required to pay a monthly fee of
Z$500,000 (US$5).

The government of Zimbabwe has put in place a number of programs that allow poor and
destitute Zimbabweans to access free services including medical care and education for their
children. The Department of Social Services under the Ministry of Public Service, Labor and
Social Welfare is responsible for running these programs.28

iii Availability of services:

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 represents the main opposition to President Mugabe. Mugabe himself labelled it an
‘urban beautification’ programme.



26
   http://www.hrw.org/reports/2006/zimbabwe0706/2.htm (“No bright future: Government failures
human rights, Abuses and Squandered Progress in Fight against AIDS in Zimbawe” publication)
27
   UNAIDS (November 2005), Evidence for HIV decline in Zimbabwe: A comprehensive review of
the epidemiological data.
28
   http://www.hrw.org/reports/zimbabwe


                                                                                                  20
Survey on HIV/ AIDS in Zimbabwe                                                   September 2007

By July 2005, it was estimated that Operation Murambatsvina had displaced some 700,000
people including over 79,500 adults living with HIV. 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 services29.




29
     http://www.avert.org/aids-zimbabwe.htm


                                                                                            21
Survey on HIV/ AIDS in Zimbabwe                                                        September 2007


Conclusion
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.

Nonetheless, there is evidence that Zimbabwe’s HIV prevalence has genuinely fallen and that
changes in sexual behaviour have played a role in achieving this. 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 relatives30.

‘Operation Murambatsvina’, has made it very difficult to give appropriate care to people living with
HIV-AIDS.




30
     http://www.avert.org/aids-zimbabwe.htm


                                                                                                 22
Survey on HIV/ AIDS in Zimbabwe                                                                                            September 2007

Annex 1 Organogram

                                                         Ministry of Health and Child Welfare


                                                          AIDS Levy                      National Aids Council                  UNDP
                                                                                                 NAC


                                                                                   Provincial Aids Action Committee
                                                                                                PAAC


                                   District Aids Action Committee             DAAC (2)                              DAAC (3)           DAAC (4, etc...)
                                              DAAC (1)


  Home-based care   Youth groups      Hospital / health trainers Mitigation programmes          Food distribution




                                                                                                                                  23

								
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