HIV/AIDS Pandemic and Sustainable Measures

HIV/AIDS PANDEMIC AND SUSTAINABLE MEASURES

ABSTRACT

The report will focus on the HIV/AIDs as a pandemic Global problem, the causes, why it important to address, most affected groups/gender (target groups), sustainability measures being implemented. Statistics from various health magazines, journals and websites have indicated that the world is taking a unified approach to eradicate HIV. The pandemic has prompted the Joint United Nations Programme on HIV and AIDS (UNAIDS) and the World Health Organization (WHO) to set global targets that are far more ambitious. One of the targets is called “90-90-90 targets”. The UNAIDS is encouraging countries to work towards this targets.

Barriers to successful implementation and eradication of the pandemic will be discussed in this paper. The paper will also focus on Zimbabwean women and young girls aged between 15-25 years as target group for discussion.

INTRDUCTION

This report will focus on Zimbabwean women as the target group for discussion. It will also review the reasons on why this particular target group has been select.

Intervention/ sustainability measures being proposed and implemented by the Zimbabwean Government to assist the international world achieve the HIV elimination targets by 2030 will be discussed.

The report will also focus on the political instability in Zimbabwe and the impact it has in the fight against elimination of HIV and the provision of a sustainable healthy services for all.

More than thirty years on after the HIV epidemic there is still no notable cure or effective vaccination. The world has united together for the past thirty years plus to find a cure. A breakthrough in the scientific world has seen the introduction of antiretroviral therapy (ART) vaccination. The ARTs have transformed what used to be a fatal disease to a chronic. The disease is now manageable and the worldwide health institutions has seen a decline in deaths and new infections.

Other intervention methods have been running concurrently with the research into HIV vaccines and vaginal microbicides. A notable breakthrough in reducing the number of HIV infections has been noted through use of the following intervention methods: voluntary male circumcision, antiretroviral to prevent mother to child transition and pre-exposure prophylaxis.

The world has united to fight this pandemic problem which has killed a lot of people young and old. The levels of infections keep going up on daily basis especially in developing countries. This is due to cultural, religious and social behavior’s/beliefs, lack of funding, economic sanctions imposed on other governments thus limiting access to foreign aid, depleted infrastructure which limits people from accessing medical attention and weak health systems (due to lack of human resources, equipment etc.)

Barriers to the intervention/sustainability measures to eradicate the pandemic will also be addressed and how this can be overcome to achieve the 90-90-90 target (elimination of HIV by 2030).

In light of the above this report will provide some recommendations for the government to implement so as to reduce the infection to the target group in Zimbabwe and other developing countries. 

HIV /Aids as a Global problem

About HIV/AIDS

HIV (Human Immuno Deficiency virus) is a virus that damages the cells in your immune system and weakens your ability to fight everyday infections and diseases. Infections that enquire are called AIDS that is (Acquired Immune Deficiency Syndrome) due to reduced body immune system which has been damaged by the HIV virus. AIDS cannot be transmitted from one person to another, but HIV virus can be. Most people won’t develop AIDS if they are diagnosed and treated early and effectively. This means they will live a normal life span.’

The body fluids of an infected person contains HIV. This includes semen, vaginal and anal fluids, blood and breast milk but it cannot be transmitted through sweat, urine and saliva.

Human Immuno Deficiency virus (HIV) is a virus that damages a type of your white blood cells in your immune system and weakens your ability to fight everyday infections and diseases (e.g. influenza, pneumonia, diarrhoea etc.)).

HIV, human immunodeficiency virus, and AIDS, acquired immunodeficiency syndrome, are diseases that attack infected human bodies by progressively weakening the immune system, according to AIDS.gov. HIV is a sexually transmitted virus and spreads through contact with infected bodily fluids. There is no cure for the disease, but it is preventable, and treatments have improved providing those afflicted with longer life expectancy than in the past.

HIV attacks the body by invading cells of the immune system, called CD4 or T cells, which the virus uses for replication, destroying the body’s healthy cells. Once the level of healthy T cells falls below 200 cells per cubic millimetre, the body becomes more susceptible to infections, and the disease progresses into AIDS. HIV spreads through direct contact with bodily fluids, such as blood, semen, rectal or vaginal fluids and breast milk, according to AIDS.gov. People become infected with the virus through unprotected sexual contact, injectable drug use, childbirth and breastfeeding, occupational exposure to infected patients or by blood transfusion.

