Treatment Gaps Threaten Zimbabwe’s AIDS Success Story

Washington DC, US – Zimbabwe’s AIDS success is under threat due to funding gaps for anterotroviral (ARV) drugs which threatens to affect almost 70,000, according to a report issued by Medicens Sans Frontieres.

The report stated that national ARV buffer stocks are currently being depleted to cover some of the shortages. The country is already eating into its allotted Global Fund money to cater for the current treatment gaps, a scenario that will result in an estimated 428,068 people eligible for treatment unable to access ARVs by 2014.

While the country has recorded major success with ARV coverage growing from five per cent in 2006, to 77 per cent among adults and 39 per cent among children, there is a danger that the lives of 435,000 adults and 41,000 under treatment could be put in jeopardy.

According to the MSF report, Zimbabwe’s AIDS levy currently pays for over 25 percent of its ARVs, it has not yet been possible to close the treatment gap.

“The immediate funding gaps in Zimbabwe are due to the transitioning out of a pooled donor fund (the Expanded Support Programme) by the end of 2011. Funding for ARVs was not part of the new basket fund initiative (Health Transition Fund), as the assumption was that providing ARVs for the supproeted ARV cohort would be done with domestic and Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) support,” stated the report.

The report added that donors such as US President’s Emergency Fund for AIDS Relief (PEPFAR) and the Department of International Development (DfID) are now trying to help close the HIV treatment gap. But most of these efforts will not be felt until later this year or early next year putting many people’s lives at risk.

“The GFATM will need to address a significant part of this shortfall, while additional funds to continue initiating new patients on ARV treatment also need to be ensured,” read part of the report.

“Zimbabwe has played a key role in changing the face of the epidemic in the region and globally. Right now, all of Zimbabwe’s success are under serious threat due to the treatment gaps, and that’s why PEPFAR must channel the bulk of its funds towards this urgent priority,”said Chamunorwa Mashoko, an community activist and one of AVAC’s 2012 HIV Prevention Research Advocacy Fellow.

HIV/TB Advisor for MSF in Southern Africa, Dr Eric Goemaere, said that increased global funding is still required in the fight against the epidemic.

“Globally we’re finally past the halfway mark with HIV treatment. Health ministries are working hard to implement latest treatment recommendations and policies to get ahead of the wave of new infections, but they can’t do it alone. We need to see a dramatic increase in global support to fight this plague,” he said.

Gender Based Violence Drives HIV Epidemic Among Women: US Study

By Chief K.Masimba Biriwasha | Global Editor At Large

Washington DC, US – One out of every four people living with HIV in the US is a woman according to a new study by the University of California, San Fransisco (UCSF). Further, it is estimated that 30 percent of women living with HIV in the country experience post traumatic stress disorder compared to 5,2 per cent in the general population.

The study has broad implications to efforts to turn the tide against the AIDS epidemic across the world in that its expected to shape the discussion on the impact of violence on women’s vulnerability to the disease.

“Women are dying unnecessarily. They can live with HIV, but are dying from the effects of violence in their homes and communities. HIV policies and programmes must prevent and address the effects of gender based violence that weave through women’s lives,” said Gina Brown, a woman openly living with HIV.

 

According to the study, which focused on approximately 6,000 women living with HIV, intimate partner violence is a disproportionately high cause of death for HIV positive women in the US.

The study concluded that traumatized  women fare worse in AIDS treatment more than women who have not suffered traumatic stress. Trauma also puts women in situations where they are more likely to spread the virus.

“For a long time we have been looking for clues as to why so many women are becoming infected with HIV and why so many are doing so poorly despite availability of effective treatment. This work clearly shows that trauma is a major factor in the HIV epidemic among women,” said Edward Machtinger, Director of the Women’s HIV Programme at UCSF in an interview.

Specifically, the study demonstrated that HIV positive women who report recent trauma had more than four times the odds of experiencing virologic failure, a situation where the HIV virus becomes detectable in the blood despite being on antiretroviral mediations.

The study also revealed that women who had suffered recent trauma were almost four times more likely to have had sex with someone without the virus or whose HIV status was unknown to them, and to not always use condoms with these partners.

“Women who report experiencing trauma often do not have the power or self-confidence to protect themselves from acquiring HIV. Once infected, women who experience ongoing abuse are often not in positions of power to effectively care for themselves or to insist that their partners protect themselves. Effectively addressing trauma has the potential to improve the health of HIV positive women and that of the community.”

Cervical Cancer Kills Women in Developing Countries

By Chief K.Masimba Biriwasha

CERVICAL cancer, caused by infection with some type of human papillomavirus (HPV), is the leading cancer-related cause of death among women in developing countries.

