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grave.
“The sixth grave is my nephew Thomas, who died of pneumonia in 1999.
“The other two graves are of my mother and father in law who died of natural causes, a long time ago.
“They all died of Aids-related illnesses. Since there was no medicine to treat them, we just watched them die.
“I cry each time I look at my children’s graves, their lives could have been saved.”
Painful memories of how HIV and Aids wiped out the children of Mbuya Getrude Chikonyes (74) of Seke communal lands.
In their illness, Chikonye did all she could for her ailing children.
She sat by their bedside in hospital and was with them at home when they were discharged after spending too many months there. The nurses had to create room for new patients who kept coming.
She made them drink herbal concoctions, prescribed by the village traditional doctor and when that did not work, turned to different apostolic faith churches where their frail bodies were drenched in holy water and were given holy stones to cast away “evil spirits” believed to be behind their illness. Sadly, the disease kept “devouring” them.
Until a few years back Chikonye, who now only has two children, associated HIV and Aids with instant death.
Her living son Mathias and daughter-in- law Catherine are both HIV positive and have been on treatment since 2003. Catherine has given birth to three HIV negative children, thanks to the Prevention of Mother to Child Transmission programmes.
Today, Chikonye can easily compare both sides of the pandemic. She has just realised that there is life after testing HIV positive.
Her loved ones can now get treatment, and live longer, and can now give birth to HIV negative children.
All this, she says, is a result of the effectiveness of Government initiatives and donor- funded infectious diseases programmes in Zimbabwe that came as a response to the pandemic.
“Had the programmes not come, we could all be dead,” Chikonye adds.
One such initiative that has saved her remaining children’s lives is the US President’s Emergency Plan for Aids Relief (Pepfar) which has a strong partnership with the Ministry of Health and Child Welfare and supports a range of Zimbabwe’s national HIV and Aids mitigation efforts.
In addition, Pepfar Zimbabwe works to develop the capacity of numerous local non-governmental, community and faith-based organisations.
This, many others say, has helped save thousands of lives and preventing new infections.
Zimbabwe has achieved one of the sharpest declines in HIV prevalence in Southern Africa, from 27 percent in 1997 to just over 15 percent in 2012.
The estimated number of people living with HIV was 1 242 768 in December 2012 with the National Aids Council pegging the prevalence at 15 percent.
This month, Pepfar celebrates its 10th anniversary and has awarded funding to six countries among them Zimbabwe.
The country will receive US$95 million.
Again this month, the one-millionth baby will also be born HIV-free because of Pepfar support – something unimaginable 10 years ago when the programme began.
Regional Co-ordinator, Women’s Health, HIV and Aids Southern Africa (WHHASA), and a beneficiary of PMTCT, Tendayi Westerhof, says she recognises and acknowledges that Pepfar has saved lives in many developing countries and Zimbabwe has tremendously benefited.
“The United Sates government through its agencies CDC, Usaid, the US Embassy and several others are supporting Zimbabwe in the national response to HIV and Aids and it is important that this support continues.
“Programmes on ARV treatment provision, health systems financing, social marketing of condoms, HIV testing centres, voluntary medical male circumcision and other HIV prevention strategies are among the several interventions that have been supported by this funding mechanism.
“This effort has also contributed in the decline of HIV prevalence,” she said.
She said such programmes helped her to access services for HIV prevention, treatment care and support and improvement in the quality of care services for people living with HIV.
“I benefited through the PMTCT programme where I successfully gave birth to an HIV-free baby,” she revealed.
Westerhof appreciates that the donor community is playing their part but points out that the onus is on Government to increase funding and fill in the gaps left by external funders.
“Zimbabwe is still a developing nation; though the country has an Aids levy, the fund falls short of the resources needed to effectively manage the national response in the hope that one day HIV will be completely eradicated and to improve the quality of life of people living with HIV.
“We must raise resources locally to support the national HIV response mechanisms. Resources can be raised through the vast mineral wealth in the country such as diamonds and platinum.
“One month turnover from one diamond mine can effectively support the country’s health budget for one year including HIV and Aids mitigation.
“This way we can be assured of continuity in the event that donors move out. Donor funding is not guaranteed as donors can pull out at anytime due to the worldwide economic recession and other reasons,” she suggested.
According to Westerhof, there is need for Government to put in place contingent measures of ensuring that resources are raised internally for sustainability and continuity of programmes.
“We want to see commitment to the Abuja Declaration where 15 percent of the total government budget should go towards health care for the nation to support the provision of integrated services.
