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Life
expectancy has fallen below 40 in Zimbabwe
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“When
we started in 2001, we used to move from door-to-door looking for AIDS
patients,” explains Moddie Sibanda.
“But
now because the stigma is dying slowly, many are seeking our help,” she says.
As
a member of Rival of Hope, one of many community groups that give ‘home-based
care’ to the scores of bedridden patients in Zimbabwe, Sibanda is at the
forefront in the fight against AIDS.
In
this country of 12 million people, the disease is primarily transmitted through
sexual intercourse and in some cases by infected mothers to their children
during pregnancy.
Sibanda is presently helping care for three people living with terminal
illnesses in her neighborhood. Most such patients suffer from AIDS-related
infections and have been discharged from hospitals to make way for other
patients since not much can be done for them in any case.
The
work is purely voluntary and entails counseling and, where they exist, helping
the patients’ primary care givers with moral support as well as health tips
and such essentials as antiseptic liquids and protective gloves.
Rival
of Hope operates in almost all the former townships, or working class areas, in
Bulawayo, the country’s second largest city of one million people.
AIDS Claims 3,800 Lives a Week
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Villagers
in Zimbabwe bury yet another AIDS victim |
Zimbabwe
is one of the seven countries in Southern Africa most affected by AIDS, the
present epicenter of the AIDS epidemic, which accounts for over 40 percent of
sub-Saharan Africa's HIV infections.
A
flotilla of initiatives and programmes are at play in eradicating HIV-AIDS
countrywide. But statistics on the dying are no less staggering. Each week
AIDS-related infections claim 3,800 Zimbabweans, according to the United Nations
AIDS Programme.
Years
since HIV was first detected in the 1980s, news of a death “from a short
illness” is now greeted by a knowing understanding and quiet acknowledgement
of the epidemic’s worsening onslaught.
The
local authority in Bulawayo says at 15 percent, the city’s death rate has more
than doubled since the late 1980s. “The single most important contributory
factor is the HIV epidemic,” says Bulawayo’s director of health services,
Rita Dlodlo. “HIV has and will have a profound impact on the demography of the
population in the city.”
However,
health minister Dr. David Parirenyatwa recently told State television that the
rate of HIV-AIDS prevalence had gone down over the last few years, from 34 to 26
percent in the 14 to 49 age group.
Lending
his voice, the manager of the state-run National AIDS Council programme, Herbert
Zimidzi, says contrary to widespread views that more people were getting
infected, the opposite was true.
“The
figures on HIV-AIDS infection are actually going down because society is now
more aware of the pandemic following widespread awareness campaigns by different
players,” he says.
Yet,
as life expectancy has fallen to below 40 years, many are set to die before the
situation gets under control.
Government
Overrides Patents to Make Drugs Affordable
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Almost
half of Zimbabwe’s population is in need of food aid |
Zimbabwe, which like several other countries downplayed and even denied HIV
prevalence in the initial period, has been criticized for having been too slow
to respond to the pandemic.
Early
last year, the country was poised to become the first of five African countries
to accept Thai technology transfer to begin manufacturing the generic equivalent
of the drug Fluconazole, a broad spectrum of anti-fungal medicine for use
against thrush.
This
drug was to sell at US13 cents per tablet - almost 10 times cheaper than the
pharmaceutical price.
A
few months later in May, the government decided to override patent protection on
anti-retrovirals, allowing the price of first-line AIDS cocktails recommended by
the World Health Organization to plummet from US$1,168 to US$412.
The
move, which was for a period of six months, marked the first time that a
government had gone beyond using the threat of compulsory licensing as a
negotiating tool, and actually declared that it would override patents to
increase access to needed medicines where prices were too high due to patent
protection.
Coming
at a time when the 23-year-old government was unpopular and had to contend with
a groundswell of support for opposition forces, the much-publicized gestures to
make drugs affordable were seen more as populist attempts aimed at shoring up
support.