The disease affects an estimated 500,000 women every year and kills a nearly quarter million worldwide. Eighty percent of the cases occur in developing countries where women have limited access to screening and treatment services.

“Among the most tragic public health failures of the last decade are the preventable deaths of young women in developing countries from maternal mortality and cervical cancer,” says Sue J. Goldie, a professor in the Department of Health Policy and Management at the Harvard School of Public Health.

HIV positive women are significantly more susceptible to having an HPV infection turn into cervical cancer.

This is despite the fact that there are tools available that can reverse this trend. Many governments in the affected countries have not prioritized the problem of cervical cancer in their national and health programs.

“We are now facing unprecedented opportunities to prevent these unnecessary and tragic deaths. In fact, recent concerted efforts have been made to assemble, synthesize, and interpret the available data with an eye towards actionable steps, and to comprehensively reflect on what has worked and what has not,” says Goldie. “Moreover, researchers, public health scientists, and policymakers are beginning to engage with the distinct purpose of agreeing on the most promising strategic approaches to eradicating preventable deaths in women.”

In developing countries, the vast majority of women with cervical cancer are diagnosed in late stages of the condition, and usually have little chances for long-term survival. To make matters worse, treatment for cervical cancer is rarely available even where the condition has been diagnosed.

“Unlike most cancers, cervical cancer is preventable through screening to detect and treat precancerous lesions. A conventional screening program, based on the cytological examination of cervical smears, can require up to three visits: an initial screening visit, colposcopic evaluation of abnormalities, and treatment. In countries that have been able to achieve broad cervical cancer screening coverage using cytology at frequent intervals, deaths have decreased considerably,” says Goldie.

For many developing countries, especially in sub-Saharan Africa, where poverty is endemic, and where health systems are in a state of dilapidation, cervical cancer is killing more women than necessary.

“In the vast majority of resource-poor settings such screening programs have proven difficult to implement and sustain due to a lack of human, technical, and monetary resources, and often inadequate health infrastructure,” says Goldie. “Additionally, the requirement for multiple visits, together with the need to screen at frequent intervals, has made it impossible to implement and sustain widespread organized screening in most poor countries.”

There’s need for a greater awareness of the severity of cervical cancer among women in developing countries. Also, there’s need for low-cost interventions that can be applied over a wide-scale.

No Condoms in Schools, Says Parirenyatwa

By Chief K.Masimba Biriwasha

Harare, Zimbabwe – Former Health and Child Welfare Minister, David Parirenyatwa said that distributing condoms at schools was a non-starter.

Adding his voice to the controversial proposal by the National AIDS Council (NAC) to distribute condoms at schools, Parirenyatwa said what is needed is schools is strengthening of sex education which could start as early as second grade.

“Let’s not entertain that debate of condoms in schools. It’s a non-starter. Let’s forget about putting condoms in schools. Of course, we can have condoms in tertiary institutions such as universities and colleges but in schools it’s a complete no-no,” said Parirenyatwa. “What we need instead is comprehensive sex education, and that can start quite early within the school system.”

The issue of putting condoms at schools recently hogged the media limelight following revelations by NAC that a consultant hired to review HIV and Aids policies in Zimbabwe had made the recommendation. Zimbabwe uses condoms as one of its HIV preventative measures. As a result of that the country has managed to reduce its HIV prevalence rate from over 20% to 14,2% in five years.

“In as much as we teach our children about protected sex, we need as well to provide them with the protection we will be teaching them. So we are saying condoms should be made available even in primary schools, because from the research we as UNFPA recently did it came out clearly that sex is happening in primary schools, with either teachers abusing young girls or even among the school children,” said Samson Chidiya, an official with the United Nations Population Fund (UNFPA).

Neighbouring country, South Africa,  introduced the Children’s Act which gives children 12 years and older the right to access contraceptives in 2007.

But locally, the issue has been controversial to say the least. According to media reports, some parents said that such a development will negatively affect the education system, arguing that schools should not be allowed to become bases for sexual activities.

“It will worsen sexual activities among school pupils, so we do not want to permit such behaviour at schools. If condoms are given to them, that is the end of abstinence as school pupils will take it as a sign that we condone sexual behaviour at schools,” said one parent.

Deputy Minister of Education, Sport, Arts and Culture, Lazarus Dokora said that his ministry will not give room for such a development as it is not government policy.

