Efforts By Government Part 2

As a continuation from last weeks post, I will explain further about ISP and its intervention on Sexual and Reproductive Health and HIV Prevention. The ISP programme will be implemented along four pillars.


Today I highlight and explain the pillars in greater detail.

• .         Pillar 1 

Focuses on the delivery of innovative social marketing of integrated sexual and reproductive health, HIV and gender based violence services through standalone private sector or NGO run family planning and HIV sites.  The PopulationServices International together with funding from Britain will support the Ministry of Health to implement this pillar.

• .         Pillar 2 

Addresses the public sector integration of family planning, gender based violence, HIV and cervical cancer services. The focus is on expanding demand for these services through community based social and behaviour change promotion and strengthening of the public sector service delivery. The pillar is jointly funded by Governments of Britain, Sweden and Ireland with the funding channeled through UNFPA to support to the Ministry of Health and Child Welfare and the Ministry of Women Affairs to implement this pillar.

• .         Pillar 3 

Involves the procurement and nationwide distribution of family planning and HIV commodities to health facilities. This is being implemented by Crown Agents with co-funding from Britain and USAID.

• .         Pillar 4 

Involves the carrying out of independent impact evaluations and the provision of technical support and guidance in areas of operations research across all pillars. The World Bank Global AIDS Team is implementing this component with financial support from Britain through DFID.

While on the other hand, ISP is expected to achieve the following:

• 300 000 male circumcisions for both adults and newborns.
• Provide over 2, 2 million Couple Years of Protection helping avert
  more than 800,000 unintended pregnancies.
  Reach more than 1 million people with behaviour change
  interventions.
  Deliver HIV testing and counseling to over 400,000 people
  Provide ARV treatment to 1,200 people living with HIV and AIDS,
  including 500 sex workers and their children.
  Provide cervical cancer screening for more than 290,000 women and
  adolescent girls.
• Provide services for 7,000 survivors of sexual assault and rape,
  and reach more than 1 million people with broad based interventions tackling underlying issues of violence against women and girls.
• Contribute towards a reduction in the proportion of 'women who feel their husband is justified in hitting or beating his wife' (a DHS indicator) from 40 percent to 25 percent.
• Support the promotion and distribution of 64 million condoms.

Once these goals have been meet successfully in 2017, then the possibility of an HIV/AIDS free generation is very much possible.

Efforts By Government Part 1`

Last year, the Ministry of Health launched the Integrated Support Programme on Sexual and Reproductive Health and HIV Prevention, more commonly known as the ISP. The four year programme has approximately $95million in committed resources from the Governments of Britain, Ireland and Sweden. 

The programme is aimed at supporting the Ministry of Health and the Ministry of Women affairs in providing integrated services in sexual and reproductive health, HIV prevention and gender based violence prevention and response. At lapse of the programme, there has to be a   reduction of maternal morbidity and mortality, cervical cancer, gender based violence and HIV.

The programme has four priority areas, namely family planning, cervical
cancer, gender based violence and HIV prevention. In most cases, these priority areas are often left out or given little attention during programming and yet they have a negative impact on all our efforts to ensure universal access to sexual and reproductive health and rights. For this reason, ISP had to have principal priorities in it.

It really doesn’t make sense for an HIV positive woman doing exceptionally well in ART to die from cervical cancer. Sexual and reproductive health challenges have remained a very big problem from women and girls which have attracted harmful effects. These negative effects include unsafe abortions increased sexual abuse and new STI and HIV infections. Although these challenges seem undefeatable in isolation, but once they are grouped together, women's health and meeting the MDG target of fighting HIV/AIDS.

Current indicators for the ISP focus areas are so far not encouraging. About 1 900 women in Zimbabwe are diagnosed and 1 300 die of cervical cancer every year while 3 in 10 women have suffered from physical violence at some point since the age of 15. HIV still remains the largest cause of death among men and women of reproductive age and children. close to 211 000 women who want to avoid or postpone childbearing are not using any method of contraception and a reduction of this number by half could avert an estimated 780 000 unintended pregnancies, 110 500 unsafe abortions and 4 200 maternal deaths. 

