…Let’s not take our foot off the pedal: ZNNP+

Ngoni Dapira

IN Zimbabwe, though stigma in communities is still prevalent against People Living with HIV (PLHIV), it is now at levels close to insignificant compared to when the global HIV virus first broke out in the 1980s, Easterntimeszim has learnt.

This is mostly because HIV and AIDS programmes are now well supported by Government through sound policies and laws. The early years of HIV and AIDS in Zimbabwe were however marred by denial and secrecy, but pivotal in fighting against external (community) stigma and self-stigma in the formative years was the late HIV and AIDS activist Auxillia Chimusoro.

Auxilia Chimusoro

In a televised interview in 1989, Chimusoro revealed to the world that she was HIV positive, after having tested HIV positive in 1987. She became the first Zimbabwean to publicly reveal her HIV positive status breaking the propensity of secrecy. She received a lot of insults but also drew a lot of admiration as she eventually set the tone for the national campaign against stigma of PLHIV in Zimbabwe. Immediately after coming out public about her status, the late Chimusoro regardless of her social status as a domestic worker, was unruffled to make her mark in the fight against the global HIV and AIDS pandemic, and stigma of PLHIV above all. She started support groups for people infected with HIV and AIDS, the likes of Batanai HIV Support Group, which has remained vibrant until today. As a result Chimusoro broke new ground by not only becoming a nationally acclaimed HIV and AIDS activist but internationally as well, until her death in 1998.

Sadly though, during that era when Chimusoro came out, there was so much denial by the government of Zimbabwe. This was up until around early 1990s when HIV and AIDS cases became excessively prevalent to the extent that people started debating about the virus in the public domain, at levels which could not be gagged by government. However, after various interventions to mainstream the HIV pandemic, several people began to understand more about HIV and AIDS. Whilst people gained understanding of HIV and AIDS issues, there however remained a lot of stigma through societal connotations calling it names such as ‘Chishuramatongo’, ‘Mukondombera’ and the ‘killer disease’ while PLHIV were called derogatory names ‘’Aripachirongwa’ ‘Arimubhazi’, ‘Chigulani’, ‘Chigodo’ and ‘Best before,’ which were discriminatory and made people shun PLHIV making them outcasts instead of supporting them.

The biggest breakthrough was in 1999, shortly after Chimusoro’s death in 1998, when Government created the National Aids Council (NAC) through an Act of Parliament. That became the highest level of Government support and acceptance with regards to the scourge that was at hand from the HIV pandemic. Government realized the need to enact supporting policies and structures to combat the HIV and AIDS virus domestically. In January 2000, the Aids Levy was introduced, whereby companies and workers started being taxed three (3) percent of their income to help fund HIV and AIDS interventions in the country.

Nevertheless, to reach the current levels of Government support towards the  HIV and AIDS pandemic, from a background of high levels of secrecy, denial and stigma, this took some bold moves and sacrifices by some individuals, the likes of the late Chimusoro. It is now 32 years after Chimusoro went public about her HIV status and impacted change about HIV and AIDS stigma in Zimbabwe. According to the Zimbabwe Population-based HIV Impact Assessment (ZIMPHIA) conducted between November 2019 and March 2020 to measure the impact of the national HIV response, Zimbabwe currently has 1.4 million PLHIV but only 1.2 million are on Antiretroviral Treat (ART). This means there is still a deficit of 200 000 people who are not on ART. This is now the second ZIMPHIA following the first one conducted between October 2015 and August 2016. To better understand the current plight of the PLHIV, Easterntimeszim talked to PLHIV advocacy forums and stakeholders to try and take stock of what has been achieved and their future anticipations especially during the global covid-19 pandemic.

Last year, as usual Zimbabwe joined the rest of the world to celebrate the annual World AIDS Day (WAD) commemorations held on December 1, which ran under the theme, ‘End Pandemics, End Inequalities, End AIDS.”

In a follow up interview with the Manicaland chairperson of the PLHIV advocacy forum, Meaningful Involvement of People Living with HIV and AIDS (MIPA), Casper Pound, he says there is still need to propagate more for community led HIV responses. He however admitted that Zimbabwe like the rest of the world is currently battling under siege from the covid-19 pandemic, which has somewhat reversed the gains achieved in attaining the 95-95-95 targets for HIV epidemic control and to end AIDS by 2030.

Casper Pound (left) at Africa Unity Square in Harare during a gathering in 2019 to petition the government through Parliament to act with greater urgency on a pending health crisis in Zimbabwe for PLHIV.