Zimbabwe Fails Its Young People

By Chief K.Masimba Biriwasha| AfroFutures.com Global Editor-At-Large| Harare

ZIMBABWE’s acrimonious political system marked by a bitter rivalry between ZANU PF and MDC political parties combined with a decade-long economic collapse has sidelined the social and economic rights of young people, according to a recently published study.

The new study, which surveyed 1500 urban-based youths  in Harare, Bulawayo, Gweru, Mutare and Chitungwiza, revealed that most young people, that is, 76 percent of the respondents had a basic understanding of their socio-economic rights. Most of the young people felt that promoting such rights through human rights education is required.

In addition, 58 percent of the youth respondents said the government has the primary responsibility for providing socio-economic rights

The study, which was conducted by Youth Initiative for Democracy in Zimbabwe (YIDEZ), aimed to investigate young people’s views on social and economic rights, focusing on awareness, availability and accessibility of such rights.

Many youths in Zimbabwe – approximately 65 percent of the total population – are currently trapped in poverty and unemployment, with their voices largely curtailed in nation building endeavours such as the constitution making process. The study, titled, “Socio-Economic Rights: Youths Know Your Rights,” revealed that the current constitution does not have a provision for economic and social rights of young people. This is despite the fact that over the years the government has ratified various international human rights instruments which it has failed to incorporate into domestic law. According to Sydney Chisi, director of YIDEZ, the ongoing constitution making process had been a missed opportunity to address the issue of young people’s economic and social rights.

“The motivation of the study was the context of socio-economic rights within the framework on the ongoing discussion on the constitution. One of the missing links is that the discussion has been largely political and there has been very little focus on issues of socio-economic rights. If you look at the political discourse in post independent Zimbabwe, you’ll see that we have been moving away from issues of social and economic rights,” said Sydney Chisi, director of  YIDEZ.

To reduce unemployment rates and increase access to jobs, most of the young people surveyed said that Zimbabwe needs major legislative and policy reforms and external assistance for economic development. Sixty-two percent felt that an effective land audit should be conducted by the government to repossess all unproductive land and redistribute it to productive farmers.

The survey found that 32 percent of young people felt that title deeds should be issued to farmers to ensure security of tenure and boost confidence in the farming sector, while 6 percent felt that government must mobilize and distribute farm inputs before the beginning of each season.

“It is all about bread and butter issues. It about access to health, education and responsible local governance. It is difficult to talk about politics and democracy without taking it consideration fundamental human rights. The absence of access to fundamental social and economic rights will exacerbate the abuse of young people. Politicians have a way to come and promise services to young people. So we want young people to know about their basic social and economic rights  as a way for them to demand accountability from their local and national governance structures without necessarily being partisan,” said Chisi.

In the study,  72 percent of the respondents, said that despite slight improvement in the provision of health care following the formation of the inclusive government, young people were still facing a plethora of challenges to access affordable and quality healthcare. In addition, the respondents felt that decrease in public financing of the education sector, exorbitant fees and shortage of teachers is hindering young people from accessing quality education.

According to the study, the sidelining of social and economic rights can be a powder keg that if left unaddressed can hinder the country’s development.

“Zimbabwe has become a nation that is marked by oppressive political arrangements that favour particular segments of society and marginalize the basic survival rights of the average masses. It is saddening to note that social and economic rights have taken second or no place at all in the country priorities,” says the study.

In Zimbabwe, Women Face Baby Pressures

By Masimba Biriwasha| AfroFutures.com Global Editor-At-Large

When Maidei Tavaziva (30) consciously chose not to conceive for approximately five years after getting married, she experienced a barrage of salient remarks from her relatives suggesting that time was up for her to reproduce.

“My aunts, my grandmother and my other relatives started telling me that I needed to have a baby. I suspect that my husband’s relatives were also talking behind my back. My grandmother would say that she now wanted a grandchild. I’m definitely convinced that in Zimbabwe, there is social pressure to produce a baby once you enter into marriage,” said Taziva.

Tavaziva added that though some of the comments appeared innocuous on the surface, the intent was clearly to influence her to get pregnant.

“Of course, I knew that what my relatives wanted was for me to get pregnant and deliver a healthy infant, preferably a boy, so that I could secure my relationship with my husband, and increase my status,” she said.

Unlike most women, Taziva said that she did not bow down to the pressure; she stuck to her guts not to have a child early in marriage because she needed to first complete her educational studies without the pressure of having to look after a baby.

According to traditional norms in Zimbabwe, a woman has a responsibility to expand the clan of her husband once she is married. Babies are often regarded as sealers of marriage – but not just any baby – women are generally expected to give birth to a baby boy who will carry the family name and inheritance.