ISP is a welcome intervention as to seeks to improve the availability and accessibility of family planning to all women particularly whose in the rural areas, girls and women living with HIV. 

Positive talk: A flashback of success

In the history of AIDS, the country has never reached a moment where Zimbabweans are able to stand up bold and say with bravery that the end of AIDS is neigh.

It the country through collective action, resilience and courage has been able to at least try to step up efforts in fighting HIV/AIDS. In spite of the economic downturn that has stretched the AIDS response to its limits, thousands of lives have been saved, as HIV treatment and prevention efforts continue to show results.

Various organisations throughout the country have made new pledges—bold, tangible and realistic. These promises now must be delivered in every city, town, every community and to everyone in need.

But has the country come to a point that AIDS-free generation is possible and that no child should be born with HIV and no mother should die of AIDS.

The gulf between treatment and prevention has finished. Treatment is prevention. After all, they say prevention is better that cure!

The split between health and AIDS has narrowed, as AIDS comes out of separation and into incorporated and holistic health services. It is treated like any other disease that anyone has. As such, the positive AIDS response has surfaced the way for people-oriented health systems were discrimination has been cramped on.

Aluta continue! The fight goes on. Let’s keep the promise!

Zimbabwe posts a decline in AIDS related deaths

The country is somewhat making steady progress in meeting MDG target for the fight against HIV/AIDS. As the country continues to alleviate and create more viable solutions especially for the rural folk where access to ARV drugs is concerned, one has focus on the success stories about the battle. There were a number of concerns that Zimbabwe had been off track and would fail to achieve the MDG that targets for the combat against HIV/AIDS, but thumps up to the country as it seems to be a bit on track.

In a 2013 preliminary report on HIV/AIDS estimates, looks like the 2015 target for access to ARV Therapy (ART) would not be met as anticipated.

A decline in HIV/AIDS related deaths could be attributed to an increase in ART access.

However, the country dipped 64. 7 percent in HIV/AIDS related deaths in the last decade. In 2003, the figures were pegged at 170 000 and dropped to about 60 000 in 2013. The number of deaths among children below 14 years plunged from 36 000 in 2003 to about 10 000 last year.

It is a good thing that HIV/AIDS related deaths have dropped but the fact that there is a difference of 110 000 doesn't make it good enough. We are talking about a gap of 110 000 in a space of ten years. According to the report, the figures went down from 50 230 in 2012 to 49 695 last year which can be translated to a disparity of 535, only. Ironically, while the country is celebrating about the significant decrease in HIV/AIDS related deaths and a drop in infection rate of about 0.13 percent, the HIV prevalence rate increased from about 12 percent in 2012 to 14.5 percent last year.

To wrap it up, I think that the above mentioned figures are a testimony of the fact that Zimbabwe is on track in the fight against HIV/AIDS even though the country trailing backwards in meeting MDG target on HIV/AIDS combat.

Teach Condom Sense

It has become a widespread belief that universities and colleges have become a major source of spreading new HIV infections, negatively affecting the reduction of HIV prevalence and reducing the country’s hopes of completely eliminating AIDS. New HIV infections are various AIDS related opportunistic diseases which both HIV affected and non affected people acquire during sex without using protection.

Last year, the media was awash with stories on how morning after pills had become scarce in Bulawayo - a phenomenon attributed to the rise in demand on the part of female college and university students. In November, over 7 000 sexually transmitted infection (STI)cases were reported in the Midlands Province between July and September of 2013. The article attracted comments such as “What is the Midland State University doing to the country?”

This has partly confirmed how young women seemed to be more scared of falling pregnant than contracting HIV or other sexually transmitted diseases. It was reported the shortage of morning after pills pointed to a pattern of engaging in sexually risky behaviour and more alarmingly to young women who might graduate with flying colours in all sorts of sexually transmitted infections.  

It is unfortunate that when young people go to university and college they would be at zero but when they come out the prevalence rate is high. This means the infection is happening during the university period. There is a need to protect the young from HIV. The reason for a high prevalence rate in tertiary institutions could be caused by the fact that young people “free” from parental supervision. Most learn away from home where there is no one to enforce rules or safety measures.

Pupils and students must be informed about how to use condoms at a tender age.

