HIV/AIDS in Zimbabwe: whose side is the government on?

Graves in Zimbabwe

It’s World AIDS day today, and Zimbabweans can enjoy a rare piece of encouraging news. This year’s AIDS epidemic update report, released by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) [2], claims that there is evidence for the first time that prevention programmes initiated are finally helping to bring down HIV prevalence in some countries, and Zimbabwe is one of the countries mentioned. Specifically, the report says this of Zimbabwe:

Recent data from the national surveillance system show a decline in HIV prevalence among pregnant women from 26% in 2002 to 21% in 2004. Other data indicate that the decline had already started in 2000 (Ministry for Health and Child Welfare Zimbabwe, 2004 and 2005, forthcoming). Findings from local studies reinforce the national evidence. In Harare, HIV prevalence in women attending antenatal or postnatal clinics fell from 35% in 1999 to 21% in 2004. In rural eastern Zimbabwe, declines in HIV prevalence in pregnant women were also reflected in declines among both men and women in the general population (Mundandi et al., 2004). A significant decline in HIV prevalence among pregnant young women (15–24 years)—which fell from 29% to 20% in 2000-2004—suggests that the rate of new HIV infections (incidence) could be slowing, too (p.20).

A decline in HIV prevalence among pregnant women from 26% in 2002 to 21% in 2004 is good news, but the figures have been received with some scepticism. A reporter writing for the Mail and Guardian two days ago [3] wondered how South Africa, the economic powerhouse of Southern Africa could continue to see "an escalating HIV epidemic, while economically crippled Zimbabwe has apparently brought down levels of HIV infection among its people". The article goes on to grimly say:

Prevalence, which measures the ongoing level of HIV infection, is not particularly informative without knowing the incidence, or the rate at which new infections are occurring. A falling prevalence rate may reflect that the number of people dying because of the virus is outnumbering those newly infected with it.

Given the economic and food security difficulties in Zimbabwe, high numbers of deaths could be behind the apparent decline in HIV infections.

The Women and AIDS Support Network (WASN) [4] is one Zimbabwean NGO that has taken a gender based approach to their fight against the HIV/AIDS epidemic (57 percent of infections and deaths in Zimbabwe are women [5]). Their efforts have included a campaign to get Nevirapine, an antiretroviral drug that helps to reduce parent-to-child-transmission of HIV by about 50 percent, into every health center in Zimbabwe. Their website explains that “out of 600 000 Zimbabwean women who give birth annually, 200 000 are HIV positive and 30 percent of them transmit the virus to their babies. This means that about 60 000 babies are infected at birth”. A fifty percent reduction in transmission would save 30 000 infant lives each year. But only a couple of weeks ago, the director of WASN and other activists and advocacy specialists were criticising the government for its apparent failure to take the distribution of life-saving antiretroviral drugs seriously [6]. A report in The Standard [7] pointed out that the Global Fund scheme [8] should by now have ensured that 270 000 Zimbabweans were accessing antiretrovirals. The government's own figures claim that up to 700 000 people are in urgent need of antiretrovirals. However, to date, only 12 000 Zimbabweans are receiving the drugs.

The deputy minister of health's response (in the same article in The Standard) again raises the question of how an economically crippled Zimbabwe could apparently bring down levels of HIV infection among its people. He blamed the government's failure to meet drug targets on a "lack of foreign currency":

"Our economy is not operating at 100 percent capacity and that means some areas will be affected like fuel supply and the provision of drugs. There is no doubt that there is need to increase the number of people on ARVs but with insufficient funding, that will always present challenges. "

Local companies manufacturing generic antiretrovirals face the same challenges that other Zimbabwean businesses do and are struggling to meet the demand due to critical shortages in foreign exchange [9]. A recent report pointed out that the cost of locally manufactured (generic) life-prolonging anti-retroviral drugs (ARVs) had shot up by more than 100 percent with manufacturers saying the increase was necessitated by the shortage of foreign currency to import raw materials.

The shortages of antiretrovirals is so severe that the Network for HIV-positive Women in Zimbabwe is advising people "not to start taking ARVs because there is a risk of drug resistance if they take the drugs and later stop because the drugs are no longer available [10]." The spokesperson for the organisation, Angeline Chiwatani, said that "ARV treatment is supposed to be uninterrupted for life". Health Minister David Parirenyatwa solution to the problem appears to be to look outside the country. Yesterday he said, “I am hoping that come next year, with the global fund money coming through, we should have more people on treatment [5]”.

It is a simple fact that the HIV/AIDS epidemic in Zimbabwe is a national disaster that affects all of us without exception. Today we cautiously celebrate the apparent gains made in the fight against HIV/AIDS, and full credit goes to the hardworking Zimbabweans whose efforts have achieved this. Their achievement is especially noteworthy given the Zimbabwean context today. But in the face of Zimbabwe's overwhelming economic, social and political challenges that show no sign of abating, can we hope to still be celebrating this time next year?