Early diagnosis of HIV minimizes the chances of a person getting infections leading to Acquired Immune Deficiency Syndrome (AIDS). Antiretroviral drug (ARVs) suppresses the virus and improves the immune function. Advances in treatments and medical care of HIV and AIDS patients has lengthened expected life spans.

Infection can be through the following practices:

• Having unprotected sex (anal and Vaginal)
• Sharing needles, syringes and other injecting equipment.
• Mother to child during pregnancy, birth or breast milk.
• Blood transfusion

HIV/AIDS has been classified as a Global problem affecting all people from all the countries which prompted the United Nations through World Health Organisation to look for ways to eradicate or eliminate the disease. HIV/AIDS is one of the United Nations Millennium Development Goals. The following statistics shows and reflects how the HIV pandemic should be addressed to avert the total global disaster.

• HIV continues to be a major global public health issue, having claimed more than 35 million lives so far (UNAIDS (2017) ‘Ending AIDS: Progress towards the 90-90-90 targets’).
• In 2016, 1.0 million people died from HIV-related causes globally (UNAIDS (2017) ‘Ending AIDS: Progress towards the 90-90-90 targets’).
• There were approximately 36.7 million people living with HIV at the end of 2016 (UNAIDS (2017) ‘Fact Sheet 2017’).

• 1.8 Million people becoming newly infected in 2016 globally (UNAIDS (2017) ‘Fact Sheet 2017’).

• The vast majority of people living with HIV are located in low- and middle- income countries, with an estimated 25.5 million living in sub-Saharan Africa. Among this group 19.4 million are living in East and Southern Africa which saw 44% of new HIV infections globally in 2016 (UNAIDS (2017) ‘Ending AIDS: Progress towards the 90-90-90 targets’).

The Millennium Development Goals (MDGs) represent a major global health initiative that has united the international global health community. They set up targets to fight the HIV and the two targets identified by MDGs are:

• Target 6A: To have halted by 2015 and begun to reverse the spread of HIV/AIDS. (Statistics indicate 40% reduction in infections recorded by 2013) www.un.org/millenniumgoals/aids.shtml.

• Target 6B: To achieve, by 2010 universal access to treatment for HIV/AIDs for all those who need it. (Statistics indicate ARTs available to all countries including the developing) www.un.org/millenniumgoals/aids.shtml.
• The focus is to have by 2020, 90% of those living with HIV to have been diagnosed and to be on treatment. Also that 90% of those on treatment to have the viral load suppressed (UNAIDS / JC2684 (English original, October 2014).
• Target 90-90-90, to have ate 73% of the global population living with HIV to have the virus suppressed by year 2020 (UNAIDS / JC2684 (English original, October 2014).
• Total elimination of the pandemic by 2030 (UNAIDS / JC2684 (English original, October 2014), if the ambitious targets set by UNAIDS (Target 90-90-900.) are religiously followed and countries work together for a successful outcome.

Target Population

The report will target women:

1. Sexually active women with multiple partners, such as sex workers.
2. Single sexually active women.
3. Sexually active women in formal or informal relationships.

Available statistics to support the choice of the target group for discussion this paper is detailed below:

1) HIV Prevalence (%) among people 15-24 years old, by sex in selected Sub-Saharan African Countries in 2013.

2. Approximately 720,000 women in Zimbabwe are living with HIV (UNAIDS (2017) Data Book).
3. Women and young girls are at high risk to HIV infections in Zimbabwe as a result of religious and cultural beliefs. Women are the most affected group and comprise of nearly half of the population living with HIV globally.
4. According to the Global Coalition on Women and AIDS, in developing countries, where HIV infections are high women make up to 57% of the people living with HIV and three quarters of these are adolescent girls and young women aged between 15-24 in 2015.www.unwomen.org/en/what-we-do/hiv-and-aids/facts-and-figures#notes
5. East and Southern Africa, young women are likely to be infected at a younger age than their peer young men (5 to 7 years earlier). According to the United Nations News Centre(2010, 9 June) “Noting progress to date , Ban Urges greater effort against HIV/AIDS”, in 2015 approximately 4500 new infections were recorded every week and these were among young women and the new weekly infections were double the infections to recorded for young men.