Well, I feel that  the high prevelance rate in tertiary institutions is an indication of how the country is failing to manage the transition period as this situation transcended to new infections which are meant to be eliminated in wiping out AIDS. But there is need for concerted efforts and vigorous strategies outlined to educate and inform the young with the necessary information and services.

Many young people have a low perception of risk when it comes to HIV and STIs-they seem to think that contracting HIV is something that will happen to “someone else’’ but never to them.

Sex education starts at the basic level. It is a must that people including school going children to know about sex education. But at times it’s bad to talk about something until it becomes like a church song. 

Good bye to Stigmatisation

AIDS has always been a stigmatised disease since its origin due to its connection with sexual promiscuity, causing people to shun talking about it, labelling the epidemic and its sufferers negatively. Do you remember those times when one could not even greet a person with HIV? And during those days, there wasn't a clear line between HIV and AIDS. It just sounded the same to most people. It was believed that once you were tested HIV positive, you automatically had AIDS. Back then, life was hopeless. Being HIV was the most feared thing. Though I stand to be corrected, I feel it was worse than being shot with a gun or dying itself. But with information and medical interventions it has become socially acceptable.

Diseases like AIDS depended on the media to be understood as it had transcended from a mystery to a controllable disease because of research and medical interventions which made it possible to at least control it.

There is no other way to go about it. It works both ways

There were lot of things that stigmatised AIDS considering that there was little knowledge about it. People depended on its characteristics sometimes misconceptions, some called it the slimming disease. People were afraid to talk about it because they knew most cases were transmitted sexually and no one wanted to talk about their sex life.

In the beginning AIDS was a great mystery and people thought it originated from the primates-the animals.It was thought that when they slaughtered the animals they were exposed to the virus through the blood. This is how people thought the virus jumped from animals to human beings and made its way to North America before spreading to all parts of the world. There were medical outcries as specialists said there is something new and is deadly serious.

But, through vigorous health communication it has become possible to control the danger of AIDS and people today could live to old ages.

What about the minors?

An estimated 58 percent of children living with HIV/AIDS do not have access to antiretroviral (ARV) drugs, a situation that is believed to contribute to an upsurge of infant mortality rates in the country.This means that only about 42 percent out of an estimated 100 000 children living with HIV and Aids have access to ARVs while up to 95 percent of adults living with HIV are able to get them.

The infant mortality ratio for children below five years in the country, is pegged at 84 per 1 000 infants. Such figures have made it hard for the country to achieve universal access treatment for minors living with HIV/AIDS. Why are infants still not a priority when it comes to the fight against HIV?

Up to now, early-infant-diagnosis technology machines that are able to detect the virus within six weeks from birth are only available at central hospitals in Bulawayo and Harare health institutions. The rest of the country is compelled to settle for machines that detect the virus within 18 months. How sad! But why is the process of decentralising these machines slow? Early detection allows a child to be put on life saving ARV treatment while a majority of those who do not have access to early diagnosis die before they even reach 18 months.

According to health experts, although HIV positive pregnant mothers could be put on drugs to prevent transmission of the virus to infants at birth through PMTCT, the method is still not 100 percent effective, hence the need for testing after an infant is born. 

The most affected infants are those born in district Hospitals in the rural areas. District hospitals still do not have the new early infant diagnosis technology and rural hospitals are compelled to send blood samples to city hospitals for testing. The situation is partly because when it comes to the distribution of ARVs to minors, it is largely done in cities and towns while remote areas are somewhat overlooked. Such developments lead to a low uptake of ARV drugs for minors living in the outskirts of major cities and towns.

At the end of the day, the country is hindered from accessing universal treatment for children living with HIV/AIDS.The accessibility of ARVs to children must be a priority because infants demand a lot of special care and I believe that the situation is more critical for HIV and Aids orphans and vulnerable children, particularly those from child headed families. Children between the ages of 6 to 12 years are accessing ARVs through private pharmacies. The outcry is that infants from poor families whose parents or guardians are too poor to afford ARVs are left out in the fight.

This situation can be likened to a seed that has fallen on a thorny bush that when it grows, it fails to reach up to the sun as it is chocked to death. If the fight against HIV is not being taken serious at grass root levels, how possible can it be won on a bigger scale?

