‘HIV is manageable in Zim’

By Samantha Nyamayedenga

In Zimbabwe, it is considered by some as "disease caused by promiscuity"

In Zimbabwe, it is considered by some as “disease caused by promiscuity”

When I came to the UK in September 2015 to study at the University of Sussex, I was told that the HIV medication I was on, was not available, which was frustrating.

It was frustrating because instead of taking a single pill containing different antiretroviral drugs, as I had been doing at home in Zimbabwe, I now had to take three different pills a day.

I’m in the UK studying for a Masters in Development Studies and recently we had a class discussing on what role health plays in the interaction with citizenship. The main subject was HIV, and it was interesting to see the different assumptions people make because of the difference in prevalence in HIV between countries such as the UK and Zimbabwe.

Access to antiretroviral medication

In the UK in 2014, the adult rate of HIV prevalence was 0,19 percent (AVERT) compared to 16,7 percent in Zimbabwe (UNAIDS). Furthermore, in the UK 91 percent of HIV positive adults are on treatment compared to 63,4 percent in Zimbabwe (UNAIDS).

It is well known that poverty is a driver of HIV, and of course the UK and Zimbabwe have very different economic situations which can help explain the difference in HIV statistics. Everyone in the UK, should they need it, has access to antiretrovirals which is very unlike the situation in some parts of Zimbabwe.

In the UK in 2014, only 29 children were newly diagnosed with HIV and only three children were known to have acquired HIV from their mothers (AVERT). In Zimbabwe 6,6 percent of new HIV cases were from mother-to-child transmission (UNAIDS). However, it is fair to point out the rate of babies born with HIV in 2009 was 29 percent, so progress is being made.

Failings to deal with HIV

Despite the difference in access to medication between the two countries, I have observed that both Zimbabwe and the UK share the same failures in dealing with HIV. For example, there are barriers to HIV prevention in both countries due to stigma and discrimination and lack of HIV knowledge.

HIV is still associated with certain groups of people in the UK, who consider it “the disease of the gay”. In Zimbabwe, it is considered by some as “the disease caused by promiscuity”. Therefore many people living with HIV in Zimbabwe are not keen on disclosing their status for fear of being judged.

Even though HIV seems to be under control in both countries there is still a number of people who are not aware of their HIV diagnosis. In the UK 17 percent of people living with HIV are undiagnosed and in Zimbabwe only 30 percent of young people are aware of their status. The major drivers of these situations are the lack of knowledge and stigma.

Managing HIV

In our class discussion, many people said that HIV was only manageable in the UK and nowhere else, especially Africa. Even the person who led the lecture agreed with the rest of the students. I wanted to raise my hand and tell them that I disagreed.

I wanted to tell them that I am a person living with HIV from Zimbabwe who is doing well because actually HIV is manageable in Zimbabwe. I wanted to say that my immune system is very strong thanks to the structures in place there. I did not speak up because I was afraid of generalising Zimbabwe’s situation regarding HIV. The only proof that I could provide in arguing against my fellow students was my own personal experience which I was unprepared to share.

Had I been prepared enough in sharing my story it would have gone like this: My main concern is that taking antiretroviral drugs for the rest of your life can sometimes result in treatment fatigue. What happens if the quantity of drugs you need to take increases? Is this not demoralising? I have no problem with the combination of antiretrovirals that I am currently receiving in the UK. However, when I was told I needed to take combination therapy in three drugs instead of just a single I felt disheartened. From this personal experience I learnt that we should exercise caution and try to avoid generalising HIV as only manageable in the UK. — Key Correspondent.




Reaching adolescents with HTS Information using peer to peer mobile discourse

Africaid, in collaboration with UNICEF, have embarked on an innovative project with the aim of reaching out to adolescents in all ten provinces in Zimbabwe with HIV Testing Services (HTS) information including HIV Prevention, Treatment, Care and Support through an innovative methodology (U-Report).

CATS demonstrating how they use the U-Report platform to UNICEF Chief of Communication, Victor Chinyama, at Zvandiri House ICT Lab in Avondale, Harare.

