Politics Shape War on HIV/AIDS

Thursday, 10 April, 2008

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Sue Armstrong

The 2005 Zimbabwe parliamentary election will take place against the background of the worst health crisis in the country’s history.

More than one in four of Zimbabwe’s people aged 15 to 49 are HIV-positive and therefore vulnerable to AIDS-related infections and possible death, unless a comprehensive programme of complex anti-retroviral treatment can be rolled out.

Amid the current economic and social chaos in Zimbabwe and the well documented decline in the country’s health services, it is unlikely that anti-retrovirals – the drugs which keep the virus in check but are not a cure – will become widely available in the near future.

A bid last July by Zimbabwe’s health ministry for a 516 million US dollar grant from the Global Fund to Fight AIDS, TB and Malaria, with which it would have bought anti-AIDS drugs, was rejected by fund officials for a series of reasons.

“It does not help the people of Zimbabwe to pass money through channels which are not well worked out,” said Richard Feacham, executive director of the Global Fund, which pools contributions from international donors and distributes them apolitically. “Yes, the politics of a nation plays a role when we determine that country’s application.”

In other words, Zimbabwe’s bid seems to have been turned down because the Global Fund did not trust the Zimbabwe government to ensure competent and transparent distribution of the money to non-government organisations, NGOs, designated by the fund. This is a reasonable assumption, given that the government in Harare has introduced legislation placing major restrictions on the activities of NGOs and charities, including an end to their right to receive foreign funding.

President Robert Mugabe has described such foreign funding as the “conduits or instruments of interference in our national affairs”.

Concern that the money would be misappropriated had already delayed release of another 10 million dollar AIDS grant from the Global Fund that was approved nearly three years ago.

Before the new law was implemented, Zimbabwe’s few remaining international donors of AIDS drugs and medical support had tended to bypass the government by channeling donations to locals NGOs or giving them directly to clinics or laboratories.

“It’s a Catch-22 situation that we find ourselves in,” the coordinator of a Zimbabwean home-care AIDS project told the Inter Press Service, a Rome-based news agency dedicated to reporting civil society issues. “Because of the new law, we cannot go behind the government and make independent applications. Besides, to operate in Zimbabwe as an NGO or charity organisation, we need to register, and we cannot afford to antagonise the government because they will simply deregister us.”

David Parirenyatwa, Zimbabwe’s minister of health and child welfare, said he had suspected politics would become a factor when Global Fund officials helped his department to process its earlier application. “The fund approved our first round application in 2002 and to this day we have not received that money,” he said. “They keep shifting the goalposts. By not including Zimbabwe in the initiative, the Global Fund is depriving the world of benefiting from Zimbabwean experiences.”

In the absence of massive international aid, Zimbabweans infected with HIV are doomed to distressing and shortened lives. Relief workers quoted by New York Times correspondent Sharon LaFraniere estimate that fewer than 1,000 Zimbabweans receive anti-retroviral drugs free through government or charitable programmes. And because of economic collapse and the law restricting independent foreign donations there is little hope of expanding that number in the near future.

The staggeringly high prevalence of HIV/AIDS, largely untreated, means that millions of Zimbabwean voters will be unfit to give their full attention to issues in the election and many will simply be too weak to get to polling stations.

The epidemic is killing people at a rate unprecedented since the Black Death swept through 14th century Europe. According to conservative estimates by the Geneva-based Joint United Nations Programme on HIV/AIDS, UNAIDS, an estimated 170,000 Zimbabweans died from AIDS-related illnesses in 2003 alone, the most recent period for which figures are available. That works out at 3,270 deaths a week.

The epidemic has swept away government ministers, members of parliament and countless civil servants. By some estimates HIV may have infected up to 80 per cent of the country’s armed forces.

But HIV/AIDS is unlikely to become a much-debated topic in the election campaign because of the stigma and taboo attached to the illness.

One of the very few individuals who have publicly challenged the taboo is Zimbabwe’s top model and businesswoman Tendai Westerhof, former wife of the country’s Dutch ex-soccer coach Clemens Westerhof. She has disclosed her own HIV-positive status, and in 2004 set up the Public Personalities Against AIDS Trust, which promotes openness about HIV and AIDS.

Westerhof says she has paid a price for disclosing her status, “The majority, most sections of society, thought I was lying. It’s not possible. It’s not normal for a person to disclose that they are HIV-positive. My business collapsed overnight. No single person would come into my modelling agency. Some of my models ran away. But I had to understand that it’s a process. I had to give a chance to society to understand that if a person comes out to say they are HIV-positive they need society’s help and they are also trying to help society.”

In this atmosphere of silence, the virus is eating away at the fabric of society. By 2000, Zimbabwe had already lost more than 10 per cent of its labour force to AIDS. UNAIDS and the International Labour Organisation predict that by 2015, more than 40 per cent of the country’s workers will either have died from AIDS or will be too sick to do their jobs.

Cadbury Schweppes, which has maintained a small factory in Zimbabwe despite the political and economic troubles, estimates that 25 per cent of its workers are HIV-positive. The company has introduced a comprehensive treatment programme for HIV-positive employees and their spouses, which includes the provision of anti-retroviral drugs.

The death of adults inevitably leaves destitute children. In a population of 11.5 million, there are now probably nearly 1.1 million “AIDS orphans” – that is, children who have lost one or both parents to the disease. The figure is based on a UNAIDS estimate that there were 980,000 AIDS orphans in Zimbabwe by the end of 2003, with approximately 75,000 being added to the total each year.

Grandmothers caring for ten or more of their orphaned grandchildren after the death of sons and daughters are now commonplace in Zimbabwe. So too are child-headed households. The United Nations Children's Fund, UNICEF, said in its annual report published last month that children as young as nine years old are caring for brothers and sisters or dying parents.

According to Festo Kavishe, UNICEF’s representative in Harare, “Orphans are dropping out of school, often with malnutrition, and are more likely to be involved in hazardous forms of labour, including prostitution.”

A decline in school attendance is, in fact, one of the most visible effects of the epidemic. According to the World Bank, the number of children in primary school will have shrunk by 24 per cent by 2010 compared with 2000. The problem is at least partly due to the loss of teachers to the epidemic. A study in Manicaland, eastern Zimbabwe, found that 19 per cent of male teachers and 29 per cent of female teachers were HIV-positive. The loss of teachers can be especially damaging in rural communities where primary schools depend heavily on just one or two members of staff.

To combat the epidemic Zimbabwe needs a wholesale political, economic and social transformation, but with Robert Mugabe’s ZANU PF government likely to take power for another five years from March, the prospect of reversing the tragedy in the short run is improbable.

Sue Armstrong is a freelance writer and broadcaster on science and health matters. She has written extensively on the HIV/AIDS epidemic in Africa as a consultant for the World Health Organisation and UNAIDS.