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Zimbabwe makes headway in AIDS fight
Michael Fleshman, UN Africa Renewal
Extracted from UN Africa Renewal, Vol.19 #4
January 2006

http://www.un.org/ecosocdev/geninfo/afrec/vol19no4/194aids.html

DESPITE economic and political challenges, Zimbabwe has become only the second country in sub-Saharan Africa to significantly slow the spread of HIV, the human immunodeficiency virus that causes AIDS.

In a brief press statement in October last year, the Joint United Nations Programme on HIV/AIDS (UNAIDS) said infection rates among a particularly vulnerable group — pregnant women — fell from 24,6% in 2002 to 21,3% in 2004.

The findings are good news in a country with one of the highest HIV infection rates in the world. UNAIDS advocacy, communication and leadership director Achmat Dangor said it showed that education and prevention programmes launched during the 1990s were beginning to show results.

Speaking in New York, Dangor, a South African novelist and former head of the Nelson Mandela Foundation, also reported that infection rates among young people, another group at high risk, had dropped even further, from about 25% to 20%.

He said that despite the impressive progress, "this is no reason for complacency. Zimbabwe still has one of the highest HIV prevalence rates in the world." The challenge is to build on the gains.

Zimbabwe is only the second African country, after Uganda, to reduce high HIV rates through education and prevention. Continued reductions in Zimbabwe, which is at the geographic and epidemiological centre of the AIDS pandemic in Africa, could mark a turning point in the struggle against the disease and offer valuable lessons to countries in the region.

Dangor said that when evidence of a decline in new infections began to arrive, he was sceptical, given the difficult circumstances in Zimbabwe. UNAIDS commissioned the Imperial College in London to review data from a variety of sources to confirm that there had been a fall in infections, rather than an increase in mortality rates or some other statistical quirk.

The challenge now is to find out what aspects of Zimbabwe’s anti-AIDS programme are responsible for the improvements. "At this stage we cannot pinpoint what the scientists call the ‘specific programme interventions’ behind the decline," Dangor explained. "We are now looking at the major programmes, governmental and nongovernmental, urban and rural, to see if we can identify them."

Early analysis suggests that behavioural changes, including young people waiting longer before becoming sexually active, fewer casual sex partners and increased use of condoms, are parts of the explanation. But Dangor also pointed out that Zimbabwe’s strong education system, its emphasis on district and community management of AIDS programmes, and improvements in the status of women since independence in 1980 could be factors.

"We have ABC," he said, referring to Uganda’s successful "Abstain, Be faithful or use a Condom" campaign. "If I could add another letter it would be ‘W’ for women, because we will never defeat AIDS in Africa until we empower the women."

The country’s progress cannot be explained by an abundance of external resources. Neighbouring Zambia received $187 in aid for every HIV-positive citizen in 2004, whereas Zimbabwe’s strained relations with some donors meant it received just $4 a person, according to the World Bank. That, Dangor said, offered an important lesson. "You do not have to wait for a massive amount of external funding to contain the spread of HIV."

As vital as resources for prevention, care and treatment were, he said, "what is even more important is that countries own both the problem and the solution, instead of the targets and the programmes coming from outside".

But the country’s struggling AIDS treatment programmes have been affected by the lack of funds. Only 15000 of about 300000 Zimbabweans in urgent need of antiretrovirals have access to them. With little external financing available and foreign currency shortages hampering imports, patient costs have soared from $7,60 to $50 a month, beyond the means of most.

"AIDS will be with us for many years — maybe forever," Dangor said. "If governments of affected countries, donors and civil society can just remove AIDS from the party political arena, the ideological arena, I think we have a chance of containing this disease much quicker." UN Africa Renewal

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