CATS demonstrating how they use the U-Report platform to UNICEF Chief of Communication, Victor Chinyama, at Zvandiri House ICT Lab in Avondale, Harare.

In March, Community Adolescents Treatment Supporters (CATS), managed to respond to 1 209 cases. U-report is a free SMS social monitoring tool for community participation, designed to address issues that the population cares about. Currently, the system has registered more than 10 648 adolescents and young people including girls and young women across Zimbabwe including those who are in remote areas.


DREAMS partners to offer comprehensive package to adolescent girls and young women through layering of services

District Administrator for Makoni, Mr Mashava welcoming  DREAMS partners and stakeholders to the planning meeting

District Administrator for Makoni, Mr Mashava welcoming
DREAMS partners and stakeholders to the planning meeting

Recently, Makoni DREAMS project Secretariat, Africaid, in collaboration with Management Sciences for Health (MSH) and National AIDS Council of Zimbabwe coordinated a district planning meeting with the aim of consolidating a work plan which will be implemented in the next 6 months.

The meeting was also attended by implementing partners ; SAfAIDS, Population Services Zimbabwe, Family AIDS Care Trust Mutare (FACT) and government ministries including the Ministry of Primary and Secondary Education, Ministry of Public Services Labour and Social Welfare and the District Administrator.

Africaid Zvandiri Programmes Manager encouraged DREAMS partners to layer services so that beneficiaries can access a comprehensive package to achieve DREAMS targets.

DREAMS partners and stakeholders during Makoni district planning Meeting.

DREAMS partners and stakeholders during Makoni district planning Meeting.


HIV stigmatisation still rampant…Early disclosure encouraged

By Shamiso Yikoniko (Published In the Sunday Mail) December 13 2015

Despite the strides in the fight against HIV, stigmatisation is still rampant and unfortunately it is not sparing children who are born with the virus.

When one acquires the virus through peri-natal transmission and lives with it through adulthood, they usually have to go through various dilemmas, ranging from status disclosure to stigmatisation. Worst still, in some communities contracting the virus is still regarded as a death sentence.

For 20-year-old Tanyaradzwa Moyo (not her real name) who shared her life experiences during the recently held International Conference on AIDS and STIs in Africa (ICASA), the journey has been a tough one.
Tanyaradzwa found out that she was living with HIV in 2007 when she was in Grade Seven.

“Having grown up a sickly and frail child, I always thought I was different from other children. The sad thing is that even my mother did not suspect HIV to be the reason behind my health problems.”

“I was attacked by herpes zoster twice, first on my right hand in 2005 and then on my left leg. On both occasions, my mother was advised to have me go for an HIV test but she ignored the advice,” added Tanyaradzwa.
Nevertheless, Tanyaradzwa’s health continued to deteriorate as she was always afflicted by several opportunistic infections.

Tanyaradzwa’s mother then took her for an HIV test at the Highfield Polyclinic and she was found to be HIV-positive.
“After being diagnosed with HIV, my mother did not tell me of my condition.

“My condition was only revealed to me when I was referred to Harare Central Hospital. Then, I didn’t know what having HIV meant, all I cared about was being well and being ‘normal’ like my peers,” Tanyaradzwa said.
She was first given cotrimoxazole for about a week while receiving counselling sessions so that she could understand her condition. Thereafter, she was put on first line treatment.
And she was well again!

But at secondary school, Tanyaradzwa faced discrimination from her peers and teachers.

“I suffered from a persistent dry cough and everyone at school suspected that I was suffering from HIV and from then on, I started facing stigma. I couldn’t make any friends at school, l couldn’t participate in any school activities and teachers would always shout at me because I was not performing well.”

“I kept asking myself why this happened to me. During that time, I thought I was the only child living with HIV. At one time I stopped taking my medication for about three to four months and I got sick again.”

Tanyaradzwa would go for treatment advice and counselling without her mother and there, she would lie that she was taking her antiretroviral medication. However, her CD4 count was telling a different story as it had dropped dramatically, which in itself is a sign of non-adherence.

