By Sophia Mukasa Monico – UNAIDS Country Director, Zimbabwe
The recently released UNAIDS Global AIDS Update Report “shows that there is a path that ends AIDS. Taking the path that ends AIDS ensures preparedness to address future pandemic challenges, and advance progress across the Sustainable Development Goals. The data and real-world examples set out in this report make it clear what that path is. It is not a mystery. It is a political and financial choice. HIV responses succeed when they are anchored in strong political leadership to follow the evidence; tackle the inequalities holding back progress; enable communities and civil society organizations in their vital role in the response; and ensure sufficient and sustainable funding.
Zimbabwe is on track to end AIDS by 2030 and is winning the war against HIV. The country has achieved epidemic control by 2022, whereby the new HIV infections (17 000) are less than the AIDS related deaths (20 000). It is one of the countries in the Southern African region which has reached and surpassed the 95–95–95 targets. By June 2022, 96 percent of people living with HIV know their status; 97 percent of those who know their HIV-positive status are on ART and 95 percent of people on ART are virally suppressed. The number of new HIV infections has also decreased by 78% from 78 000 in 2010 to 17 000 in 2022. These results have been achieved through governments, partners and community commitment to follow the evidence in the implementation of a combination of behavioral, biomedical, and structural prevention interventions targeted at diverse groups based on their needs as prioritized in national strategic plans.
Although there has been remarkable progress in Zimbabwe towards reaching the global targets, inequalities continue to pose barriers to accessing lifesaving services for marginalized groups such as Key Populations, Adolescent girls and Young Women and People living with HIV. The 2022 People Living with HIV Stigma Index indicated an increase in stigma and discrimination against PLHIV from 65% in 2014 to 69.7% in 2022.The country through its Zimbabwe National HIV AIDS Strategic Plan 2021 -2025 (ZNASP 2021- 2025) has identified addressing stigma and discrimination as a priority through strengthening community led responses, reporting mechanisms and developing comprehensive programmes to reduce stigma and discrimination as a critical enabler towards the agenda of eliminating AIDS as a public health threat by 2030.
Global trends show that progress has been strongest in the countries and regions that have the most financial investments, such as in Eastern and Southern Africa. The government of Zimbabwe is collecting AIDS levy which is 3% of taxable income that is channeled towards funding the HIV response. However, sustainability of the HIV response in Zimbabwe remains a cause for concern as is it heavily dependent on donor funds. More than 80% of the funding for HIV is from external funders. The country developed a sustainability road map to eliminate HIV as a public health threat. The options identified for generating additional revenue include:
- The expansion of the fiscal space through innovative healthcare financing mechanisms. This includes continued earmarking of specific taxes such as the AIDS levy and airtime health levy in addition to allocations from the national budget.
- Improvements on budget resource allocation inefficiencies to ensure that resources allocations have been linked to population needs and disease burden. The government will improve resource allocation and spending efficiencies remodel the public and private partnership to tap into the resources from the private sector.
Progress towards eliminating AIDS as a public health threat has been strengthened by ensuring that legal and policy frameworks do not undermine human rights, but instead enable and protect them. In 2022, Zimbabwe’s parliament repealed section 79 of the Criminal Law Code, which criminalized HIV transmission. Laws which criminalize HIV transmission have proven to be ineffective, discriminatory and undermine efforts to reduce new HIV infections. The UNAIDS Executive Director, Winnie Byanyima commended Zimbabwe for taking this important step highlighting that, “this decision strengthens the HIV response in Zimbabwe by reducing the stigma and discrimination that too often prevents vulnerable people from receiving HIV services.”
Globally, four thousand adolescent girls and young women aged 15—24 years old are newly infected with HIV every week. HIV incidence among adolescent girls and young women is more than three times higher than among their male counterparts. The HIV incidence among young women who are 15 -24 years was 0.25 which is 3.6 times higher than their male counterparts 0.07, in Zimbabwe. Deeply entrenched gender inequalities and discrimination, often combined with significant levels of poverty, increase the risk of HIV infection, among Adolescent Girls and Young Women. It is vital to advance safe societies so that young women can protect their health and wellbeing.
In 2022 the President of Zimbabwe signed into law the Marriage Act which prohibits the marriage of minors under the age of 18. This act seeks to protect young girls from the effects of child marriage, increased risk of domestic violence and sexual violence, which increase their vulnerability to HIV infection and other negative SRHR outcomes. It is critical to ensure that interventions focusing on gender transformative and social norms changes are scaled up and coordinated. Interventions aimed at increasing knowledge and utilisation of integrated HIV prevention, SRHR and SGBV services such as the Sister to Sister programme, DREAMS and SASA programmes have proven effective in reaching Adolescent Girls and Young Women with knowledge and improved access to critical lifesaving services.
Punitive laws and policies, human rights violations and discrimination continue to increase the risk of HIV transmission and sabotage efforts to control the epidemic among key populations. In Zimbabwe, HIV prevalence among Sex Workers is estimated to be 42% while prevalence among men who have sex with men is at 21.1%. Findings from the Legal and Regulatory Environment Assessment LEA indicate that that despite protective provisions in the law and policies, several laws lack alignment with the Constitution and do not address HIV, AIDS, TB health status, or the various inequalities and human rights violations experienced by people living with HIV, vulnerable populations, and key populations. The LEA provides a set of recommendations aimed at improving the legal and policy environment for Key Populations and PLHIV which include the following.
- Ensure existing constitutional human rights are enforced.
- Strengthen and monitor the implementation of health and HIV-related laws and policies and the delivery of health care, including sexual and reproductive health care and prevention, treatment and support services for people living with HIV, TB and vulnerable and key populations, including young key populations.
The country through the ZNASP 2021-2025 has committed to “ensuring that key populations receive defined accessible affordable high quality HIV services by 2025”
The obstacles in the way of progress are not fate. We can overcome them. The path that ends AIDS requires collaboration – South and North, government and communities, UN and member states together. And it requires bold leadership. The route map set out in UNAIDS new report shows how success is possible, in this decade – if we move together and with urgency. The African proverb says “If you want to go fast, go alone. If you want to go far, go together.”
