Zimbabwe achieves universal access, but has the fight been won?


by Joshua M. Dziba, PhD and Kevin P. Monroe | HIV/AIDS|Zimbabwe Charity, INC (HAZ).

World AIDS Day, 2012.

This year, Zimbabwe marks World AIDS Day with the realization of a long sought-after milestone: the achievement of universal access to antiretroviral therapy (ART) for Zimbabweans living with HIV/AIDS.

At the beginning of October of this year, the Global Fund to Fight AIDS, Tuberculosis and Malaria announced a disbursement of US$84 million to help Zimbabwe achieve its plans for universal access to AIDS treatment by the end of 2012.  This funding, along with Zimbabwe’s own internal efforts, have made it possible to ensure that by the end of this year, at least 80% (the general definition of Universal Access) of Zimbabweans in need of ART, will have access to such therapy.  This is indeed a moment Zimbabweans all across the globe ought to pause in recognition of, and ought to celebrate.  But does this mean the country’s fight against HIV/AIDS has now been won?  Far from it!

Zimbabwe’s realization of universal access to ART for its citizens living with HIV/AIDS brings both new hope and new concerns.  To sustain the momentum that the country has demonstrated thus far in the fight against HIV/AIDS will require that we continue to embrace innovative approaches.  Some approaches may be home-grown (such as the globally acclaimed National AIDS Trust Fund, also commonly known as the AIDS Levy) and some may be derived from the international community.  Zimbabwe will need to remain vigilant in strengthening programs and services, ensuring retention in-care for patients already enrolled in care programs, and in collecting data to monitor the rate of new HIV infections and more critically, to monitor for the development of drug resistance.

The 2012 International AIDS Conference highlighted successes and advances in the global understanding of HIV/AIDS, including increased understanding of the use of HIV medications as prophylactics, understanding of the benefits of male circumcision in reducing the rates of HIV infections, the decline in the rate of Mother To Child Transmission and a greater appreciation of the ability of sero-discordant couples to give birth to healthy, HIV-negative babies, amongst other issues.  However, the hope and promise that prevail in the global fight against HIV/AIDS as we mark World AIDS Day 2012 are at risk unless we commit resources to sustain our achievements, ensure a high quality of HIV care for all who are now accessing ART, and prevent the exhaustion of HIV therapies during the lifetime of those living with HIV/AIDS.

Universal access to ART comes with a set of new and complex challenges that must be overcome.  These include:

  • the development of drug resistance, elevated when treatment plans are not followed properly or when poor treatment plans are administered
  • the need for more robust patient education and involvement in their care to ensure compliance with treatment plans
  • the need to put in place programs to help combating stigma that may be associated with taking HIV/AIDS medications and living longer lives with HIV
  • putting in place safeguards against gender inequity and/or gender bias in HIV/AIDS care and prevention programs
  • preventing domestic violence
  • increasing laboratory resources and ensuring adequate access to those resources for patients on ART, as a way of monitoring for continued effectiveness of therapy
  • securing resources to fund new prevention strategies, and
  • putting in place the infrastructure and resources to facilitate the accurate and timely access to patient data .

Zimbabwe seems to have successfully navigated issues related to the “Testing and Linkage” phase in the protracted battle against HIV/AIDS.  The nation’s efforts to encourage people to know their HIV-status have indeed been helped by the fact that once tested, individuals can now more readily be linked to the resources they need to manage an HIV positive status.  In addition to access to medications, Zimbabweans can for the most part, access sound counseling services post an HIV-positive diagnosis.

The country now faces a new challenge in what we may call the “Retention and Adherence” phase of the battle against HIV/AIDS.

Efforts during this phase of the battle are being targeted at retaining patients in care, and ensuring adherence to effective treatment plans aimed at maintaining an undetectable viral load in patients on ART.

In an ideal setting, every Zimbabwean known to be HIV positive should also be successfully maintained at an undetectable HIV viral load.  This calls for routine, complex and often costly laboratory tests on all such patients.  A recent report published on HAZ on the findings of a recent fact-finding mission to the Matebeleland South Province of Zimbabwe tells us that even with Universal Access to ART now recently achieved, the country is only now entering the fight to achieve Universal Retention and Adherence.

To compliment the enormous investments that have already been made to ensure universal access to ART for Zimbabweans, innovative approaches are now needed to safeguard the progress the country has already made.   Such approaches may perhaps include a more aggressive effort to tap into the country’s underutilized private physician capacity, to ensure that under-served populations such as those described for parts of Matebeleland South, are receiving quality care.  Mobile and scalable multidisciplinary HIV/AIDS care teams can be deployed to remote parts of the country to ensure no citizens are denied quality care due to lack of transportation.   The country may also start thinking about adopting online medical records to facilitate easier access to patient records and laboratory results.   Nutritional supplementation can be made a part of routine HIV/AIDS care, particularly in resource-limited settings.

If there is one thing that we have learned as a country over the years of fighting HIV/AIDS, it is that the greatest weapon against HIV/AIDS is an empowered and educated citizenry.  The fight against HIV/AIDS cannot be someone else’s fight.  Each and every Zimbabwean’s life is at stake, and each and every Zimbabwean has a personal responsibility towards ensuring firstly that they protect themselves against possible exposure to HIV,  but also to ensure that they help others in protecting against HIV.  HIV/AIDS|Zimbabwe Charity (HAZ) this year sought to tap into this “People Power”  by introducing the “I Am / We Are Zimbabwe AIDS Relief” (I Am ZAR / We Are ZAR) Campaign.

The “I Am ZAR” campaign is our humble effort to encourage direct participation by all Zimbabweans in Zimbabwe’s fight against HIV/AIDS.  Each of us has the capacity to engage and stay engaged by choice. One important way to start is within the family (examples: fathers ensuring their sons get accurate information about HIV prevention, personal responsibility and respect for women; families talking about deadly HIV stigma; family units knowing their HIV status, etc.).

We each have both individual and collective roles to play in making an AIDS free generation possible. This is what we at HAZ believe the global “Getting To ZERO” vision is all about.  There are many ways each of us can become part of the relief Zimbabwe requires to bring an end to AIDS and its destruction.

HAZ this year was witness to the energy and commitment of Zimbabwe’s young men and young women in the fight against HIV/AIDS. In July 2012, an event was organized by young volunteers in Mutare to engage the local community and raise awareness about how each of us can become a source of relief to the impact of AIDS in Zimbabwe.  The “HAZ Community Engagement Expo” provided us with the opportunity to demonstrate that it does not take just professionals to fight against HIV/AIDS.  The HAZ Community Engagement Expo was a fun, engaging and teaching opportunity that also served to encourage our young volunteers to step out of the shadows when it comes to relating to HIV/AIDS.

We invite you to join Zimbabwe and join us in increasing awareness on Zimbabwe’s efforts, challenges and needs in the fight against HIV/AIDS.  We welcome your engagement with our Campaign.  For example, you may submit content for publication on our website, or simply visit the site to find out what is going on in Zimbabwe’s fight with HIV/AIDS.  We offer other forms of engagement that you can learn about on our site.  And if not engagement through HAZ, we encourage you to be a part of Zimbabwe’s efforts against HIV/AIDS in any other way and with any other entity, so as to ensure that Universal Access to ART will translate into Universal Retention and Adherence, as we make our way towards getting to Zero new HIV infections, Zero discrimination and Zero AIDS-related deaths.

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