“I would also like to see programmes that are aimed at addressing sexual and reproductive health and rights for women and girls, gender disparities as well as traditional and religious practices that make women and girls vulnerable to HIV and Aids and the elimination of all forms of violence against women. These areas have still not been adequately addressed,” she emphasised.
She added: “There is need for all sectors of society, especially policymakers to commit themselves to addressing adolescents` needs in a culturally appropriate and sustainable way to ensure healthy young people in Zimbabwe.”
US Embassy Pepfar co-ordinator Ms Megan Petersen said Pepfar has been supporting the Government of Zimbabwe to achieve an Aids-free generation through the scaling up of a broad range of interventions.
Explaining why the programme has been a success, she said Pepfar provides essential technical support and additional human resource capacity to the MOHCW while solidifying country ownership of the national HIV and Aids response.
Ms Petersen said from the beginning, Pepfar Zimbabwe assistance has been designed to support high impact HIV prevention, treatment, care and support interventions and utilises verifiable indicators to measure progress. Pepfar assistance also supports health systems strengthening to enhance the sustainability of HIV and other related health sector programs (such as supply chain management and medical laboratories).
As such, Zimbabwe’s Pepfar programme has been recognised for its robust co-ordination with donors and for significantly leveraging other donor support.
Achievements on the ground for the 2012 fiscal year are evident of the successes.
For instance, the number of individuals who received testing and counselling for HIV and received their test results in 2012 was 863 400.
And, an estimated 80 000 people were receiving antiretroviral treatment as of 2012.
The number of HIV positive pregnant women receiving antiretroviral prophylaxis for PMTCT in 2012 was 49 300.
Pregnant women with known HIV status (includes women who were tested for HIV and received their results) in 2012 were 448,800.
Orphans and vulnerable children who were served by an OVC programme in 2012 were 168,800.
All the above statistics could not be imagined 10 years ago.
Ms Petersen revealed that since 2004 the USG, through Pepfar, has provided nearly US$450 million to Zimbabwe to help the country combat the Aids epidemic.
“Pepfar has pledged US$95 million towards the response to HIV/Aids in Zimbabwe for 2013.
“Pepfar’s focused investments have helped to reduce HIV prevalence in the country and to increase access to life saving antiretroviral drugs and therapy.
“Additionally, the US government has contributed to increasing access to health care generally and to improve health services for other health risks, thereby helping to save lives of people stricken with other deadly diseases such as TB and malaria and working to reduce the number of women who die from childbirth complications,” she said.
Ms Petersen explained that their government also indirectly supports other assistance to the health sector in Zimbabwe.
For example, Zimbabwe has benefited substantially from grants from the Global Fund to fight Aids, TB and malaria (GF), to which the US is the largest single contributor.
To date, the US has contributed US$7,1 billion to the GF for worldwide use.
With all the success stories of programmes like Pepfar, there have been fears of what could happen if the financial rug is suddenly pulled from Zimbabwe’s feet.
Ms Petersen says like other donors to the health sector, Pepfar works closely with the MOHCW to ensure that all their programmes are integrated into the national response to HIV and Aids.
In doing so, she says, Pepfar reinforces national programming, and ensures continuity.
She also described Zimbabwe’s health programmes as generally well co-ordinated and robustly led by the MOHCW.
“Evidence-based decision making provides a solid foundation for the ministry’s policy-making and co-ordination of inputs. It is within this complex context that the US government is working to support an appropriate balance of service delivery and systems strengthening activities.
“Moreover, the Pepfar programme in Zimbabwe leverages the platforms of other bilateral and multilateral donors to maximise resources and integrate programmes within national systems,” she added.
Pepfar’s goal is to achieve results that will have broader systems strengthening effects which will enhance national systems to deliver a full package of health care that meets the needs of the Zimbabwean population.
Ms Petersen added that three Pepfar programmes, for example, are notable for their successes in Zimbabwe.
“One is the supply and distribution of condoms for the sexual prevention of HIV. Pepfar supplies roughly 98 percent of all the condoms (both male and female) brought into Zimbabwe.
“Another is a programme that supports Voluntary Counselling and Testing (VCT) through the New Start Network that delivers testing and counselling services to more than 350 000 Zimbabweans each year.
“A third is the effort to expand the availability of ART.
“Pepfar supported the MOHCW to introduce ART into the country and has expanded the assistance that purchases ART drugs from 80 000 to 140 000 patients annually,” she said.
In 2012 Pepfar Zimbabwe made vital contributions to improving the lives of people living with HIV and Aids in Zimbabwe.