“I became suicidal and all I wanted was to die. That is the reason l stopped taking medication. I was asked to bring my parents but lied that I was staying alone. I was then advised to join a support group. At first I was hesitant since I was thinking that I was the only young woman living with HIV,” she said.

It took several counselling sessions for Tanyaradzwa to agree to join a support group. She however, was pleasantly surprised to discover that people of various ages where living with HIV.

“Attending the support group restored my hope. I regained my confidence and felt that life had to go on,” Tanyaradzwa said.

“In 2009, I was put on second line treatment since first line treatment had failed. Although I had received a new lease of life, I was being monitored for adherence by a Community Adolescence Treatment Supporter.”

The Community Adolescence Treatment Supporters (CATS) programme, which is administered by an organisation called Africaid Zvandiri, was established in 2009 with the aim of providing community-based treatment, adherence, monitoring and counselling for youths living with HIV. Tanyaradzwa’s mother also got tested and was found to be HIV-positive.

“It was explained to my mother that the only way I could have contracted HIV was through mother-to-child transmission,” said Tanyaradzwa.As Tanyaradzwa grew into a woman, another challenge presented itself.

“I became interested in starting a relationship but the dilemma was how I was going to reveal my status to my partner. I have been dating this guy for three years now and I only managed to disclose my status after one-and-a half years of dating,” she explained.

“One day when I was coming from collecting my medication, my boyfriend insisted on carrying my bag. I was afraid he would open the bag and see the ARVs,” Tanyaradzwa added.

“After a week, I shared with him my life experiences and disclosed to him that I was HIV-positive. He accepted me as I am and we have bigger plans for the future together. We, however, agreed to abstain from sex until we are married.”

After realising that being HIV-positive is just a condition and not a death sentence, Tanyaradzwa dreams of becoming an HIV/Aids counsellor.

Currently, she is a volunteer with the CATS programme. In Zimbabwe, about 170 000 children below the age of 15 are living with HIV.

Early disclosure encouraged PARENTS and guardians have been urged to disclose their children’s HIV statuses from as early as five years so as to avert adolescents’ HIV mortality rate.

Thousands of young children and adolescents living with HIV have died in recent years as their parents failed to initiate them on treatment.

Lack of access to healthcare services due to either late or non-disclosure by parents has been identified as a leading cause of child mortality.Such children would have acquired the virus through peri-natal transmission.

According to the data released by Unicef last month, the number of adolescents who died from HIV-related infections has tripled in the past 15 years.

Among HIV-affected populations, adolescents are the only group whose mortality figures are not decreasing.
Experts attending the 18th edition of the International Conference on AIDS and STIs in Africa (ICASA) made a plea to guardians taking care of children living with HIV to disclose their HIV statuses early.

Dr Johnface Mdala from IntraHealth International, Namibia, said disclosure is as important as adherence.

“Earlier disclosure helps young people to learn about their condition, to develop skills to cope with their condition and to be involved meaningfully in their care and decisions about their health,” said Dr Mdala.

“In Namibia, we have developed tools aimed at tackling the matter which includes partial disclosure by the age of five years and make it a gradual process up until full disclosure by the time they reach 10 years.”

Full disclosure involves giving a child all the information about their HIV status. The information is more detailed in terms of what HIV is and how it affects the body.

“It’s encouraged for parents to use illustrations, drawings or cartoons to explain in simple ways what HIV is, how it affects the body and how ARVs work,” added Dr Mdala.

Aids is the number one cause of death among adolescents in Africa and the second leading cause of death among adolescents globally.

Africaid-Zvandiri director Ms Nicola Willis said although disclosure is a difficult process, more people are realising that the earlier, the better.

“We have come a long way in terms of people’s understanding about when is the right time to inform a child that he or she is HIV positive. A few years ago, it was commonly thought that disclosure should be done in late adolescence,” she said.

“We generally advocate that there is no set age at which disclosure should take place as every child has individual needs, experiences and circumstances. Most importantly, they should know their HIV status, particularly if they are on ARVs as this helps to adhere better.

“However, this must be done carefully in the best interests of the child and led by the child’s family. Health care facilities across the country are being trained to support and counsel families in the disclosure process.”
Support groups have also been cited as helpful as this is a place where adolescents can come together to learn more about growing up with HIV, including adherence to ARVs.