Andrew
Moyo of the Matabeleland AIDS Council, says the government’s announcements on
AIDS drugs have not translated into improved availability or access to cheaper
drugs for people living with the HIV virus.
“Access
is still an issue, affordability is an issue, availability is an issue,” he
says. “In other words, in those six months that the government spoke about
overriding patent protection there wasn’t – and there still isn’t - an
increase of say, anti-fungal drugs or antibiotics within the nearest clinic.”
Anti-retroviral
drugs are available, but only at the few pilot sites spread around the country.
Zimbabwe’s
untenable political situation and worsening economic conditions have given rise
to food shortages, a three-figure inflation rate and 70 percent unemployment.
This means very few people have been able to take advantage of cheaper drugs,
not least those living in the rural areas and impoverished farming compounds.
A
fact-finding mission by the UN’s Food and Agriculture Organization and the
World Food Programme to Zimbabwe in May this year concluded that 5.5 million of
the country’s 12 million people were in need of food aid.
All
Hope Lies in State-Controlled AIDS Levy
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Zimbabwe
currently has 780,000 AIDS orphans |
Moyo says for a cocktail of drugs, people living with AIDS in Zimbabwe need more
than Z$200,000 (US$200) a month, when few are earning close to the living wage
of Z$123,000.
With
43 people having died of malnutrition in Bulawayo between January and April and
the WFP announcing recently that it might start giving food aid in urban areas,
there is no doubt that drug-needy AIDS patients are facing a double-edged sword.
The
only meaningful window of hope for the majority of patients comes from the AIDS
levy that all Zimbabweans in formal employment have been paying since 1999 at a
rate of 2.4 percent of their salaries.
The
takings are placed in a centralized fund managed and administered by the
government through the National AIDS Council.
The
ultimate aim of the fund is to secure a pool of cash that will go towards
cushioning the impact of the AIDS pandemic on individuals by providing them with
a dedicated source of income that would go towards people whose lives have been
affected by HIV-AIDS.
Zimudzi
says the National AIDS Council recently gave Z$1.2 billion (US$600 000) from the
AIDS levy fund to the Ministry of Health “with an instruction that this should
cascade to village-level.”
The
money, which is only for drugs that eliminate opportunistic infections and not
those that boost immunity, is in addition to the Z$2.5 billion (US$1.25m) the
Ministry received from Treasury this year.
Access
to money from the AIDS levy fund has been decentralized, allowing for the needy
to approach any councilor or village head for assistance. Every three months,
each of the country’s 84 districts receives Z$15m (US$7,500), which is meant
to assist patients and orphans. The number of AIDS orphans stands at 780,000.
“There
is a serious commitment in the ministry to provide drugs,” says Zimudzi,
adding that there was also caution in introducing patients to drugs since in the
absence of a regular supply, a patient’s condition worsens. He says the
Ministry “is looking at the larger picture.”
But,
given the magnitude of the problem, the monies allocated are a drop in the ocean
and, in a country where the government has no foreign exchange to import fuel
and power, procuring the needed AIDS drugs would be not be first priority.
As
the government struggles to deal with the impact of AIDS, worsened by the
economic climate, thousands of poor Zimbabweans whose lives could have been
prolonged by immune-boosting drugs have to look death in the eye.
In
such a situation where the system cannot cope, it is foot soldiers like Sibanda
who, despite not providing any medication themselves, have stepped in to make a
difference.
Sources:
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UN
AIDS 2002 Update, Zimbabwe
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Sarudzayi
Zindoga, ‘HIV rate falls’; July 6, 2003; The Daily News on Sunday
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Medicins
Sans Frontieres, press release, May 29, 2002
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City
of Bulawayo, 2002 Health Services Annual Report
Wilson Johwa is an independent journalist and photographer based in Zimbabwe. You can reach him at:
wilsonjohwa@yahoo.com.