“A woman who has a first-born child who is a girl is not as revered as one with a boy. So women are under pressure to produce baby boys,” said Betty Makoni, Global Advocate for CNN for protecting the powerless and CEO of Girl Child Network Worldwide.

However, a woman who has a child outside of a recognized and socially sanctioned sexual union faces the risk of being ostracized by family, the community and religious organizations to which she belongs.

“Girls who fall pregnant force themselves into marriage or are forced into marriage. Many women are married because they’ve fallen pregnant,” said Makoni.

For most newly married women in the country, the desire to fulfill social expectations to conceive immediately after marriage supersedes efforts to engage in proper family planning.

“I have friends whom after marriage have experienced pregnancy check-ups from their relatives. They will start to check the skin tone, whether you have nausea and at family gatherings they expect to see you with a bump. Society still expects women to follow the conventional trajectory of dating, marriage, and then children,” said Buhle Makamanzi, a development sector consultant and mother of three.

“This is not to say that motherhood is a bad thing; for me, there is nothing in this world as fulfilling as being a mother – your heart certainly grows bigger.”

According to a Women and Law in Southern Africa Research and Educational Trust (WLSA) study titled “Pregnancy and childhood: Joy or despair?” women’s sexual lives are mediated by those of men.

“Women must conform to male strictures or so they believe. Thus, if their sexuality is perceived as a reproductive resource by males and is controlled by male norms and values, women who are dependent on males will seek to conform to those norms and values,” states the study.

But as Tavaziva revealed the pressure on her came mainly from her female relatives, and that may have been no coincidence.  According to the WLSA report, women often use their reproductive capacity to support their entitlement to benefit from resources held by men.

“This reliance on reproductive roles means that women are obliged to fill that role and produce children to secure their membership in their marital families and build up status that secures their entitlements in that family in their later years,” says the study.

The study also noted that women’s sexual integrity may be demanded and enforced by their natal families to maximize their opportunities for successful marriages.

Makamanzi commented that as women become more independent-minded due to increased access to educational opportunities, social expectations about the timing of pregnancy within marriage are beginning to shift, albeit, slowly.

“One major factor is whether the husband succumbs to pressure, if he does, then as a woman, you’re forced to try for a baby even if it wasn’t your plan. With the buzz on women’s empowerment, some women are beginning to think outside this box. However, pregnancy borne out of societal and family pressure is still rampant even among the so-called career women,” said Makamanzi.

Africa’s Quest for a Green Revolt

EARLY in the morning, Mary Kanyaire, 33, collects water and firewood, and then prepares a meal for her two school-going children before she heads out to the fields, approximately 3 kilometers away from her homestead.

Alone, under the hot sun, she weeds groundnuts in a sandy field with a hoe. Although she knows she will not get a good yield, she strives on, buckets of sweat pouring down her face.

8 Nuggets to Living a Simple Life

Like many people, you probably run through your life bogged down by a heavy load of worries about finances, traffic jams, your career, how you look, and what people think of you etc.

Thoughts rummage through your head like the mad rush of a river on a stormy day, all needing attention which reduces you to a monkey-state. In reality, as much as you worry about giving shape to your life, you need to realize that you actually have very little control.

Human Trafficking for Sexual Exploitation: The Need for a Global Perspective

Across the world, approximately 200,000 women and children are trafficked each year for purposes of sexual exploitation. Currently, approximately two million women and children are held in sexual servitude. Many of them die of AIDS, other STDs, ill-health physical and psychological abuse, violence and drug abuse. A surge in public indignation supported by empirical evidence is required to put an end to this cruel form of modern human slavery.

AIDS funding falls likely to increase burden on care providers

The dip in funding levels for HIV and AIDS programmes will undoubtedly put paid years of progress in the response to the epidemic in sub Saharan Africa. Reduced funding will not only cause more deaths, but also in more offloading of responsibility to poor and marginalized communities. Persons in need of care will increasingly have to resort to already over-burdened community and home based care providers, mainly women and girls.

Given that the financial drawback for AIDS programmes is occurring at a time when two million people are still dying each year in sub-Saharan Africa due to the disease, the consequences for will be drastic particularly at community and familial levels.

“The donor turn-around will not make the patients in need of life-saving treatment go away. On the contrary, it is likely to increase the numbers of people in urgent need of care and will negatively impact their family, community and the health care system. In the end, the cost of inaction will be far higher than that of action,” states a recent report by Medecins Sans Frontieres titled, “No Time to Quit: HIV/AIDS Treatment Gap Widening in Africa.”