Factors contributing to the increase in HIV infections in women

Biologically women are considered to be at high risk to HIV infection in heterosexual intercourse. The risk for women to get the HIV from infected partners is statistically twice in comparison to men in a similar situation.

Gender inequality and rights within relationships and marriages that exists in Zimbabwe and other parts of the Su-Saharan countries HIV infections continue to increase. A good example is that only 69% of men believe a women can refuse to engage into sexual activity with a man after discovering that the man is involved in promiscuous behavior.  In retrospect the minority, 23% of females are afraid and believe they have no rights to ask a male partner to use protection during sexual activity (Zimbabwe National Statistics Agency (2016) ‘Zimbabwe Demographic and Health Survey 2015’).

Due to poverty in developing countries men are the only gender preferred to peruse their education at the expense of a girl child. Poverty is rife and girls and women suffer the most resulting in them been taken out of school  Poverty in Zimbabwe and other Sub-Saharan continent is driving young girls/women into prostitution, early marriage or arranged marriages.

Poverty has resulted in young girls/women falling prey to the so called “sugar daddies”. Sugar daddies are older men who engage in sexual activities with young girls in return for financial gains.  This ‘sugar-daddy’ culture is contributing to the increase in HIV infections among the young girls and women as they are taken advantage of through the financial muscle. These so called sugar daddies use the financial muscles to engage into multiple sexual activities with different young women. The age difference will give the sugar daddy the power in the relationship that’s determining on whether to use protection or not. According to HIV and AIDs Zimbabwe 2016 publication “In 2015, 17% of young women aged 15-19 in Zimbabwe reported having had sex with a man 10 years older in the past 12 months”.

Sexual violence is very high in Zimbabwe and a number of cases are not reported, this is due to gender inequality. According to HIV and AIDs Zimbabwe 2016 publication “In 2015, 14% of women reported experiencing sexual violence at least once in their lifetime and 8% reported experiencing it in the last 12 months”. Married women experience high levels physical and sexual violence form their partners thus putting them at high risk of HIV infections. Use of condom in a marriage is regarded as a taboo, thus limiting women’s power to negotiate safe sexual practices.

TYPES OF INTERVENTIONS/SUSTAINABLE MEASURES

Sustainability is a critical approach to reaching and maintaining epidemic control. Understanding sustainability challenges and opportunities is important for all country-level stakeholders to know where to invest both focus and resources to accelerate progress towards sustaining control of the HIV epidemic?

How can the Government and the community implement sustainable approaches? Below are some of the important interventions required to curb spread of the HIV pandemic. These interventions will help achieve the UNAIDS (Target 90-90-900) to have Total elimination of the pandemic by 2030 UNAIDS (2016).

Source: HIV Prevention Programme Overview/Avert: https://www.avert.org/professionals/hiv-programming/prevention/overview

Government Policies, Planning and Coordination- Behavioural

Source: HIV Prevention Programme Overview/Avert: https://www.avert.org/professionals/hiv-programming/prevention/overview

Government to implement positive approach to sustainable measures such promoting behaviour changes in all walks of life and seeking the buying in from the community. The following behaviours are common in Zimbabwe and the government should work towards change.

1. Polygamy- This is a common practice which is acceptable within the Zimbabwean community. A man is allowed to have more than one wife. This has contributed to a rise in HIV infections among women. Polygamy should be abolished and anyone who want be married to a second wife should declare their status before committing to get married. Compulsory testing for HIV should be implemented as government policy.

2. Poverty elimination to reduce prostitution. Poverty elimination will reduce the financial muscles which are currently being exploited by the so called sugar daddies to infect the vulnerable young women.
3. Gender based violence to be eliminated through empowering women and encouraging them to report any kind of inappropriate sexual behaviours. Free unanimous reporting lines for women to report sexual harassment should be introduced so as to change the current behaviour of silence towards sexual abuse in all forms.

