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.

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.

Domestic Resources Missing in Africa’s AIDS Response

By Chief K.Masimba Biriwasha Biriwasha | DevAge Global Editor At Large

HARARE, Zimbabwe – Ninety per cent of AIDS programmes in Africa are foreign funded, a situation that is highly unsustainable especially in the face of the global economic crisis, Director of the UNAIDS Regional Support Team for East and Southern Africa, Professor Sheila Tlou revealed in an exclusive interview at the inaugural GlobalPOWER Women Africa conference held recently in Harare, Zimbabwe.

“There are individual variations among countries but indeed in a lot of our programmes continent-wide, ninety-percent of the funding comes from external sources, for example, the Global Fund, PEPFAR and other development partners. There is an AIDS dependency on the continent,” she said, adding that Africa needs increased domestic resources targeted towards the AIDS response.

“We need to have domestic resources because if every country can own the epidemic and say that it’s ours – that can do quite a lot.”

She attributed the continent’s AIDS dependency to the history of epidemic which has been largely characterized by foreign funding of AIDS programmes.

“When HIV came, I would say, a lot of donors were willing to pour a lot of money in, and maybe the situation could have continued had the world not experienced the global economic crisis,” she said.

Tlou said that though African governments have long-recognized that they need to dedicate domestic resources to the AIDS response, there was still a lack of political commitment to implement declarations.

“In 2001, African presidents met in Abuja and made a declaration to devote 15 per cent of national budgets to health but it’s happening in a very few countries. If we can have at least every African country saying we’re going to put 15 per cent of their national budgets to health, we would be far much better off,” she said, pointing out that countries such as Botswana, Mauritius, Namibia and South Africa had committed fifteen percent of their national budgets to the health sector with tangible improvements in the response to AIDS.

“The political commitment needs to be there. Fifteen percent is not a magical bullet but it shows that countries have goodwill to respond to the epidemic whereby donors can say we are helping those who’re helping themselves.”

Tlou added that AIDS programmes in Africa currently exist in silos, far removed from each other, lacking in integration and a holistic approach.

“The real problem is that the AIDS response in Africa is disintegrated. We need to take AIDS out of isolation and make sure that it is integrated into the whole healthcare system,” she said.

Zimbabwe’s AIDS Success Was Doubted: UNAIDS Executive Director

By Chief K.Masimba Biriwasha | iZiviso Global Editor At Large

HARARE, Zimbabwe – UNAIDS Executive Director, Michel Sidibe, said that no-one believed that Zimbabwe could succeed in responding to the AIDS epidemic at the inaugural GlobalPOWER Africa Women Network conference held recently in Harare, Zimbabwe.  Image

According to UNAIDS, Zimbabwe has achieved one of the sharpest declines in HIV prevalence in Southern Africa, from 27% in 1997 to just over 14% in 2010. With 10 times fewer resources for AIDS per capita than other countries in sub-Saharan Africa, Zimbabwe has expanded coverage of antiretroviral treatment among adults, from 15% in 2007 to 80% in 2010. At the end of 2011, nearly half a million people in the country were receiving lifesaving HIV treatment and care.

“No-one was beliving that Zimbabwe could be a success story with all the difficulties the country was facing but Zimbabwe managed to demonstarte that they can reduce by 52 percent the adult infection rate during the last ten years. Zimbabwe managed to increase the number of people in need of treatment by 50 percent during only the last two years which is important for us to underline,” Sidibe said

He added that Zimbabwe was also a success story because it introduced innovative ways to mobilize internal resources. Zimbabwe’s AIDS Levy, a tax on income to increase domestic resources for the national HIV programme has enabled the country to diversify its domestic funding for its AIDS response, raising an estimated US$ 26 million in 2011. This year the levy is expected to raise US$ 30 million.

However, the majority of people on antiretroviral drugs continue to be supported by the donor community: 76 percent of the 347 172 people on treatment are supported by donor funding.

“In general, any data, you put out is questioned. When we mentioned in our report for the first time that Zimbabwe was making progress, they were reducing the number of new infections and increasing the number of people on treatment, death was going down, people questioned us how that could happen. Many aspects about the country pointded otherwise,” he said.

He said that question surrounding the fact that the country was undergoing serious economic problems made people question the results.

“We asked the one of the best institutes in the world, Imperial College, to come and validate our data. They did all the epidieological analysis and caem up with the validation of the dats. Any place where HIV has success response record, its about leadership at all levels. Secondly, what happeend in Zimbabwe is change in behaviour.

He said that the AIDS levy had played a key part in the Zimbabwean AIDS response, and UNAIDS used it as best practice in raising locals resources for the AIDS response.

“Today, its only 13 percent of the formal sector paying for the levy. We could really look at the informal sector, it will even bring more resources. Zimbabwe’ efforts during the last two years to increase treatment in the past two years is one of the best practices,” he said.

“The Zimbabwe AIDS Levy is an excellent example that demonstrates to other African countries how to generate domestic resources to maintain and own their national AIDS responses. I encourage the Government of Zimbabwe to explore how this initiative could be expanded to tap into the informal sector to boost the resources of the trust fund.”

