Zimbabwe’s prisoners have been classified as a key population in the fight against HIV and Aids with a prevalence rate of 28% in prison, while the national average is around 14%. In a bid to get scientific evidence-based reasons for the high HIV prevalence rate in prison, the government, through the National Aids Council (NAC) in partnership with the Zimbabwe Prisons and Correctional Services, has undertaken a study to establish the cause of the high prevalence rate.
INTERVIEW: Xolisani Ncube
NAC chief executive officer Tapuwa Magure (TM) told NewsDay senior reporter, Xolisani Ncube (ND) that the study would, among other things, assist the government in making a decision on whether or not to avail condoms in prisons in a bid to end new HIV infections by 2020.
ND: Over the past 30 years, we have had the epidemic. What has been the progress in managing the HIV and Aids response for Zimbabwe? Has the Aids levy helped or it is just a tax with no benefit to the taxpayer?
TM: In the late 1990s, HIV prevalence rate (total number of people infected with HIV was around 30%, meaning for every 100 people, 30 people were infected with HIV. Today, or let me say as at December 31, 2017, the prevalence rate has dropped to 14%. The incidence rate which measures the percentage of people who are newly getting infected with HIV has dropped to 0,5% according to the Zimbabwe Demographic Health Survey. In 2017, a total of 40 500 people were newly infected with HIV, 36 700 being adults and 3 800 being children. In 2004, when the country rolled out the antiretroviral programmeme, we had 11 000 people on ART (Anti-retroviral therapy), a figure that has drastically increased over the years. By December 2017, we had more than 1,3 million people living with HIV and of those, 1,1 million were on anti-retroviral therapy (leaving a gap of 200 000 people. We are currently implementing some programmemes to identify these people and put them on ART. This gives us a coverage rate of 86%.
ND: Are all health institutions in the country initiating people on ART?
TM: To date, 100% of the public health institutions are now initiating people on ART and offering other HIV and Aids services. Zimbabwe is receiving support from Global Fund, the US government, DFID (Department for International Development) and her international donors. The other major driving force to this success is the multi-sectoral approach which we adopted. HIV and Aids are not only regarded as a health issues as HIV affects all sectors of the economy, hence the approach to take every sector on board in the response to HIV and Aids.
ND: As a country, we are currently experiencing economic challenges. How has this affected funding for the HIV response?
TM: Zimbabwe is going through economic recovery. With an improved and performing economy, we will be able to reduce the funding gaps which we have and we will also be able to reduce the support we require from external partners. We have, however, managed to ensure universal access to HIV and Aids services with the funding we have.
ND: You have indicated that we have funding gaps. How safe are we from shortages of ARVs as a country given the current economic situation?
TM: Zimbabwe has always had enough stocks of ARVs. The few facilities which have been said to have experienced shortages were due to logistical issues. To ensure that ARVs are always available in our health facilities, we have formed community monitoring groups made up of people living with HIV at national, provincial and district levels.
These groups monitor ARV availability and other issues to do with access to treatment in their respective constituencies.
ND: Many State institutions have been rocked by allegations of corruption and abuse of office, especially with tenders. As NAC, what have you done to ensure public funds are protected and used for intended projects?
TM: NAC, as a public institution, has been audited every year by the office of the Auditor-General and these audited financial statements have been made available to the public through publishing them in our national newspapers and the electronic media. By the way, we also manage donor funds which have been audited every year by external auditors. I am happy to say that NAC has never received an adverse audit report both from the internal and external audits. The organisation has its own internal audit department which reports directly to the NAC board to ensure its independence.
ND: The United Nations Programme on HIV/Aids (UNAids) has identified gender-based violence and the prisons as key population issues that need attention, just like sex workers and cross-border traders. As NAC, what are you doing in these areas to ensure that no one is left behind?
TM: The Zimbabwe national response to HIV and Aids has always been developed to leave no one behind. We have designed special programmes with support from Global Fund and UNFPA [United Nations Population Fund] to ensure access to HIV and Aids services by the key populations who include prison inmates and sex workers. Gender-based violence (GBV) in Zimbabwe has had an impact in the response to HIV and Aids as GBV victims find it difficult to access HIV and Aids services. We have come up with the DREAMS and SISTA2SISTA, programmes which are meant to empower young women and girls and make HIV and Aids services available to them.
ND: Staff at NAC have raised sexual harassment allegations against you and your administration, how do you respond to these?
TM: As an organisation, we have also developed internal policies which guard against gender-based violence and sexual harassment at work. These policies will ensure that if any cases of GBV and sexual harassment at work place arise they will be dealt with accordingly.
ND: UNIADS has indicated that HIV response mechanisms have evolved over time. We now have pre-exposure prophylaxis and self-testing kits. As NAC and as Zimbabwe, how are we responding to the new trends in dealing with the pandemic?
TM: The HIV and Aids responses keep changing with new evidence coming out on how to combat the epidemic and as Zimbabwe we have never been left behind. pre-exposure prophylaxis is ART given to people who are at risk of contracting HIV to prevent them from getting HIV. In Zimbabwe, we have made pre-exposure prophylaxis available to our key populations including sex workers, whose HIV prevalence rate is above 60%. Self-testing is a potentially very useful emerging approach to HIV testing. Zimbabwe has been piloting the HIV self-testing initiative in selected districts with a view to roll it out nationally if it proves working.
ND: There have been calls by HIV activists for government to distribute condoms in prisons. Lesotho has been doing this. What is Zimbabwe’s position on that?
TM: NAC, the Ministry of Health and Child Care in partnership with the Zimbabwe Prisons and Correctional Services have commissioned a study which will determine whether prison inmates are getting infected with HIV whilst in prison or not. This has been necessitated by these calls and the fact that HIV prevalence is high in prisons, standing at 28%, compared to the national average of 14%. As Zimbabwe, we will make an evidence-based intervention using the results of this study.