Articles

1. Introduction
The first case of AIDS in Zimbabwe was identified in 1985. HIV prevalence peaked at 29.3% in 1997, and has gradually come down to 13.71 in the 15-49 year olds. Incidence rate has also dropped from 5.6% in 1993 to the current 0.4% (Zimbabwe National Health Strategy 2009-2013).

 An estimated 1.2 million adults and children are living with HIV. Of these, about 600 000 need treatment urgently, and about 80 % of them are already on treatment. Deaths from AIDS amounted to 230 per day in 2009.

Key drivers of Zimbabwe’s epidemic include multiple concurrent partnerships, low and inconsistent levels of condom use among married couples or those in long term relationships, low rates of male circumcision and age disparate sexual relationships. The situation is exacerbated by the current harsh economic climate, high unemployment(85%), malnutrition and an under-funded health delivery system, to name but a few.

 Zimbabwe is losing its productive and economic sector to this epidemic. Our fathers, mothers, sisters,brothers, doctors, nurses, teachers, engineers, administrators, economists,lawyers, entrepreneurs, students, religious leaders, political leaders.

The epidemic’s most disturbing long-term feature is its impact on life expectancy, now at 47 years. This is presenting a serious threat to the country’s social and economic development. There is still no cure or vaccine. The only options are to prevent the further spread of HIV/AIDS, to minimise its impact, to mitigate and provide a caring and compassionate environment for those infected and affected. This calls for an expanded and intensified response to mobilise all players to take action aimed at slowing the spread of the epidemic, and managing its impact. We shall spare no energy to achieving the three zeroes: zero new HIV infections, zero stigma and discrimination, and zero HIV/AIDS deaths. 

2. Vision
Creating an AIDS free Zimbabwe.

3. Mission
Put in place policies and programmes that seek to minimise the effects of HIV and AIDS on the socio-economic development of Zimbabwe while aiming to attain minimum infection.

4. Past and Current Responses
Zimbabwe’s response to the epidemic was slow at the beginning, with a notable absence of political will and leadership.The national response then, confined the epidemic to a medical issue alone, excluding the socio-economic and developmental issues.

However, the following is acknowledged:

• Universal screening of blood by the Blood Transfusion Services (B.T.S.) since 1985.
  
  
• Phased schedule plans for creating public awareness among selected specific, population groups by the then NACP, in collaboration with civic and private sector organisations since 1987.
  
  
• The gazetted Labour Relations Code of Conduct on HIV/AIDS (SI 202/98) targeting the employment sector, with regard to discrimination practices, in the workplace, based on one’s HIV/AIDS status.
  
  
• The National HIV/AIDS policy of December 1999, co-ordinated by the NACP with valuable contributions made by many ASO’s (Aids Service Organisations) and civic groups (of concern was the slow pace and level of the policy implementation).
  
  
• Establishment of the National AIDS Council and the National Aids Trust Fund, and the introduction of the AIDS levy in January 2000 (of concern was the general politicisation of the Fund and weak mechanisms for accountability).
  
  
• Establishment of training programs for Health Care Workers in government institutions.

The highly commendable and committed responses and efforts over the years came from various private sectors and N.G.O. groups, participating actively in HIV/AIDS awareness, Sexually transmitted Infection (STI) prevention and control, condom procurement and distribution, home and community based care, counselling and impact mitigation.

While the decline in both incidence and prevalence rates have been noted, there appears to have been insufficient behaviour change to halt transmission completely. With this in mind the MDC now calls on all stakeholders, political leadership,civil society, the private and public sectors, the traditional sector and NGOs, to put HIV/AIDS crisis at the centre of the national agenda. Now is the time to act decisively. The enhanced commitment will need to be as broad as the epidemic it self and intense enough to make up for the late start.The MDC government will mobilise all the stakeholders to face the harsh realities of the epidemic head-on, and will work to drop those areas of conventional wisdom which no longer work, and differentiate clearly between myths that hold us back and proven good practice and knowledge that we should be implementing.

Confining the responsibility for HIV/AIDS solely to the health sector is seen as a major stumbling block to drastically reducing the spread of HIV and TB. HIV/AIDS must be recognised as a socio-economic and developmental crisis, as well as a health issue.

The MDC Agenda for HIV/AIDS prevention will therefore look at the socioeconomic issues, which exacerbate the spread of HIV/AIDS, including:

• The harsh economic environment.
• High unemployment (85%) and extreme poverty.
• Lack of empowerment of, and poor economic opportunities for women.
• Stigma and discrimination of those infected and affected.
• Housing insecurity and overcrowding.
• Poor water and sanitation delivery and access.
• A poorly financed health delivery system.
• The high cost of essential drugs.
• Poor and often non-existent health delivery in rural and resettlement areas.
• Break down in the rule of law resulting in condoned political crimes such as rape, torture, and physical and mental abuse.