4. Encourage married couples to stay together thus eliminating the current belief or behaviour which detects that women should live in the country side and do the farming whilst men live in urban areas alone.

5. Religious beliefs- Some apostolic faith groups do not believe in seeking medical help. This will result in members of the faith group not getting tested for HIV or even getting treatment. This religious belief increases the risk of infecting the unborn babies. Infections will also occur through breast feeding. The Government should promote safe feeding programmes and also encourage the Apostolic Faith group members to get tested and also treatment early. This can be achieved through education and support of the members of the faith organisation. Prosecution of the members who denies their family members to seek medical help and attention should be introduced and made into law.

6. Raising the costs of risky behaviour. An alternative strategy to reduce risky behaviour is to make it illegal, more difficult, or costlier, for example, by enforcing laws against commercial sex or drug use, or by reducing the drug supply.

7. Encourage voluntary medical male circumcision (VMMC). This will reduce the spread of HIV. A number of young men in Zimbabwe have undergone the procedure and according to the Government statics the procedure is achieving the expected results.

8. Lowering the costs of condom use and safe injecting behaviour.

9. Genital mutilation is one of the unproven cultural factor that has led to an increase occurrence of Aids in Africa. The belief/hypothesis that intercourse with a circumcised female is conducive to an exchange of blood. This should be made a punishable offence.

10. Inheritance: It is a cultural belief/behaviour in Zimbabwe that a brother can inherit the brother’s wife when he passes on. This behaviour has been prevalent in the increase in the number of infections. This belief and cultural behaviour should be banned and made a punishable offence.
11.  Stigma and shame -People being shy to discuss about the epidemic, open up about status and getting tested. Government to encourage people to open and this can be achieved through use of media and using people living with the virus.

Government Policies, Planning and Coordination- Structural interventions

They seek to address social, economic, political or environmental issues that affect groups of people vulnerable and easily exposed to HIV infections. Addressing and focusing on these structural issues will help the Governments achieve the desirable set targets i.e. elimination of the pandemic by the year 2030.

The below diagram highlight the key structural initiatives which will be described in detail in this report.

Source: HIV Prevention Programme Overview/Avert: https://www.avert.org/professionals/hiv-programming/prevention/overview

1. Gender equality should be emphasised so that women and men can get equal opportunities to acquire education. This will eradicate stigma and discrimination.
2. Laws to protect people living with HIV and this will encourage people to open up and talk about it and live positive.
3. Eliminate and encourage safe sex by sex workers and homosexuals. Discourage discrimination of homosexuality as this is currently considered a taboo in Zimbabwe. Homosexuals are currently not protected resulting in them not coming out to get safer sex education. They fear persecution resulting in high levels of stigma among homosexuals. Laws to protect them will reduce the spread of HIV.
4. Encourage prostitutes to get tested. This intervention method will empower women to have power over a relationship and make decisions on safer sax practices. Stigma and discrimination tendencies will also be eliminated and people in the sex industry will be open to discuss their HIV status and share knowledge on issues regarding safer sex and sexual health with other women.
5. Same sex relationships and marriages not to be decriminalised including the freedom of expression through cross dressing.

 

Focus on funding on HIV/AIDs programmes.

Funding is critical to fight the epidemic, lack of funding will hinder the progressive scientific researches in finding the vaccines for the HIV, vaginal microbicides and also the implementation of other intervention methods such as: voluntary male circumcision, antiretroviral to prevent mother to child transition and pre-exposure prophylaxis.

International donors have been the major funders of the HIV intervention and research programmes to most developing countries. Focus for funding has been on the developing countries leaving some of the developed countries at risk. Recently, according to the Ministry of Health Zimbabwe report dated January 2018 the minister reported that “Zimbabwe has been successful in securing a US $ 502 million additional healthcare funding from the Global Fund to fight HIV. The grant will be implemented by the Ministry of Health and Child and Child Care (MOHCC) and UN in collaboration with Civil Society Organizations and the National AIDS Council (NAC) will support HIV, Tuberculosis and Malaria programmes for the next three years”.

Developing countries where there is a high volume of injectable drug use, they are not considered for Global Fund support (Bridge, J, et,al (2012)).