Efforts from the Zimbabwean front

Zimbabwe is one of the 22 high-priority African countries with children contracting most of the new HIV infections while the country’s AIDS levy has been commended as one of the innovative HIV and AIDS funding method, as the country continues its fight against these diseases.

The other 21 countries are Angola, Botswana, Burundi, Cameroon, Chad, Côte d’Ivoire, Democratic Republic of the Congo, Ethiopia, Ghana, India, Kenya, Lesotho, Malawi, Mozambique, Namibia, Nigeria, South Africa, Swaziland, Uganda, United Republic of Tanzania and Zambia.These African health ministers shared  ideas and experiences on four focus areas related to the implementation of the Global Plan: Financing and political ownership; quality of care; community engagement; and human resources.

The future is in our hands

In 2010, an estimated 390 000 children were born with HIV but with access to complete HIV services, the risk of transmission can be reduced to below five percent.In response to this, UNAIDS and US President’s Emergency Plan for AIDS Relief (PEPFAR), convened partners to develop a global plan to stop new HIV infections among children by 2015 and keep their mothers alive.

The plan focuses on the 22 countries in which 90 percent of new HIV infections in children occur, 21 of which are in sub-Saharan Africa.By building bridges between the movements of AIDS, maternal and child health and women’s movements, it will quicken the pace of this race towards zero.

The Global Plan launched at the 2011 High Level Meeting on AIDS states great strides have been made in reducing HIV infections among women of reproductive age and expanding access to antiretroviral therapy for pregnant women living with HIV.

However, progress is not being scaled up as quickly on meeting the family planning needs of women living with HIV, preventing maternal mortality and making sure all children living with HIV have access to antiretroviral therapy. All of which are key elements in the global plan to achieve zero new HIV infections in children.Close to 15 percent of the funding for HIV prevention goes to the elimination of new HIV an infection among children.

Third-Line ARV drugs... where art thou?

Last year, Government through the Ministry of Health said it would introduce third-line antiretroviral therapy (ART) as response to treatment failures of the first and second lineregimens. HIV/AIDS activists in Zimbabwe overwhelmingly welcomed the move since the third-line ARV drugs would address the problem of drug resistance. But sadly, twelve-months down the line, the introduction of such a brilliant initiative, that gave a ray of hope to drug resistant patients, could have just melted away. 

According to a research by PharmAccess, a Dutch foundation providing HIV treatment services to the private sector in sub-Saharan Africa, has shown that in 11 countries, transmitted drug resistance increased by 38 percent for each year the country scaled-up ARV treatment. But third-line drugs are either unaffordable or unavailable in many developing countries.

THE World Health Organisation (WHO) announced a summary of new recommendations as far as consolidating ARV guidelines. According to the recommendations, all populations globally should come up with national programmes through policy for third-line ART. I feel that if the Ministry of Health, advocated for a national policy on third-line ART, last year just after saying that it wanted to introduce third-line drugs, maybe today Zimbabwe would be singing a whole new different song. 

File graphs of possible projections of thrid-line ARVs.

The change of patient’s regimen due to the emergence of resistance means relying on newer, patented, and thus expensive drugs. The price of a third-line regimen is nearly 15 times more than the most affordable first-line regimen, and over six times more than the most affordable second-line regimen. Third-line ART are prohibitively expensive and without adequent funding, governments cannot effectively introduce them. Patients and treatment providers are once again faced with the prospect of drugs being priced out of reach.

HIV drug resistance can be acquired, in which resistance develops following a patient's poor adherence to treatment, or transmitted, in which a person becomes infected with a drug-resistant strain of the virus. 

Levels of drugs resistance in sub-Saharan Africa are less than five percent, but a few studies in East and Southern Africa have reported increasing levels of transmitted drug resistance. 

Zimbabwe, which introduced ARV therapy in 2004, is reaching an estimated 650 000 with treatment, with an estimated 15 percent in need of the drugs. At the moment, patients that have failed to respond to second-line ART are being referred to research organisations.

To wrap it up, the long awaited introduction of third-line ART, could help solve the increasing number of patients resistant to ARVs.

Let's keep the promise!