The adolescents will also share their experiences. A Unicef official based in Tanzania, Ms Alison Jenkins weighed in to support that disclosure is the key.

“It’s important to start the disclosure process early so that the child doesn’t hear their HIV status from other sources rather than the parents or caregivers,” she said.

Disclosure is the process of informing a person about his or her HIV status.
According to the Ministry of Health and Child Care estimates, 6 176 children out of 156 718 living with Aids in the zero-14 years age group died in 2014.

In 2013, 8 741 died of HIV-related diseases.


Sex & relationships in the lives of young women living with HIV

By Sungano Bondayi

A woman living with HIV hopes to have her own family. She wants her children to be born without the virus and this is now possible with the right treatment. But when that service is non-existent in her local area, where does she stand?

Living in a world where you must rely on the people around you to accept you and your status is difficult. Sometimes you just know that it is never going to happen. For women, it is a necessity to stand together and fight for the rights of women living with HIV. This was the dialogue which was facilitated by Africaid Zvandiri on 3 December 2015, at a session during the International Conference on AIDS and STIs in Africa, focusing on sex and relationships for women living with HIV.

Maximina Jokonya , a young woman openly living with HIV, facilitated the discussion with a panel of young women from countries such as Burundi, South Africa, Uganda and Zimbabwe, who were advocating for those living with HIV. In a move to empower young HIV positive women, they discussed challenges faced by women in their diverse communities and the possible ways forward.

Addressing HIV stigma

In Uganda, the environment is sometimes not welcoming to women living with HIV, especially pregnant women living with HIV. Services for prevention of mother to child transmission of HIV have improved over the past few years, with more attention to and availability of medication for pregnant women living with HIV. However, stigma remains a real issue in the community, including in health facilities where women go to get the care and support they need to stay healthy.

There was a strong call for women living with HIV to involve their partners since for some, it could lessen the burden and helps their partners better understand the different issues women face. Lebohang Motsumi, the South Africa ambassador for non-governmental organisation ZAZI, (a Nguni word meaning “know yourself”), highlighted challenges women living with HIV face in their relationships.

She said: “When a guy asks you out, the first thing you think of is your HIV status.” This should not be the case, and the fact that women have to constantly think of their status in these kinds of situations is due to the stigma.

Disclosing HIV status

Claudia Nizigiyimana from Burundi spoke about women understanding their rights. “If people know your status and they see you in a relationship they start saying that you want to kill your boyfriend with your virus.” Most young women in Burundi want to disclose their status to their partners but they are afraid. Even if the partner accepts it, in the end the relatives will reject the young woman based on her status, as a result these young women opt not to disclose. The fear of being the subject of gossip in the community is not flattering and they end up just flowing with the tide.

The panellists all advocated for changes in attitude towards women living with HIV. But how to make this happen is an ongoing debate.

One point agreed upon, is that the empowerment of young women living with HIV starts by sensitising the communities so that they do not threaten and discourage women from having sexual relationships. More information needs to be provided so that communities have a deeper understanding about HIV, including how it is transmitted and what services are available to support women living with HIV and their partners to enjoy fulfilling sexual relationships. And communities should advocate for youth-friendly services.

Improving sexual and reproductive health information

Young women living with HIV also need to be informed about their sexual and reproductive health, and how they can use preventive measures to avoid the transmission of HIV, the acquisition of sexually transmitted infections (STIs) and unplanned pregnancies. Health workers also need to know that women living with HIV have rights to quality and integrated sexual and reproductive services just like anyone.

Young women living with HIV need support to accept their HIV status, support each other and work together with the community. When holding support groups they should not be more focus only on those infected by HIV as this will cause them to stigmatise themselves but these groups should involve all women, it is important to include other members of the community who are negative because everyone is affected by HIV.

Ending HIV is not an individual concern, it requires a team effort. As Motsumi said: “Do not shut yourself from the world, work with the world.”