Zimbabwe is one of the developing countries which continue to benefit from the Global Fund and other Non-Governmental institutions like: Red Cross, UNICEF, USAIDS etc. To add to the funding portfolio, the introduction of AIDS levy by the Zimbabwean Government was a positive approach to support measurers to eradicate the epidemic. Employees contribute 3% towards the funding and companies also contribute their share. Fostering relationships with the international community for funding support and seeking funding from other international health organisation i.e. World Health Organisation (WHO). Engagement with the other countries for aid and information sharing.

Governments also need to invest in public goods essential to the control of HIV: monitoring infection and behaviour, providing information.

 

Provision of sufficient Health Service Delivery Systems and Access to public information including properly trained and skilled resources on the ground to implement the proposed sustainable measures

1. Improved, well equipped public health facilities –Government should make testing and counselling centre easily assessable and people not to spend a lot of time waiting for these services. Free access to health provision services, and the health facilities should be well equipped to deal with the demand and the conditions. Promote safe health care practices equally for clients and staff.
2. Counselling and Testing- a lot of people who are HIV positive do not know it. Meaning they might spread the disease unknowingly to their sex partners while they are unaware of their HIV status due to non-presence of symptoms. Partners should be encouraged to be tested every couple of months not a once off activity.
3. Effective and continuous training sufficient health workers –Health care workers such as community nurses , primary counselling to be trained to maintain confidentiality and moral support to the clients because some people refuse to get tested they are afraid of stigma and discrimination.
4. Media and social network (Facebook, twitter, Snapchat, WhatsApp, LinkedIn etc.) usage to spread the word- In some remote areas there are some place where media is not accessible so if it’s made available the community can make use of it to get the health education. Also radio and newspapers to raise awareness through phone in on radio, and interviewing people living with HIV and Aids and your organization. Free WiFi to allow easy access to health information through the internet.
5. Sex education in schools-In some remote areas its considered as a taboo to talk about sex to school children of which we have to catch them young. Some children are HIV positive from birth because they transmitted the disease from their parents and at school they may indulge in sex with other children thus spreading the disease so if they are taught at an early age they are aware of HIV and how to prevent it and also support other children who are already positive .Also, the condoms should be distributed in schools and lessons should be carried out on how to use them.
6. Road shows- They help to raise awareness of the pandemic because some people get infected because of lack of knowledge.
7. Community mobilization- engagement of the community elders and civil society leaders. The community to know the plight and problems people living with HIV and Aids experienced by their families, and help the community to look after the people who are affected. The Government should also target leadership in the community as they have touch with many people and they can take advantage of their position to convince the people. Attitudes can be changed by taking advantage of leadership in their community as they area already valued and respected people will follow the example they set and listen to their suggestions. The government should try to involve people like:

• The local mayor, ward councillors, members of parliament, traditional leaders, traditional healers, sport and cultural stars, popular business people, community organisation leaders, shop stewards, teachers and school principals, clinic and hospital administrators.

8. Easy access to condoms- People need easy access to them .A lot of condoms are distributed everyday but they end up being wasted. People should be taught how to use them properly, and how to store them and how to throw them safely after use. There is some resistance to condom use in some cultures so it is important to empower women on proper use of condom it might be male or female condom they just have to know how to use them (etu.org.za).
9. Openness should be encouraged to stop stigma and silence surrounding HIV and Aids.
10. To encourage HIV testing to all people who are sexually active and makes sure that there effective counselling that goes with the testing.
11. Ensure that individuals understand their rights and treatment modalities options once they have been diagnosed.
12. Public education –and awareness programmes- they are very effective when they consider their target group that they are focusing on and their culture ,language and attitudes .Also the right slogans messages to really influence and convince the target group, the right methods should also be considered, they also need proper planning of resources.
13. Awareness campaign-are done to make people understand and change their attitude and issues to be made visible. Health workers/personnel to be sensitive by the way you campaign and the message must reach thousands of people. The people can be turned away by aggressive or negative campaigns. Positive campaigns should include some of the following:

• Aids ribbons like the crowd should wear them to show their support especially local leaders.
• Banners-makes a striking banner and hang it in a clear place where many people gather like soccer match grounds.
• Posters, pamphlets to raise the issue.
• Matches, events and culture – Breaking the silence events where people living with HIV and Aids come to open up about their status and how they are living positive either through songs, plays and poems. And also to talk about their experiences.
• Prayer meetings- funerals and other community events, use these gatherings to do the HIV and AIDs campaigns as an opportunity to raise awareness.
• Door to door campaigns – Health workers should do home visits to talk to people about HIV and Aids. Get many volunteers, train them and go from door to door m an area. This is more effective to reach people who never attends events who always say they are busy. If they do not want to talk leave a pamphlet.