Some of our government's policies do very little to support those in the frontline in the fight against HIV/AIDS, and there seems to be little political will to face hard truths and to take a more responsible role in the fight against the disease. For example, we know that nutrition is key to building immunity and helping people to fight off infections. The HIV virus targets immune systems, and yet access to simple nutritious affordable food continues to be a major crisis in our country [11]. Incredibly, the zanu-pf government even decided to withhold the distribution of food aid to struggling communities until after the senate elections had taken place [12]. Robert Mugabe went even further [13] by using food, again, as a campaign gimmick in worst affected areas.

It is also true that poverty and HIV/AIDS have a grim co-dependent relationship. There is no question that economic mismanagement and failed government policies have contributed to immense hardship for ordinary Zimbabweans. But, in actions that can only be described as criminal, the government also compounded the error of their ways by deliberately depriving people of their homes and means to survive - Operation Murambatsvina [14].

Unemployment in Zimbabwe exceeds 70% leaving the majority of people to scratch out a meagre income through informal means. These people were the target of the government's crackdown on 'illegal traders' during Operation Murambatsvina, people that Police Commissioner Augustine Chihuri described as a "crawling mass of maggots bent on destroying the economy [15]". In actual fact, the 'mass of maggots' included people like 23 year old Shamiso Makamba, the mother of three children under the age of 5, who lost both her home and her livelihood under the government's onslaught:

"Our lives have been destroyed. I was living in the Joburg Lines [in Mbare] with my younger brothers and sister while I made a living selling vegetables at the bus terminus. Now that they have destroyed our houses and prohibited us from selling our wares from Mbare Musika, we do not know what to do next" she said (from Genocide Watch) [16].

And what does a 23 year old mother of three small hungry children do to survive in a country dogged by unemployment and hyperinflation? The truth is, her options are limited. Madeleine Bunting, writing for The Guardian [17] two days ago, commented:

In a country with high levels of poverty [...] the deal offered by a truck driver or street vendor with some Mozambican meticals in his pocket can represent the best survival strategy for a woman. This is a disease that is feeding off desperate poverty. If you're worried about where your child's next meal is coming from, or how you are going to avoid being thrown out of your shack for not paying rent, longer-term risks such as dying of Aids carry little weight.

And there are regular reports coming out of Zimbabwe on how women are turning to prostitution to survive. Like this one [18], for example, which comments that in Beitbridge, business and sex go hand in hand: "As the shortage of basic commodities worsens, women are forced to engage in sex for preferential treatment in the purchase of restricted goods". Or this one [19], which describes how Tracy Bunjwali, a university student, is forced into part-time prostitution in an effort to support herself and her brothers and sisters:

"She has little choice, she says. Orphaned during the last term of high school two years ago, the 23-year-old has to support a brother and sister still at school after her parent died of AIDS-related illnesses." And yet another article [20] tells how Operation Murambatsvina has forced as many as ten families to share one house in Harare, and "Even though HIV and Aids pandemic continues to be a major problem in Zimbabwe, several women at the house are reported to have resorted to prostitution for survival". Yet another article (The Guardian [21]) tells of how there are a growing number of young women forced to turn to prostitution to make ends meet - competition is fierce:

'Look, I'm a working girl. I need to sleep and do things around the house during the day,' said Talent Mushonga, 23. Samantha Hazvinei, 24, said girls as young as 15 and middle-aged married women were turning up. 'We are too many ladies looking for too few men. I need to come earlier and earlier and stay longer to get business.'

Increasing risky sexual behaviour combined with extremely high HIV/AIDS statistics paints a stark picture for the future, and the government has to be forced to take some responsibility for ratcheting up the poverty that brings the two together.

There are other areas too where the government could play a role in the fight against AIDS, and yet it seems unwilling to do so. We all know that education is key to survival, and that access to information plays a critical role in the fight against AIDS. A report released by the Panos Institute [22] in August this year noted that the Southern African media has played a vital role in raising awareness about HIV/AIDS, but it goes on to say that "in light of the immensity and complexity of the epidemic, there is a great need for the media sector to not only do much more, but to make a more comprehensive and positive contribution."