New HIV & AIDS Treatment Guidelines

HARARE – The World Health Organisation (WHO) has set new HIV and AIDS treatment and prevention guidelines to allow for early interventions once the condition is detected.

The latest information released on September 30 titled: Guidelines on when to start ART and PrEP (Pre-Exposure Prophylaxis) for HIV requires one to start anti-retroviral drug treatment upon testing HIV-positive regardless of their CD4 cell count.

It also advises countries to use HIV treatment as a prevention choice for people at high risk of infection.

Previously, ARVs were only given to HIV-positive people whose CD4 cell count had dropped to 500 and below and to vulnerable people such as children below five years, pregnant women, tuberculosis patients, and discordant couples regardless of their CD4 count.

Under the early guidelines, the first recommendation on ART initiation was based on evidence that many lives could be saved if people start treatment early, while the second guideline was based on further evidence of tenofovir — a first line ARV drug used in most countries — that it was effective in preventing HIV acquisition from an infected partner if taken as a pre-exposure prophylaxis.

“The first of these recommendations is based on evidence from clinical trials and observational studies released since 2013 showing that earlier use of ART results in better clinical outcomes for people living with HIV, compared with delayed treatment.

“The second recommendation is based on clinical trial results confirming the efficacy of the ARV drug, tenofovir for use as PrEP, to prevent people from acquiring HIV in a wide variety of settings and populations,” reads part of the guidelines.

The latest development will form part of the WHO’s revised and updated consolidated 2016 guidelines on the use of anti-retroviral drugs for treating and preventing HIV infection expected to be released during the International Conference on AIDS and STIs in Africa (ICASA) taking place here in Zimbabwe in December.

“The full update of the guidelines will consist of comprehensive clinical recommendations together with revised operational and service delivery guidance to support the implementation,” said the WHO.

Head of AIDS and TB Unit in the Ministry of Health and Child Care Dr Owen Mugurungi, said Zimbabwe welcomed these guidelines but now awaited the release of the 2016 comprehensive guidelines at ICASA.

Dr Mugurungi said the test and treat guidelines required wide consultations with stakeholders, on Monday including people living with HIV and the donor community.

If we are to adopt these guidelines, it means everyone has to be committed because this will definitely push up the figures (of people demanding ARVs),” Dr Mugurungi said.

He said there would be need for more people to get tested and to link all those tested to treatment and care.

Other stakeholders involved in HIV response also commended the WHO for the latest development, saying the guidelines would go a long way in reducing the impact of HIV and AIDS.

The executive director for Avac, a non-governmental organisation involved in HIV and AIDS advocacy, Mr Mitchell Warren, said there was need to swiftly and comprehensively fund and implement the new guidelines to begin the process towards ending AIDS.

“We can’t let these ground-breaking guidelines sit on a shelf. If taken seriously, they can help ensure that millions of people with HIV live long and healthy lives, and that millions more women and men at high risk can remain uninfected,” said Mr Warren.

He, however, said there was need for enough funding to ensure effective implementation of the guidelines.

“If fully funded and implemented, the recommendations will greatly simplify ART for people living with HIV and revolutionise prevention for people at risk. But there is much work ahead to translate them into practice, from securing resources to revamping HIV guidelines in country-after-country, to implementing comprehensive treatment and prevention programmes,” he said.

Director of Medicines Sans Frontiers’ Southern Africa medical unit, Dr Tom Ellman, said there was need for increased support from donors and governments to turn these recommendations into reality.

“HIV care has to move out of clinics and into the communities with mobilized, empowered and engaged people living with HIV that actually are part of the response. This will need effort and money, said Dr Ellman.

Dr Ellman said from his experience in Southern Africa in HIV programmes in the past 10 years, about a third of people diagnosed with HIV but not eligible to start treatment, never returned to the health facility.

“Offering such individuals treatment once they test positive could substantially reduce the number of people who may never return,” he said.

National HIV estimates show that one million people are living with HIV in Zimbabwe although infection rates are reportedly declining.

The country’s HIV prevalence rate, however, remained static at 15 percent while the number of people on anti-retroviral treatment is pegged at 63,4 percent for adults and 55 percent for children.

Source: Herald