The above elements are inextricably linked, hence the responses required to militate against the impact of the epidemic need to be multi-sectoral.

5. Shortfalls and Constraints in the national response to the epidemic;

Some of the challenges are;

• Many communities and households provide awareness and care services with grossly inadequate support.
  
  
• Poor domestic financing for the response, and over-reliance on donor funding.
  
  
• Existence of an ambient environment conducive to the spread of HIV and progression from HIV to AIDS rapidly, namely: substantial social and economic inequalities between the rich and the poor, women and men; where people lack adequate and secure housing; employment insecurity or where families are split, sometimes by their employment by the state; where parent-child and partner communication is weak; where people lack access to adequate food, are unable to access health services, and where there is political instability and a breakdown in the rule of law.

This situation represents one of the greatest challenges to a new MDC government.

6. The Way Forward
The MDC government’s position on the challenges for tackling the HIV/AIDS problem is one of recognising the importance of leadership to tap organizational capacities, in order to implement the options.The government will take immediate measures to recognize the epidemic (in policy and law) as a national emergency, in view of its devastating impact on both social and economic development.

The MDC government will ensure that the core elements of the response begin to match the scale and seriousness of the epidemic, and ensure:

• Visible and committed leadership from the top levels of government, public and private sectors, in preventing the spread of HIV, with clear assigned responsibilities for dealing with the epidemic.
  
  
• Co-ordination of a national response that involves and mobilises all social and economic institutions.
  
  
• Identifying priority areas for action for prevention and care based on best practices.
  
  
• Mobilizing resources and identifying priorities, ensuring that these reach the target groups with meaningful and effective support services.
  
  
• Providing public information to support changes in KAPB (Knowledge, Attitude, practice and Behaviour) around HIV/AIDS.
  
  
• The wider social and economic determinants of HIV/AIDS will be managed through specific programmes for improving access to education (especially for the most vulnerable), housing and health care, outlined in other policies.

Attainment of best practice in HIV Medicine as far as possible in terms of;

• Correct use of ARV’s based on current knowledge and best practice.
• Assessment of ARV resistance in the population, taking appropriate measures in light of available data.
• Establishment and sustainable support of laboratory services for the proper case management and monitoring of treatment.
• Universal access to care and treatment.

A national HIV/AIDS policy (December, 1999) was drafted involving wide stakeholder consultation.

The MDC government recognizes the valuable contributions made by many social groups in this process and does not seek to duplicate it. The national policy provides for health and human rights, policies on care for people living with HIV/AIDS,gender and workplace rights, and policies on information.

The MDC government will ensure that;

• Labour market institutions actively enforce non-discrimination in the workplace.
• Public health institutions are properly equipped to manage the epidemic.
• National campaigns are carried out to reduce the incidence of STI’s and TB.
• Increase condom distribution.
  
  
• Hospital and palliative care for people with HIV/AIDS is improved with a minimum platform of resources and professional supervision observed.
  
  
• VCT (Voluntary Testing and Counselling) facilities are increased and accessible to all population groups.
  
  
• Minimum safety standards are legislated and implemented in all settings where health care providers are in contact with body fluids, and that post exposure prophylaxis is available for all occupational exposures and other accidental exposures.
  
  
• Increased resource allocation to youth programmes to ensure that in and out of school youth have access to appropriate information on life skills, sexual and reproductive health services, counselling, VCT etc.
  
  
• Information, education, counselling, male and female condoms, and STI care services are made available to commercial sex workers.
  
  
• Appropriately strong measures are taken to prevent and penalise gender violence and sexual abuse in all forms, especially in children.
  
  
• Far greater attention is given to the risk environments that increase the spread of HIV, and in particular support more rapid and intensive housing programmes for low-income groups and sustained access to formal education for youth, particularly female adolescents.
  
  
• Public and private sector employees are not separated from their families in their employment (e.g. Teachers), that they are adequately housed and that specific measures are put in place to reduce the time of family separation, where possible.
  
  
• Ensure health service and information access for mobile workers particularly truck drivers.

The MDC government will buttress the national response by integrating HIV/AIDS measures as an employer, as a provider of essential services, and as a facilitator of social security. The government will put in place measures to implement responses to HIV/AIDS by government in all these spheres:

• MDC will take more immediate measures to recognise the HIV/AIDS epidemic as a national emergency, and to set up and support a national HIV prevention network coordinating and ratcheting up existing prevention work, procure low cost treatments for HIV related opportunistic infections, for prevention of MTCT, and post exposure prophylaxis for health workers and victims of sexual abuse and establish the clinical facilities, drug procurement channels and financing mechanisms for treatment of AIDS. The MDC government will ensure that public spending on treatments for HIV / AIDS or related infections do not only, or preferentially, reach groups that currently have better access to health services, by improving the health service infrastructure.
  
