Jennifer Julliet Mugonda (51) stays in Patchway, a farming community in Kadoma, Mashonaland West province. She is married and has four children. In 2009, she tested positive for HIV. A year later she was diagnosed with Tuberculosis (TB) and got initiated on treatment.
By Michael Gwarisa
Since 2009, Jennifer has been battling a number of HIV related opportunistic infections including Cervical Cancer.
In her own words, Jennifer says she feels like the walking dead as she has failed to get cancer treatment and is now faced with the Sisyphean task of raising money to have a hysterectomy, which is a surgical procedure to remove the womb (uterus).
Jennifer’s HIV story:
“I got married at a very young age because I was an orphan,” said Jennifer. “I had two children in my marriage. However, the marriage did not last. I got into a second marriage in 2008 because I was desperate and needed a man to take care of me.
“In 2009, I fell very ill. I was also pregnant. I went to the clinic, I got tested and the results came out positive. My husband also came out positive. That is how I was initiated on treatment. I was taking Co-trimoxazole first before I got initiated on Antiretroviral Therapy (ART) in 2010 after my baby had passed on soon after birth.”
That same year after initiation on ART, Jennifer’s health deteriorated further. After making countless visits to the clinic, she decided to take a TB test and it came out positive. She was initiated on TB treatment and it took her a while to fully recover. Soon after her recovery, her husband became critically ill.
That became our lifestyle. We would fall sick one after another. It’s like we were taking turns to fall ill. The TB resurfaced again in 2020. I fell sick probably more than I was before. At this time, it was difficult to even afford nutritious foods because both I and my husband do not work.”
Jennifer’s Cervical Cancer Diagnosis
The TB relapsed again in 2022. She completed her TB treatment in September 2022. Jennifer felt some relief after completing her TB course. However, her joy was to be short-lived after it emerged that another shocker was looming on the horizon.
“In the midst of all these challenges including the recurring TB, not having enough food in the house and not having money to send my children to school, I was also diagnosed with Cervical Cancer. In 2022, while I was taking TB treatment after it had bounced back, I went for a VIAC test and it was discovered that I had cancer lesions on my cervix.
“I was referred for Cryosurgery (a treatment that uses extreme cold produced by liquid nitrogen or argon gas to destroy cancer cells and abnormal tissue). However, I failed to go for the procedure since I was bedridden and still sick with TB,” said Jennifer.
How the Health System Failed Jennifer
Feeling better, Jennifer went to the hospital where she had the cancer samples removed and sent to the laboratory in Harare. The results from the samples were sent back after three months indicating that there were some remnants of the cancer cells that were still inside her and the only way to get rid of them was through surgery or radiation combined with chemo.
“When I tried to go to Chinhoyi, I was told that the radiotherapy machine at Chinhoyi Hospital was not functioning and I had to wait for it to be fixed. That was last year, I have been waiting ever since. I bought some medications waiting for the machine to be operational. 26 January this year, I went to our local hospital where a VIAC team was conducting services, I asked them what I should do. They unfortunately told me that it was now too late, I should be booked and have my womb removed (hysterectomy) because the cancer has spread in my womb.”
Losing hope
Jennifer says all this is happening too fast and it seems there is no break for her.
“Sometimes I fail to sleep thinking what life is going to be like for my children. I am now an old woman. I am 51, I can’t work like I used to. My husband is hopeless, he actually is a charity case. I feel like I am dead already even though I am still alive and walking. I don’t even know how I will get help.”
In Zimbabwe, Cervical Cancer is the commonest female cancer and women living with HIV have a disproportionate risk of invasive cervical cancer, as they are 2–12 times more likely to develop pre-cancerous lesions.
Speaking at the National Stakeholder Feedback and Validation Meeting on Evidence Generation on Ageing Women Living with HIV in Zimbabwe, Pan-African Positive Women`s Coalition (PAPWC) National Director, Tendayi Westerhoff said women living with HIV and advanced in age were at greater risk of other comorbidities.
“Majority of members in PAPWAC are aged women. Majority of these women are on treatment but during our engagements, they are complaining that they are suffering from other health conditions such as obesity, diabetes, hypertension among other health conditions. There is no intervention that is targeting women and men ageing with HIV.
“We want to protect our young men and women living with HIV. While we appreciate that HIV affects all other at risk groups, we are saying in the interest of leaving no one behind, lets involve ageing in HIV, looking at both men and women who have aged with HIV,” said Westerhoff.
She added that ageing women face significant social, psychological and physical challenges including depression, stress, anxiety and fear, stigma and discrimination by others, inability to work due to poor health condition, loss of employment leading to a reduction in or loss of family incomes, increased health expenditure and mental health problems.
According to data, in Zimbabwe, the population of the people living with HIV aged 50 and above has steadily increased from 117,539 in 2010 to 170,513 in 2015 before rising to 248,638 in 2020 and to 286,985 in 2022 (HIV Estimates, 2023). By the year 2022, the estimated number of men above the age of 50 and living with HIV was 133, 212 and while that of women was 153, 773.
Dr Cleophas Chimbetete, a medical doctor and HIV Researcher said the HIV pandemic in Zimbabwe now wears an elderly face.
“The HIV pandemic is ageing. Why? Because we have been successful. As a nation and globally, we are doing extremely well in preventing Mother to Child transmission of HIV, therefore, less children are being born with HIV. The children feed into the adolescent population so because we have less and less children with HIV, it means less and less children with HIV will grow up to become adolescents. Which means the adolescents population with HIV is dwindling. That is good news.
“We also have adults between the ages of 15 and 49 who are living with HIV. Because we have been successful, we have stopped them from dying, they are growing old. Literature tells us that by 2030, 70-75 percent of PLHIV will be above the age of 50,” said Dr Chimbetete.
He noted that while the world is paying attention to already defined Key Populations, no one was paying attention to the elderly who are equally at high risk of getting new HIV infections. For those above 50, Dr Chimbetete said there are key issues that must be paid attention to.
“As you grow older, there is immune ageing, we know that toxicity of ART can affect the elderly. For women, ageing itself affects kidneys. As women, ageing itself leads to menopause and menopause itself leads to loss of bone mineral density. Now we bring in treatment, Tenofovir Disoproxil Fumarate affects our kidneys, it also affects our bones. These are things that we should start talking about.”
He also said there were unique clinical issues, “that can’t be ignored in those ageing with HIV for example, prolonged intake of ART leads to renal complications and in the elderly population, the risk of developing kidney challenges is very high.”
