Country situational analysis [1]

HIV prevalence is on a decline in Zimbabwe. According to 2010 UNAIDS estimates and projections, HIV prevalence in the adult population in Zimbabwe was estimated to be 23.7% in 2001, and declined to 18.4% in 2005, and 14.3 %in 2009. The adult HIV prevalence peaked in 1997 at 26.5%. Prevalence for males 15-24 peaked in 1993 at 10.6%. Similarly, in females the prevalence peaked at 26.0% in 1995.

The main conclusions of the epidemiological review attributed thedecline in HIV prevalence and incidence to change in sexual behavior specifically a decrease in number of sexual partners, increased condom use and mortality.

A decline in HIV prevalence among all pregnant women (15-49 years) in 2004 was first reported by the Ministry of Health and Child Welfare. This trend continued in 2006, with prevalence decreasing from 25.8% in 2002, 21.3% in 2004, 17.7% in 2006 to 16.1% in 2009 among antenatal clinic attendees, 15-49 years. Similar trends were also observed among younger pregnant women (15-24 years) where prevalence declined from 20.8% in 2002, 17.4% in 2004, 12.5% in 2006 to 11.6% in 2009. The above downward trend in HIV prevalence among women 15-24 may be depicting a concomitant decline in HIV incidence in the population.

According to the 2010 UNAIDS report on the global AIDS epidemic, there were 1.2 million people living with HIV in Zimbabwe at the end of 2009. The number of people on antiretroviral treatment was 218,589, which corresponds to 34% coverage of all those in need. The percentage of HIV positive pregnant women receiving antiretroviral treatment to provent mother-to-child transmission of HIV was 56% in the same period.

Key elements of the national response

The Government of Zimbabwe has continued to scale up the multi-sectoral response to HIV and AIDS based on the Zimbabwe National and HIV AIDS Strategic Plan (ZNASP) (2006-2010) that was launched in July 2006. This plan builds on lessons learnt in the implementation of the National AIDS Policy of 1999 and the National HIV and AIDS Framework (2000 -2004). The strategic plan continues to highlight HIV and AIDS as an emergency that requires Government and all stakeholders to urgently mobilize the required resources in order to fight the epidemic.

In addition to the political commitment, demonstrated through policy and national strategic frameworks, an enabling environment has also been created for HIV and AIDS advocacy. For instance the National Partnership Forum is a very active policy, advocacy and coordinating body, while the Zimbabwe AIDS Network (ZAN) brings together 400 civil society organisations that are involved in HIV and AIDS programme implementation and advocacy.

Recognizing the need to move from awareness to action Zimbabwe has established a National Behavior Change Strategy (NBCS) covering the period 2006-2010. This plan provides guidance to all stakeholders on their contributions to behavior change promotion using key prevention elements such as condom use, reducing multiple partners and promoting faithfulness as a way of addressing root causes of risk behaviors.

The NBC strategy also encompasses a plan of scale up prevention of mother-to-child transmission of HIV and strategies to reduce the incidence of HIV especially among young people aged 15-24 years.

Key achievements

• The number of people on antiretroviral therapy increased from 25,000 at the end of 2005 to 218,589 at the end of 2009
• The Zimbabwe National AIDS Council (NAC) was established in 1999 to coordinate and facilitate the national multi-sectoral response to HIV and AIDS
• The National Plan of Action for Orphans and Other Vulnerable Children (NAP FOR OVC) was launched in 2005 to guide the care and support of orphans and vulnerable children in Zimbabwe
• The National HIV and AIDS Policy for 1999-2004 was launched in 1998. It adopted all 12 International Human Rights Guidelines on HIV and spelt out key principles such as confidentiality, safe blood transmission, promotion of marital integrity, reduction of sexually transmitted infections, condoms and care for people with HIV
• The Zimbabwe Government declared HIV a national emergency in May 2003 paving the way for pharmaceutical companies to import generic drugs into the country
• The National Behavioral Change Strategy (NBCS) for the period 2006-2010 was launched in 2005. It aims at guiding systematic and strategic programming in the area of behavioral change promotion
• In early 2007 a plan of action was developed to incorporate male circumcision in the public health system

Key challenges

Economic environment

The country received limited donor funding in the period 2007-2009 and this affected the coverage of most HIV and AIDS preventive, treatment and care programmes. The inflationary pressures arising from the drought, low economic growth, high fuel prices on the international market, sanctions and high HIV and AIDS disease burden have negatively affected the effective response to HIV and AIDS in Zimbabwe. Consequently, the economic challenges encountered in the period 2000-2008 led to poverty, unemployment and international migration among the general population to levels that were unprecedented. Most women then engaged in cross border trading exposing themselves to sexual and other forms of abuse during the course of their work.

Human resources

Many health facilities in Zimbabwe were seriously and chronically short of staff as a result of low remuneration not commensurate with the prevailing economic conditions in 2008. This was also coupled with massive exodus of staff to neighboring Southern African countries and abroad. The challenges associated with staff attrition in the health sector have impacted on the quality and coverage of HIV and AIDS health programs. The shortage of equipment also made work in the health sector non-conducive leading to low morale.

Funding of the response

The global and local economic meltdown; politically-induced tension, anxiety, and uncertainty in the country; and less than optimal external donor support especially to the public sector contributed to the inadequate funding needed for the national response in 2008 and 2009. For example, many peoplel living with HIV were eligible for antiretroviral treatment were on the waiting list for antiretroviral treatment in 2008 and 2009. This is severely hindering the implementation of the ZNASP and achievement of UNGASS targets. Thus, there is need for domestic and international resource mobilization to cover the existing funding gaps.

Health system

The economic challenges that the country has gone through over the years have severely dented the country’s health system. The country’s health facilities are riling under severe shortage of essential supplies such as lab equipment, reagents, drugs, HIV and HBC test kits. Health facilities are suffering from frequent breakdowns of essential lab equipment such as CD4 machines, hematology and chemistry machines which are essential for provision of quality HIV/AIDS service. Hospitals have poor transport and communication facilities making referral of patients a challenge.

Useful links

• National Strategic Plan
• Zimbabwe National Aids Council
• PMTCT and Peadiatric Care and Treatment Fact Sheet
• 2010 UNGASS Report

Contacts