Pepfar Zimbabwe provided critical support to strengthening laboratory services, health informatics, human resources development, and conduct of surveillance and program monitoring and evaluation.
“These health system-strengthening activities are vital to ensuring evidence-based programming and efficient delivery of HIV and Aids services, as well as informing the country and Pepfar how much progress has been made toward achieving global and national health goals,” Ms Petersen.
In 2012, Pepfar launched an increased effort to accelerate the expansion of PMTCT services which will allow additional support for: scaling-up ART at maternal, newborn, and child health site; increasing the reach and quality of early infant HIV diagnosis; and, assessing PMTCT program outcomes.
The overall, this initiative is designed to help improve the continuum of care for PMTCT services with the ultimate goal of assisting Zimbabwe reach its goal of virtual elimination of vertical HIV transmission by 2015.
Worldwide, Pepfar is supporting countries in providing HIV prevention, treatment, care and support to their people.
“As outlined in the Pepfar Blueprint, ‘Creating an Aids-free Generation,’ we recognise that creating an Aids-free generation is too big a task for one government or one country. It requires the world to share in the responsibility.
“We call on partner countries, other donor nations, civil society, community and faith-based organisations, the private sector, foundations, multilateral institutions and people living with HIV to join us as we each do our part.
“Additionally, countries affected by the epidemic need to commit serious domestic resources to the long-term effort to mitigate the disease,’ she said.
They are working to reduce the cost of ARVs, streamlining supply chains, and working with partner countries to increase their investments.
Pepfar is also the largest donor to the Global Fund to fight Aids Tuberculosis and Malaria.
“One-third of every dollar going into the Global Fund comes from the US government, which translates to US$7,1 billion in US funds to the Global Fund as of 2012. “Now that the Global Fund was recently renewed in Zimbabwe with funding levels of US$311 million over three years, continued support to people living with HIV has been fortified with this additional investment,” she said.
Ms Peterson said they would continue working with faith-based organisations globally, as well as in Zimbabwe. “Pepfar Zimbabwe understands the important role that faith-based organisations and leaders play in communities and consistently works with them to ensure national goals related to HIV and Aids and other public health concerns are addressed in a collaborative, holistic manner.
“Without the contributions of our faith-based partners, Pepfar could not have achieved the extraordinary global impact on the HIV and Aids epidemic over the past decade.
“Supporting antiretroviral treatment for nearly four million people living with HIV, interventions to prevent mother-to-child transmission that allowed approximately 200 000 infants to be born HIV-free in 2011 alone, care for over four million orphans and vulnerable children, faith-based organisations have been central to all of these achievements,” she said.
The faith-based organisation partners, she said, work with them in areas of the world that have been hardest hit by Aids.
In sub-Saharan Africa, it is estimated that 40 percent of health care services are provided by faith-based organisations, many of which serve the most rural areas and the most marginalised people.
Faith-based organisations have long histories and strong community roots, and a deep reservoir of trust on which to draw. Robust participation of faith-based organisations is not optional, it is essential for an effective response to Aids.
She said in its second five-year phase, Pepfar focused on supporting expanded country leadership of HIV responses – a key to long-term sustainability.
The contribution of faith-based organisations to country leadership is sometimes overlooked, but it is essential, she added.
It has not been smooth sailing as people are still dying despite such interventions.
“Creating an Aids-free generation is a new policy imperative for the United States. To be clear, we still face enormous challenges.
“Far too many people are still dying from this disease. We need to reach more people with both prevention and treatment services. But today, thanks to the remarkable scientific discoveries and the work of countless individuals, organisations and governments, an Aids-free generation is not just a rallying cry, it is a goal that is within our reach,” she said.
She said the blueprint prepared by the office of the Global Aids Co-ordinator on World Aids Day last year reflects lessons learned from many years of experience with Aids-related programmes.
“It is our ongoing commitment to support countries in building sustainable health care systems that can deliver for the long term.
“Despite ongoing challenges, the blueprint is an unequivocal message that the US commitment to the global Aids response will remain strong, comprehensive and driven by science.
“Through its continued support for scale-up of combination prevention and treatment interventions in high-burden countries, Pepfar will help countries reduce new HIV infections and decrease Aids-related mortality, while simultaneously increasing the capacity of countries to sustain and support these efforts over time.
“This USG support, in turn, will help move more countries past the programmatic tipping point in their HIV epidemics – the point at which the annual increase in new patients on ART exceeds annual new HIV infections – and put them on the path towards achieving an Aids-free generation,” she said.
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