14. Government to run prevention and education programmes and campaigns-Educating people about HIV and AIDs how to prevent it and how it spreads and what we can do to protect ourselves. The community must be encouraged to change sexual behaviour and to practice safe sex at all times.

 

Private Sector Engagement

1. Employers to promote and support workers suffering with HIV.
2. Avoid discriminatory employment practices.
3. Promote health and wellbeing at work.
4. Assist government through funding activities
5. Support facilities and encouraging a culture of openness about the epidemic
6. Encourage employees to get tested through use of anonymous facilities where employees can discuss their status after taking an HIV test and also receive counselling without compromising their position at work.

 

 

 

Biomedical interventions

Easy access to the following drugs to infected and vulnerable population groups

1. Antiretroviral medications:
2. Pre-exposure prophylaxis (PrEP)
3. Vaginal microbicides

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BARRIERS TO SUSTAINBLE MEASURES

Funding/ Sanctions

Some political leaders and their governments are unwilling to support HIV intervention programmes due to political differences and corrupt tendencies.  Zimbabwe is one country where there has been recorded diminishing levels in funding from the international community, thus posing a threat and high risk to desire to fight the pandemic.

Currently due to poor human rights and economic status the country is only relying on donations and can assess other sources of external funding. Economic sanctions imposed on Zimbabwe are making the implementation of the HIV intervention unachievable.

The following activities have been either reduced or abandoned due to lack of funding from external donors or even private organizations:

1. Road shows to promote awareness
2. Community programmes which includes voluntary testing and counselling
3. Free treatment
4. Provision of free condoms
5. Continuous Professional development of healthcare providers
6. Ease access of post exposure prophylaxis drugs
7. Free maternity services for pregnant mothers

 

Weak Healthcare Systems

Poor health system in Zimbabwe is a big threat to the HIV elimination intervention. Zimbabwe’s health system has crumbled and very poor and the country has been experiencing a very high level of brain drain. Corruption, misadministration and poor salaries have all hindered the provision of good quality health services in Zimbabwe. The young women are the worst affected as the majority are still affected by the gender inequality and have no access to health advices and good quality education for them to make informed judgments on health issues.

Poverty is very rife with 90% unemployment record, the worst in the works and a lot of families are living below the poverty datum line. Women under these circumstances will be worst affected as they would engage into prostitution, early marriage, arranged marriages or fall prey to the so called sugar daddies. Lack of better informed health advice and health facilities to poor communities is affecting the government and the world agenda to eradicate the HIV by 2030.

External funding to facilitate construction of new health facilities, purchase the equipment for the hospital and provision of attractive salaries for the healthcare personnel. Retention of good quality healthcare should also be a top target for the government as a lot of the staff have moved to countries where they are paid well.

Infrastructure

Zimbabwean infrastructure (roads, sewage and water supply structures) have deteriorated drastically. Some areas of the country are not easily accessible. This is limiting the distribution of information regarding the pandemic. Also the implementation of some of the intervention/sustainable measure planned and advocated by the Zimbabwean Government cannot be achieved due to accessibility issues. Delivery of the AVRs and also healthcare staff employment to these rural /country side areas which are not easily accessible is a tall order to implement.

Compulsory HIV, voluntary medical male circumcision, structural and behavioural interventions will not be achieved if the road network is as bad as it is currently in Zimbabwe. Some of religious and cultural behaviours are still solid and recognised as a norm even though they are contributing to high levels of HIV infections. This is attributed to the poor road infrastructure resulting in lack of knowledge and information.