Zimbabwe, however, operates under extremely oppressive press laws; ours is the only country in the Southern African Development Community that requires newspapers and journalists to register with a government-appointed commission as a precondition for operation. The Media Institute for Southern Africa (MISA) noted that, “with newspapers being forced – by law and economy – to shut operations, the public is left to the mercy of government media which, in most cases, seem to have little regard for the principle of public interest” (p.57 in the report) [22]. The notorious Access to Information and Protection of Privacy Act (AIPPA) has also created conditions which make it very difficult for journalists to play a critical role in the fight against HIV/AIDS. For example, accessing information about HIV/AIDS from government sources is difficult, costly, and slow, as the Media Monitoring Project of Zimbabwe (MMPZ) points out:

The time limit for providing a document is 30 days – which is not very quick – and that may be extended. If a member of the public makes a request to the wrong body, then the request will be passed on to the correct one and the time period will start all over again.

The authorities will be able to charge a fee for the information that they provide, including the services they provide, with no upper limit set in the law.

Requests for information must be made in writing, with detailed information about the person or group requesting.

The MMPZ [23]also points out that AIPPA "creates a series of wide and vague offences that can be committed by journalists, such as intentionally falsifying or fabricating information and publishing a false statement. These offences can attract severe penalties [24]".

Laws like these make it difficult, and risky, for journalists to pursue stories that may expose failure in government polices or expose corruption in the administration of funds, for example. But when dealing with a disease like AIDS, stories like these could be the difference between life and death for many people. The MMPZ says [25] that the effect of laws like these "can only be to discourage journalists from exposing information that might be uncomfortable for the authorities; for fear that they will lose their accreditation (and thus their livelihood).

One NGO worker summed up the position with the media as follows [22]:

Externally, there is a weak interface between the local media and AIDS service organisations. This has resulted in limited information and knowledge among journalists on HIV/AIDS. Lack of ethics attached to HIV/AIDS is also a major challenge. The media does not recognise HIV/AIDS as a human rights issue and, as such, the media in its coverage does not conform to ethics attached to covering human rights issues. Another external challenge is the existence of restrictive policies and legislation such as the Access to Information Protection and Privacy Act. Internal challenges include lack of resources, general lack of capacity and their personal attitudes which might lead to stigma and discrimination of peers and their source of information.

Even more challenges - again, ones created by the government - potentially face the 260 NGO's working in the HIV/AIDS sector. The NGO Bill gazetted in August last year (now only waiting for Mugabe's signature before it becomes law) threatens to severely restrict their ability to do their work. Sokwanele highlights some of the areas of concern:

Initial drafts of the NGO Bill caused concern among NGOs because the proposed Council to register NGOs would be entirely controlled by government, with a majority of government members, and a minority of NGO members. The NGO umbrella organisation NANGO proposed a Council controlled by NANGO. But all lobbying attempts were ignored. Government knew what it wanted, and was not going to be deterred.

The real sting in the new Bill when it was finally gazetted was the attack on the organisations concerned with human rights and governance. The definition of an NGO is expanded by the addition of institutions whose objects include "the promotion and protection of human rights and good governance" and "the promotion and protection of environmental rights and interests and sustainable development". And, critically, it no longer exempts Trusts registered with the High Court. Furthermore, a new section prohibits any local NGO from receiving "foreign funding or donation to carry out activities involving or including issues of governance".

NGOs have argued strongly against the bill [26]:

"All the work that NGOs do is human rights work whether its access to water, land, information, education, treatment or promoting the rights of people with disabilities or living with HIV and AIDS," [...] "Some of our members have already lost some of their funding as a result of the Bill. This will result in the reduction in foreign aid and foreign currency in-flows into the country.

"It is our conviction, as NGOs that given the current socio-economic situation in the country, where 70-80 percent of the population is surviving below the poverty datum line and unemployment hovering between 60-80 percent, where over one million children are orphans and where 25 percent of the population is infected by HIV/AIDS, the NGO sector is a safety net".

Life expectancy in Zimbabwe was 69 when Mugabe came to power in 1980, but official figures in Zimbabwe show the Aids pandemic has lowered average life expectancy to 38 [27]. In the meanwhile, the government's struggle to control dissenting voices and political opposition has resulted in a series of actions and laws that cultivate an environment where HIV/AIDS thrives. Given the scale of the pandemic and the catastrophic effect it has on people's lives, these sort of decisions taken by people in a position of authority should be considered a crime against humanity.

And while we are delighted to hear that there has been a decline in some of the statistics in our country, we would be foolish to assume that these figures would continue to fall - if they already have? There is no sign that the economy will improve, little evidence that poverty will improve or that conditions in our country will improve to such and extent that NGOs in the fight against AIDS can work with the full support of the government and unhindered by senseless laws.

The zanu-pf government clearly intends to hang onto power at all costs, but have they realised, or do they care, that that price might be an entire nation? And given that stark fact, at what point will the world's leaders - and especially regional powers - start holding the government accountable for the decisions it takes, decisions which knowingly hinder and restrict efforts to fight HIV/AIDS? At what point do we stop talking about this as a disease, and start using the term genocide instead?