The ambitious 95-95-95 strategy which was announced by the Joint United Nations Programme on HIV and AIDS (UNAIDS), aims to end the AIDS epidemic by 2030 by achieving 95% diagnosed among all PLHIV, 95% on antiretroviral therapy (ART) among diagnosed and 95% viral suppressed (VS) among treated.

Pound said whilst the number of new HIV infections is decreasing in Zimbabwe, many subpopulations remain at high risk of infection due to lack of or limited access to decentralized HIV prevention, treatment, care and support during covid-19 induced lockdowns.

“These strategies should include same-day ART initiation, community (home-based) ART initiation and index case testing that links to HIV and tuberculosis screening and referral for care, decentralisation of ART services to the primary health care level and integration of HIV care in other health care services,” said Pound.

He said an additional concern that emanated for PLHIV during the severe 2020 lockdowns was the double stigma that has arose for PLHIV who also tested positive for covid-19 and had to ‘unnecessarily’ reveal their status to the police at road blocks and security guards at hospitals just to get their ART drugs.

Pound said there is need to upscale access to HIV diagnosis and treatment citing that Mutare did not have viral load testing for PLHIV for over three months in 2021, which is risky for those that would have just been tested and initiated on ART. He added that a “one size fits all” approach is unlikely to result in achieving the next UNAIDS 95-95-95 targets by the end of 2030.

“Key populations like sex workers, artisanal miners and cross border traders, all should be taken on board as we commit to community-led interventions and leave no one behind in closing the gap. There is need to do away with stigma. All of us are expected to be involved in this fight. HIV testing must be intensified. People must know their status as this is key to accessing treatment and have their viral load checked,” said Pound, adding that HIV self-test kits need to be subsidized, encouraged and extensively promoted as a national strategy to intensify campaigns for everyone to know their HIV status.

Pound also spoke against Apostolic church prophets who dissuade members from taking ART after being prayed for and given holy water. He said it should be considered a criminal offense for such prophets to stop the practice.

He also propagated for more localized funding initiatives. Since 2003, the United States through its President’s Emergency Plan for AIDS Relief (PEPFAR) support to Zimbabwe towards HIV and AIDS programmes has contributed US$1.7 billion. This has supported services for the 1.4 million Zimbabweans living with HIV according to the latest statistics done in 2019 ZIMPHIA.

Pound said he is thankful to partners such as the USAID, Global Fund, UNAIDS and PEPFAR to mention a few, that provide the bulk of the money for HIV and AIDS programmes in Zimbabwe, but called on Government to learn from the covid-19 global pandemic reality check, where donor fatigue emerged for certain funded programmes after most developed nations were overburdened by the covid-19 pandemic.

“To make progress towards sustainable health financing, Government must prioritize health in its budgeting process and implement sustainability plans to prepare for the eventual phase-out of donor support,” said Pound.

Moses Chananuka

Zimbabwe National Network of People Living with HIV (ZNNP+) Manicaland provincial coordinator Moses Chananuka said Zimbabwe has now met the second and third UNAIDS 90-90-90 targets and has achieved the overall target for 2020 by exceeding 73% of viral load suppression among all adults living with HIV.

“Zimbabwe is well positioned to achieve the UNAIDS goal of ending the AIDS epidemic by 2030, but more efforts need to be continued to expand HIV diagnosis and life-saving antiretroviral treatment in the wake of the covid-19 pandemic and increasing economic deterioration in the country,” said Chananuka.

Chananuka however stressed on the need to keep guard of milestones citing that over the years tangible results have only emanated after persistently pushing Government.

“20 years ago, PLHIV marched from Marondera to the same parliament to petition the government to make available a fund that would guarantee access to HIV treatment for all who required it. This led to the creation of the National AIDS Trust Fund (NATF), which is administered by the NAC,” said Chananuka.

He added that in July 2019 PLHIV, ZNNP+ and other civil society organizations gathered at the Africa Unity Square in Harare to again petition the government through Parliament to act with greater urgency on a pending health crisis after there was continued and continuous shortages and stock outs being experienced throughout the country particularly the second line drugs, among other issues.

“This is not the time to take our foot off the pedal. We are therefore asking government to honour their commitments on prioritizing the allocation of resources towards the fulfillment of PLHIV’s right to health as enshrined in the constitution. This is the only way we will achieve the 90, 90, 90 targets and achieve an AIDS free generation by 2030,” said Chananuka.