Political instability

The political scenario in Zimbabwe the country focus for this report is hindering progress in implementing HIV interventions. There is no freedom of expression at all levels and the adversarial relationship between the ruling party Zanu PF has not helped the partnership to embrace common understanding to eliminate societal issues associated with increase in HIV infections.

Common engagement and mutual trust is currently present. There is also healthcare service discrimination by current Government to members of the opposition party. This behaviour and attitude towards the majority of Zimbabweans who oppose the current ruling Zanu PF party is leaving many women who form the majority of the population at risk from HIV infection.

Human rights deprivation has resulted in sanctions being imposed against Zimbabwe. Sharing of important health information and resources will be limited and there by impacting the successful implementation of the intervention methods and achievements of the set targets.

Social, Religious and civil barriers

Polygamy is one of the social and cultural behaviours in Zimbabwe and has been practiced for a long time. The government should target to change this behaviour to eliminate the spread of HIV.  Like any business set up people are afraid of change and will take a lot of convincing for people to change.  As this is a culture which a number of tribes abide by it is going to be difficult for the government to change this behaviour. According to Zimbabwe National Statistics Agency (2012) 20% of people in a polygamous relationship were living with HIV compared to 16% in a monogamous relationship.

On a similar note the Zimbabwe National Statistics Agency (2012) noted that gender violence still persist as it a cultural belief that men have a right to have sex with their partners at any time and that beating a women is a norm in the a African culture. Use of a condom in a marriage arrangement is still regarded as a taboo. All these cultural and social rights will take a longtime to be eradicated as they are passed from one generation to another.

On the religious note, the same applies to some faith groups who are resistant to change and still believe in polygamy, not seeking medical help well not well and also marrying their underage daughters.

Unless the above behaviours and traits are made a punishable offence, these barriers to HIV eradication will never be overcome.

Legal and data collection barriers

Most countries in the Sub-Sahara criminalize homosexuality and sex workers. This practice and approach will result in stigma and the population (homosexuality and sex workers) will go underground for fear for victimization and prosecution.

Victimization and prosecution treat will force these group of people not to seek medical help thus increasing the HIV infections within as the records and data will not be available to the authorities.

Stigma and discrimination

Stigma and discrimination are some of the major traits that hinders progress in eliminating the HIV epidemic.

The following statistics below from the “Zimbabwe National Network of People living with AIDS (2014): Zimbabwe Index Research Report highlights how stigma can be a detrimental factor to fighting and elimination of HIV:

1. 65% of people living with HIV had experienced discrimination.
2.  Survey data from 2015 found 22% of women and 20% of men who were aware of HIV had discriminatory attitudes towards people living with HIV.

The following statistics below from the “Zimbabwe National Statistics Agency (2016): Zimbabwe Demographic and Healthy Survey 2105” highlights how stigma can be a detrimental factor to fighting and elimination of HIV:

1. Around 6% of women and 9% of men did not think children living with HIV should be allowed to attend school with children who are HIV negative.
2. Additionally, 19% of women and 16% of men would not buy fresh vegetables from a shopkeeper with HIV.

RESILENCE OF HIV AND AIDS AMONG WOMEN-REDUCING HIV AND AIDS RISK TO TARGET POPULATION

Community Resilience

1. Inclusion and equality-involvement in community programmes, empowerment which involves decision making in matters of household budgets and economic issues.
2. Organizational capacity- Being party to management structures responsible for deliberating issues involving (sanitation, HIV, financial structures, private sectors initiatives, infrastructure development).
3. Mobilization to effect community support and manage discriminatory behaviours. Involvement in risk assessment and vulnerability mapping.
4. Access to educational programmes, healthcare facilities and treatment.

5.  Awareness to community programmes, plans and responses within the district.

Individual Resilience

1. Social and individual aspects-Focus on gender, age, vulnerability and the support structures available to reduce the risk. Assessment of confidence, easy access to protection from community and knowledge on rights and responsibilities associated with HIV.
2. Capabilities and skills- Self rating of capabilities and self-esteem. Easy access to education to be informed of any issues involving/regarding HIV.
3. Access and Assets- Knowledge about available health services provisions, HVI status, available methods of prevention available on the market and social support schemes for people living with HIV.
4. Adequate financial support to afford the required to afford basic commodities.