  
• The MDC government will review both the National Aids Council and the National Aids Trust Fund, which will be run by a Board of Trustees appointed by Parliament. The Trust will report annually to Parliament and will be required to obtain approval for its annual budget at the same time. The Trust will assist in financing the network of prevention programmes, the additional resources needed in the health sector to guarantee the prevention and treatment of STIs, TB and HIV related infection and the prevention of maternal to child transmission, the support of any community based caring and the support of orphan care, education and health needs. The trust funds will be disbursed through community orphan support and fostering schemes, community prevention networks, linked to multi stakeholder district AIDS Committees and to the local authority. A proportion of the funds will be applied to building or reinforcing these community-based mechanisms in all parts of the country.

In all the programmes and processes, the MDC government will open up to wider stakeholder and civil society participation. This will allow for incorporation of, and response to, community views, to tap and support community institutions, and improve reporting, monitoring and accountability to/from communities on the responses.

At the same time the MDC will participate actively in regional platforms that seek to  resources to community and public infrastructures,reduced trade, cost and tariff barriers to drugs and other inputs for AIDS management and through providing recognition of the links between AIDS and poverty.

7. Areas of Priority for Implementation in the First 180 days in Office
HIV/AIDS Programme - Whilst the existing efforts in addressing Zimbabwe HIV/AIDS are appreciated, they will be reviewed regularly in order to improve effectiveness.

Declaration of HIV/AIDS as a National Emergency/Disaster - The MDC plan is one that will distinguish the HIV / AIDS emergency from the ones catered for by the Civil Protection Act chapter 10.06. The HIV/AIDS emergency will be backed by (a different) legislation so that:

• Generic drugs can easily be imported as per the WTO position, that, countries can only import generic drugs if it/they declare, through parliament, that it is facing National Disaster. “Generic drugs cost ¼ of the trade-marked equivalent”
  
  
• Legislated declaration of emergency (complimented by the National Policy, giving guiding principles) will mobilise both financial and human resources, and leadership, as well as mainstreaming responses in all spheres of social, economic and political activities.
  
  
• The National HIV/AIDS Policy of 1999 will be reviewed through a consultative and all-inclusive approach to bring it up-to-date and provide for implementation. (Currently, the policy has seriously lacked advocacy)
  
  
• In addition to the above, an urgent all Stakeholders National Conference will be organised to streamline the co-ordination of the national implementation programme on HIV/AIDS. The programme will define roles of stakeholders and provide for stocktaking.

8. Treatment

• A policy on drug acquisition; pricing; distribution and general management will be worked out on a long-term basis.
  
  
• In the first days of administration, an expeditious move will be undertaken to ensure that appropriate anti-retrovirals are made available for those living with the virus.
  
  
• The major pharmaceutical companies will be encouraged to cheaper drugs are made available through local manufacturing of the generic forms of the proved effective ARVs. (International companies have indicated their ‘will’ to lower prices only when working in partnership with governments. However, it has not been obvious that the current Administration is playing a meaningful and consistent partnership role).
  
  
• The Treatment programme will expand the MTCT (Mother to Child Transmission) and general ARV’s programme to cover all the clinics and hospitals. The MDC governmemt  will assist in providing adequate infrastructure for optimum medical management of HIV including laboratory and radiological facilities for diagnosis and treatment of opportunistic infections and drug toxicities.
  
  
• Training in all aspects of HIV medical care will be supported for all members of the health professions i.e. Doctors, Nurses, Pharmacists etc. The MDC government will work in partnership with private sector programs already in place i.e. ZIMA (the Zimbabwe Medical Association), Government training programs and HIV Clinicians.
  
  
• In addition to the all stakeholder national programme planning and implementation, the existing VCT programme will be increased to cover the whole country, using drug and NATF resources as incentive.
  
  
• A National standard on counselling, and registration, will be established to ensure quality counselling and training.
  
  
• Sentinel testing is vital for government’s national planning purposes to facilitate and plan appropriate and timeous prevention, treatment and drug acquisition.

9. Funding
Both short term and long term programmes will be funded through the national fiscus (budget), Solidarity and Global inflows and through the National AIDS Trust Funds (NATF). A study will be commissioned on the NATF disbursement structures, as a matter of urgency:

• To do away with ‘politicisation’ of funds and eradicate power dynamics.
• To eradicate mismanagement and abuses of funds.
• To ensure transparent and accountable disbursement processes.

In the medium term, the NAC Act will be reviewed to provide for improved responsibility and accountability.

10. Conclusion
HIV and AIDS have emerged as threats towards sustainable development in Zimbabwe. Prevalence is high in the reproductive age group and is a burden on the economy. It is thus imperative that a sound policy underpinned by strong implementation structures be developed to curtail the burden on the country. This policy paper represents the MDC’s policy on dealing with the scourge of HIV and AIDS. It calls for stronger state intervention and the need to channel more resources in the fight against this pandemic.