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.

Advertisements

Rectal Microbicides Seen As Key in Preventing New HIV transmissions

By Chief K.Masimba Biriwasha | Global Editor At Large

Washington DC, US – Unprotected anal sex is a key driver of HIV transmission in many parts of the world. The practice is surrounded with much stigma and discrimination which is a key barrier to developing protective measures.

Microbicide research has gained momentum in recent years with focus largely on products to prevent HIV transmission during vaginal sex. However, there is a growing momentum to develop rectal microbicides for women, men, and transgender individuals around the world who engage in anal intercourse.

Rectal microbicides are products – that could take the form of gels or lubricants – being developed and tested to reduce a person’s risk of HIV or other sexually transmitted infections from anal sex. In spite of the public health need for rectal microbicide research, there is serious institutional, socio-cultural and political stigma around the issue.

According to estimates, the risk of becoming infected with HIV through anal sex is 10 to 20 times greater than vaginal sex because the rectal lining, the mucosa, is thinner and much more fragile than the lining of the vagina.  Because the rectal lining is only one-cell thick, the virus can more easily reach immune cells to infect.

Against this background, developing safe, effective, affordable rectal microbicides is key priority to turning the tide against HIV among populations that engage in anal sex, said Dr Ian McGowan, a leading rectal microbicide researcher.

“We are moving through the early and middle phases of the development of a rectal microbicide,” McGowan, adding that funding is part of the science and that more researchers are required as the research unfolds.

“We need mo people engaged, we need communities to take up the issue – we should follow the science.”

Jim Pickett, Chair of the International Rectal Microbicide Advocates (IRMA) and Directyor of Advocacy at AIDS Foundation of Chicago said that funding for rectal microbicides remains a key challenge for developing rectal microbicide. Pickett said that a total of US 100 million is required to engage in the next phase of studies.

“What is important in developing the next phase of studies is to develop a product that is about pleasure, intimacy, connection, emotion and love. The tools that are out there do not adequately fulfil this need,” he said. “Making the rectal microbicide safe, effective, affordable and acceptable for all who need them is a key priority.”

AIDS Vaccine Advocacy Coalition (AVAC) Executive Director, Michael Warren, said that money dedicated to rectal microbicide has been a blip on the map and a more strategic approach is required to attract additional resources.

“We need to articulate what exactly is required for the rectal microbicides; we need to build a comprehensive ask for what is required. It must come with a specific plan so that it does not appear like we are requesting for a blank. We need a clear strategy described scientifically and costed effectively in order to get support,” said Warren.

 

Carol Odada, a Kenyan AIDS activist said that rectal microbicides were not an innovation limited to men who have sex with men only.

“HIV has a woman’s faces, a woman is the main victim but nobody thinks. Every other prevention is other. Every prevention works differently works differently. There is a lot of anal sex going around. It’s unfortunate that some women are forced to engage in anal sex. Rectal micorbicide is not a gay issue. Women have to drive the call for rectal microbicide,” she said.

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.

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.


Diabetes in Zimbabwe: It’s Not All About Sugar

GROWING up in Zimbabwe, diabetes (a polygenic disease characterized by abnormally high glucose levels in the blood) was something that the old people always talked about, and the fear of the disease grew over me like a giant baobab.

To describe a person with diabetes, the old people would say in local parlance “Ane shuga”, which literally means: “He/she has sugar”. Essentially, it meant that the affected person has a disease associated with sugar.

To my childhood fancy, I thought that the people who were affected with the diabetes ate a lot of sugar only to discover later it was the common understanding.

Most people in Zimbabwe associate diabetes with a high intake of sugar, particularly in tea.

Little to no other foods are associated with the onset of this condition. Put simply, very few people know that eating too much of carbohydrates, fats, proteins can increase the incidence of diabetes.

I discovered later that diabetes mellitus occurs when the pancreas does not make enough or any of the hormone insulin, or when the insulin produced doesn’t work effectively. In diabetes, this causes the level of glucose in the blood to be too high.

According to experts, the number of people with diabetes in Zimbabwe is growing. In 2003, Zimbabwe recorded more than 90 000 cases of diabetes, an increased of 3 000 from the 1997 figure.

The Diabetic Association of Zimbabwe estimates that around 400 000 people in the country have the disease but many are unaware on their condition.

“About 50 percent of Zimbabweans are diabetic but are not aware of the condition, so many people are suffering from diabetes but do not have any knowledge about it,” a Zimbabwe Diabetes Association official was quoted in The Herald newspaper.

“It is sad that a lot of people have died because of this disease without knowing it, and only relatives will know about it after a post-mortem has been conducted,” added the official. Continue reading

The Great Vasectomy Fear

For most men, the idea of vasectomy, a surgical procedure to cut and close off the tubes that deliver sperm from the testicles, is a complete no-can-do associated with being sexually dysfunctional in the male psyche.

According to the latest issue of Population Reports, titled “Vasectomy: Reaching Out to New Users,” published by the Johns Hopkins Bloomberg School of Public Health, vasectomy is simpler and more cost effective than female sterilization and offers men a way to share responsibility for family planning.

“The most entrenched and powerful rumors concern manhood, masculinity, and sexual performance. Many men confuse vasectomy with castration and fear, incorrectly, that vasectomy will make them impotent,” says the report.  But in fact, “Castration involves removal of the testicles. In contrast, vasectomy leaves the testicles intact, and they continue to produce male hormones.”

The procedure which typically takes from 15-30 minutes and usually causes few complications and no change in sexual function is one of the most reliable forms of contraception. Though it does not offer protection against sexually transmitted infections or HIV, for couples it is a way for men to be directly involved in family planning. Family planning has been largely seen as the responsibility of women but vasectomies allow men to play a part.

The report states that the largest number of vasectomized men are in China, where almost 7% of women in relationships — or more than 17 million couples — rely on vasectomy for birth control. Continue reading