 

 

 

 

CONCLUSION AND RECOMMENDATIONS

HIV INTERVENTION IMPLEMENTATION SUCCUSS

A few of the invention success statistics will be discussed in this document:

Behavioural Changes:

1.  Use of condoms increased as confirmed by the statistics below:

Population Services International (PSI) Condom Sales in Africa, 1988-1994.

SOURCE: Adapted from PSI (1994c, 1995).

2. South Africa recorded the largest condom distribution a few decades ago and doubled the distribution of male condoms.

3. Substantial increase in number of Voluntary Medical Male Circumcision (VMMC) in Mozambique from 100 performed in 2009 to approximately 200,000 in 2015.

Structural Interventaion

1. Sex Workers in Kinshasa

Population Services International (PSI) Condom Sales in Africa, 1988-1994.

SOURCE: Adapted from PSI (1994c, 1995).

Biomedical Prevention Methods

Antiretroviral medications:

Statics indicates that following a successful clinical trial in 2011, results indicated approximately a decrease of 96% in risk of infecting partners with HIV after taking ARTs.

 

Pre-exposure prophylaxis (PrEP):

Taking a dose or injecting PrEP by those not infected with HIV will reduce the risk of acquiring HVI by 90% and 70%respectively. This has been confirmed by a series of clinical trials thus confirming the effectiveness of the biomedical intervention method.

RECOMMENDATIONS TO BARRIERS

1. On drug use the governments should avoid the following measures

• Suppression of non-injecting drug use.
• Legal restrictions on the distribution and possession of needles and syringes- this will create a shortage injection equipment and encourage sharing thus increasing the risk of infection.
• Incarceration of large numbers of addicts.
• Squeezing the balloon’ of international drug distribution- drug addicts will go underground and new routes will be opened

2. Improve infrastructures for easy access and increase staff retention.
3. Improvement on remunerations-increased staff retention.
4. Improve relationships with Civil Society Organizations to break the barriers on social, cultural and religious beliefs.
5. Improve human rights so as to continue good relationships and improved funding streams from the international world.
6.  Avoid associating politics and social and healthcare provisions
7. Recognize freedom of speech and expression including the rights for homosexuals.
8. Provisions of easy accessible well equipped healthcare facilities with professional trained staff.
9. Provision of funding for research and development and also encouraging the private sector engagement.

References

1. World AIDS Day Report 1 2011
2. Zimbabwe National Statistics Agency (2016) ‘Zimbabwe Demographic and Health Survey 2015
3. UNAIDS (2017) ‘Data Book’
4. Zimbabwe National Statistics Agency (2016) ‘Zimbabwe Demographic and Health Survey 2015’
5. UNAIDS ( 2016)- Prevention Gap Report
6. Stimson GV, Des Jarlais DC, Ball A. Drug Injecting and HIV Infection: Global Dimensions and Local Responses. London: UCL Press, 1998.
7. Normand J, Vlahov D, Moses LE. Preventing HIV Transmission: The Role of Sterile Needles and Bleach. Washington, DC: National Academy Press/National Research Council/Institute of Medicine; 1995.
8. Courtwright D, Joseph H, Des Jarlais DC. Addicts Who Survived: An Oral History of Narcotic Use in America 1923-1965. Knoxville, TN: University of Tennessee Press; 1989.
9. Braithwaite RL, Hammett TM, Mayberry RM. Prisons and AIDS. A Public Health Challenge. The Jossey-Bass Health Series. San Francisco, CA: Jossey-Bass Publishers, 1996:224 pp
10. UNAIDS (2017) ‘Ending AIDS: Progress towards the 90–90–90 targets
11. 13. UNAIDS (2017) ‘Data Book’
12. Zimbabwe Ministry of Health (2016) ‘GARPR Zimbabwe Country Progress Report 2016‘[pdf]
13. 15. Busza, J. et al. (2017) ‘Good news for sex workers in Zimbabwe: how a court order improved safety in the absence of decriminalization’ J Int AIDS Soc, 20(1): 21860
14. 17. Busza, J. et al. (2017) ‘Good news for sex workers in Zimbabwe: how a court order improved safety in the absence of decriminalization’ J Int AIDS Soc, 20(1): 21860