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No
Bright Future: Government failures, Human Rights abuses and Squandered
Progress in the Fight against AIDS in Zimbabwe
Human Rights Watch (HRW)
July 28, 2006
http://hrw.org/reports/2006/zimbabwe0706/index.htm
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Summary
My
husband left when I fell sick. He now stays with another wife. Before
my husband left I was on medical aid and then he left and I had
nothing. My husband doesn’t pay any maintenance and he took my property
away. We were together for 13 years … My relative who I stay with
doesn’t know that I am HIV positive. There are three other families
in the same household and the others suspect that I am HIV positive
and they aren’t comfortable with me. If they knew they would chase
me. I don’t work. I do some embroidery but business isn’t going
well. I have had to sell some of my clothes to meet expenses. I
just manage to pay the rent. We only have one meal a day in the
evening. It’s tough. Sometimes you just think that maybe if you
die, things will get better. I have to find transport to get my
ARVs and when I don’t have the money I walk to get the ARVs. I am
so stressed. I nearly committed suicide because things are so tough.
There’s no bright future because when you don’t know what you are
going to eat tomorrow, there’s no future.
—Cecilia M., 40, living with HIV/AIDS
Zimbabwe has been
widely hailed as a success story in the fight against AIDS since
reporting in October 2005 a decline in HIV prevalence among adults
from 25% in 2001 to 20% in 2004. In the face of the devastating
impact of HIV/AIDS on the country, a declining economy, growing
international isolation, decreased funding from international donors
for HIV/AIDS prevention and treatment, and a disintegrating public
health sector, Zimbabwe’s achievement was indeed significant.
Despite the positive
news, however, the HIV/AIDS epidemic in Zimbabwe remains a serious
crisis with some three hundred and fifty thousand of the 1.6 million
people carrying the virus in immediate need of life-saving antiretroviral
(ARV) drugs and another six hundred thousand in need of care and
support. With an HIV prevalence rate of 20%, Zimbabwe still has
one of the highest prevalence rates in the world. Of greatest concern
is that the progress gained so far could be undermined by Zimbabwean
government policies and practices that violate the rights of people
living with HIV/AIDS (PLWHA) and those most at risk of infection.
These violations threaten their rights to health, information, work,
equal protection before the law and nondiscrimination.
Zimbabwe’s health
and social welfare policies have resulted in the denial of access
to healthcare for tens of thousands of Zimbabweans living with HIV/AIDS
in immediate need of HIV/AIDS-related treatment.
Thousands of PLWHA
are unable to access HIV/AIDS-related treatment and care services
because they cannot afford the high costs of user fees for health
services. The government has established a system of exemptions
or waivers for health user fees to assist in equitable access to
health care for the poor and vulnerable. However, lack of information
on the criteria and availability of the exemptions, combined with
a failure to have an enforceable and standardized assessment process
by which all social welfare officers administer the exemptions,
leads to their subjective and ultimately arbitrary application.
The result is unnecessary obstacles for vulnerable and poor PLWHA
who urgently need access to healthcare, leaving them at risk of
fatal deterioration in their health.
A lack of public
information on antiretroviral therapy (ART) policies also restricts
access to treatment for thousands of people in desperate need of
life-saving antiretroviral drugs. Failure to provide sufficient
information to public sector physicians, AIDS service organizations
and networks of PLWHA on national standards for ART , and specifically
on the necessity and role of CD4 tests (a marker of immune system
function) in the eligibility criteria for ART, has led to thousands
of people being turned away unnecessarily from access to ART.
The repressive
political environment in Zimbabwe has prevented activism and debate
on HIV/AIDS and human rights among civil society and PLWHA. NGOs
working on HIV/AIDS report that they face difficulties advocating
for the human rights of PLWHA and the political and economic aspects
of the pandemic because government officials and members of the
government’s Central Intelligence Organization (CIO) regularly intimidate
and harass them when they try to do so. Restrictive legislation
has also curtailed the ability of NGOs, including those working
on HIV/AIDS to work freely around the country.
Tens of thousands
of PLWHA continue to suffer from the catastrophic consequences of
the government’s program of mass evictions and demolitions (Operation
Murambatsvina) which has disrupted their lives and access to
HIV/AIDS treatment, care and support.
Further, the government’s
economically ruinous policies towards informal traders and the informal
economy have increased the risk of infection for thousands while
further imperiling the lives of those already infected with HIV.
Economic restrictions
on informal trading put in place by national government authorities,
pose a significant obstacle to the ability of PLWHA to earn a livelihood
and afford HIV/AIDS -related treatment and care. These restrictions
have also narrowed the livelihood strategies of a significant part
of the population which relies upon the informal sector most, such
as women and other poor and marginalized individuals. As a result
of these policies and discrimination against women in the workforce
generally, women in particular are left with few choices and often
engage in high risk behaviors and strategies such as "survival
sex" which put them at greater risk of HIV infection. The report
also documents the plight of women who bear the brunt of the epidemic
and are often economically insecure. Women continue to face overlapping
abuses of their human rights including domestic violence, discriminatory
legislation and violations of property and inheritance rights which
leave them vulnerable to HIV infection or unable to alleviate the
consequences of living with HIV/AIDS.
The report also
examines the role of the international donor community, which has
significantly pulled back direct assistance to Zimbabwe since 2000.
Given the enormity of the HIV/AIDS epidemic in Zimbabwe, a substantial
increase in donor funding is crucial. Increased funds from the British
and US governments, and from the Global Fund against HIV/AIDS, Malaria
and Tuberculosis, are now imminent. It is imperative that the international
donor community not allow well founded concerns about the state
of democracy in Zimbabwe to block the provision of much needed assistance
for HIV/AIDS programs in the country. At the same time international
donors should continue to call on the government of Zimbabwe to
respect human rights and provide an environment that is conducive
to effectively addressing the crisis.
The 2001 U.N.
General Assembly Special Session (UNGASS) declaration of commitment
on HIV/AIDS recognized that the realization of human rights is essential
to reducing vulnerability to HIV/AIDS and that protecting human
rights empowers people living with HIV/AIDS.
The government
of Zimbabwe risks a reversal in the progress achieved thus far in
the fight against HIV/AIDS unless it takes serious steps to address
violations of human rights and creates an environment that is conducive
to free expression and activism on human rights and HIV/AIDS. Human
Rights Watch calls on the government of Zimbabwe to meet its international
obligations and respect the rights of its citizens including PLWHA
to information, employment, freedom of expression, association and
assembly, nondiscrimination, and health. It must show its commitment
to fighting the HIV/AIDS pandemic by ensuring equitable and nondiscriminatory
access to health care for all its citizens, reversing economic policies
that have the effect of further impoverishing its poor and vulnerable
citizens, ceasing policies that prevent and restrict advocacy on
the part of people living with HIV/AIDS, and supporting the efforts
of international and local organizations working with and providing
treatment and care to PLWHA.
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