TB/HIV poses challenges for Zimbabwe

By Chief K.Masimba Biriwasha

Harare, Zimbabwe – Charles Raradza, 44, fell seriously ill in 2001, coughing uncontrollably. He went to get tested for tuberculosis (TB) at a nearby hospital but the bacteria was not detected in his sputum.

Unconvinced, Raradza went to another hospital where a sputum and lung X-ray test revealed that he was indeed TB-infected.

“I was immediately enrolled into the hospital’s directly observed treatment therapy (DOTS), and had to take 13 tablets a day. The tablets were very painful. I guess because I love life so much I never defaulted during the six months that I was on the course,” said Raradza.

After two years, Raradza started coughing again. He went to get tested for TB again.

“At the hospital, it was discovered that I had TB, so I was given 60 injections and tablets – its was painful but I stuck through it. I was put on the 6-month long DOTS programme again,” he said.

In 2005 Raradza said he went to a Voluntary Counseling and Testing centre to get tested for HIV.

“It was unheard of then for anyone to go and get tested but I gathered my courage and went to the testing centre. I tested HIV positive, and was enrolled into the anteritroviral programme,” he said.

After noticing Raradza’s poor response to the AIDS drugs, Raradza said that a doctor-friend of his recommended another TB test. For a third time in his life, Raradza had TB, and he had to go through the treatment regimen of 60 injection and tablets.

According to Dr Tonderai Murimwa, an official in the Ministry of Health and Child Welfare’s AIDS and TB Unit, Raradza’s case of failed detection of TB is not unique and is attributed to changing epidemiological patterns in Zimbabwe.

“Diagnosis of TB is usually straightforward, the best test is sputum microscopy. But HIV changes the way the body reacts to infections. That’s why X-ray is now required but it is very expensive technology and the country cannot afford it at the moment,” said Dr Tonderai Murimwa, an official in the Ministry of Health and Child Welfare’s AIDS and TB unit.

Murimwa added that the drug distribution in the country had experienced severe challenges over the past decade due to lack of material resources such as transport, fuel and personnel.me

TB is a leading cause of illness and death for people living with HIV—about one in five of the world’s 1.8 million AIDS-related deaths in 2009 was associated with TB. The majority of people living with HIV and TB are in sub-Saharan Africa. The risk of developing tuberculosis (TB) is estimated to be between 20-37 times greater in people living with HIV than among those without HIV infection.

According to UNAIDS, TB places a heavy burden on people living with HIV including significant illness that requires at a minimum six months of treatment, with the associated economic costs to the individual, his or her family and the health-care system.

Among African nations, Zimbabwe is one of those most heavily affected by tuberculosis (TB). The deadly combination of TB and HIV epidemics is igniting a silent and uncontrollable epidemic of drug resistant TB that will negate previous national health gains.

The 2009 Global Tuberculosis Control Report from the World Health Organization (WHO) ranks Zimbabwe 17th among 22 countries worldwide with the highest TB burden. Zimbabwe had an estimated 71,961 new TB cases in 2007, with an estimated incidence rate of 539 cases per 100,000 population.

For the past 20 years, Zimbabwe has fought TB fairly successfully, providing free access to WHO-recommended treatments. In the past few years, however, the disease has re-emerged as a leading killer, especially among HIV positive people, who are often not identified though long-established TB tests.

An estimated two-thirds of Zimbabweans with TB are also infected with HIV. As a consequence, Zimbabwe has a staggering six times more TB cases than it did 20 years ago. According to statistics, the success rate of directly observed treatment is just 74 percent, far below the WHO recommended rate of 85 percent.

“In Africa, HIV is the potent factor in the progression of latent TB. People living with HIV are susceptible to TB infection. TB is the most common serious infection associated with HIV infection. The two diseases go hand in hand. This call for an integrated and collaborative approach in dealing with the two conditions,” said Dr. Patrick Hazangwe, a WHO official.

In Zimbabwe, the TB problem is compounded by the fact that patients often fail to complete treatment because they cannot afford the transport costs to and from health centers. The lack of access to health services in remote or rural parts of the country adds to the likelihood that large numbers of TB infections are going undetected and untreated.

To complicate matters, the brain drain of qualified front-line health care workers from Zimbabwe has resulted in poor healthcare delivery. Leck of medical practitioners coupled with obsolete machinery has also worsened the problem.

According to Betty Chikava, Member of Parliament for Mt Darwin East, poor financing of the health ministry is a key hindrance to an effective response to TB and other diseases.

“The Ministry of Health and Child Welfare has received paltry funding – only 7 percent of its projected budget; medical personnel in the hospitals and clinics are seriously overworked. The Ministry of Finance needs to be brought into the picture so that they can finance the health ministry adequately,” she said.

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.

AIDS: Wheregoes the Money?

JUST how much money are the recipients of AIDS funds putting into programmes that have a real impact on communities affected by the disease without hip- hopping around the world or engaging in endless AIDS workshops? It appears that unless there is serious public account of where exactly AIDS dollars are going, we are in for a long ride with the epidemic. Continue reading