BY MOSES MUGUGUNYEKI
Tendai Runhare (not real name) and her husband were diagnosed with HIV, but decided to have children. They approached a doctor, who assured them that it was fine since Runhare’s viral load was undetectable.
Her husband accompanied her for her first antenatal appointment where they were both tested for HIV and advised to take their antiretroviral treatment correctly. They were also given medical advice to keep the mother and her baby healthy.
Unfortunately, a few days after the antenatal appointment, government announced a lockdown that was meant to reduce the spread of coronavirus.
For Runhare and her husband, this meant their antenatal appointments at St Mary’s Clinic in Chitungwiza from their newly found home in Stoneridge Park on the other side of Hunyani River were to be disrupted.
“We had just moved into our new home in Stoneridge Park, but I had registered my pregnancy at St Mary’s Clinic in Chitungwiza. This meant, we had to commute for antenatal appointments,” Runhare said.
“Unfortunately, there came Covid-19 and the lockdown. I still recall sometime in April [last year] we had an antenatal appointment and we wanted to replenish our ARV medication. There was no transport allowed to pass through a police checkpoint at the bridge. As of public transport, there was none.
“I had to send my husband on foot to get the drugs despite his condition. He brought with him the drugs, but he was told by the matron that I should have come for the routine antenatal rendezvous.”
Runhare said despite the relaxation of the travel restrictions, it was difficult for her to travel to the clinic because most of the public transport had been barred from ferrying passengers.
However, Runhare towards the end of last year delivered a baby boy at Chitungwiza Central Hospital.
Her predicament mirrors how people living with HIV and other vulnerable groups’ remain at high risk due to lack of or limited access to preventative services, as well as clinical care and treatment because of Covid-19.
Zimbabwe is one of the countries worldwide saddled with the HIV burden and, according to a recent Global Aids Monitoring Report, about 1 278 000 people in the country are living with HIV and 90% are on treatment.
However, a Zimbabwe Population-based HIV Impact Assessment survey (ZIMPHIA 2020) said 86.8% of adults living with HIV were aware of their status and of those aware of their status, 97.0% were on antiretroviral treatment. Among those on treatment, 90.3% achieved viral load suppression.
Health experts said the data demonstrates the country’s continued progress towards achieving HIV epidemic control by 2030, thanks to a comprehensive combination of high impact HIV prevention interventions the country has undertaken over the last decade.
However, the advent of Covid-19 weakened Zimbabwe’s HIV and Aids prevention and treatment programmes. There has been a diversion of human capital, equipment and other resources that were meant for the HIV programmes.
Speaking to journalists at the presentation of the Global Aids Monitoring Report in Harare on Thursday, National Aids Council (NAC) CEO Bernard Madzima said the country had made significant strides in its quest to end HIV infections by 2030 despite challenges brought about by Covid-19 and other emergencies.
“The Global Aids Monitoring Report shows that we have dramatically succeeded in bending the trajectory of the Aids epidemic, and achieved all the three 90s. I am glad to say that this has also been confirmed by the recent ZIMPHIA whose results are now out. These achievements have emboldened us to pursue the 95-95-95 as we inch towards ending Aids as a public health threat by 2030,” he said.
The three 90s approach is an agenda for quickening the pace of implementation, focus and change at the global, regional, country, province, district and city levels by 2020.
Madzima said the country’s HIV success story was a result of the comprehensive combination of high impact HIV prevention interventions, which included HIV testing services, prevention of mother-to-child infection, condom promotion and distribution, treatment as prevention, behaviour change and voluntary medical male circumcision.
According to the latest Global Aids Monitoring Report, the HIV prevalence rate in Zimbabwe is 11.9%.
The Health and Child Care ministry has over the years decentralised treatment to more than 1 600 health centres across the country, which has contributed to the closing the tap of new infections as people who are stable on treatment have low viral loads and, therefore, have less chances of transmitting HIV.
However, Zimbabwe should not sit on its laurels as ending Aids by 2030 requires commitment from everyone.
“It’s not easy to get this kind of result. It calls a lot of commitment and it’s a great milestone worth celebrating,” said Amen Mpofu, NAC monitoring and evaluation director.
Mpofu said it was still a long road to travel to get people to be fully empowered against HIV and Aids.
Health experts have always reiterated the need for people to know their status, arguing that it is the single most important intervention that allows people to live and plan their lives productively.
One such approach of achieving such a target would be for government to explore various ways and mechanisms, including sustainable financing, to enhance the national response to HIV and Aids.
“We need to move away from this donor funding and increase domestic funding for our health sector. There is need to support local manufacturing of commodities; we can’t be seen importing things like syringes or even Paracetamol,” Madzima said.
“We are happy that people in the Health ministry are coming up with policies that talk about capacitating the local manufacturing industry. The Covid-19 pandemic has taught us about this.”
Zimbabwe’s own domestic fund, the Aids Levy (National Aids Trust Fund), is inadequate to meet the country’s programming and treatment needs. The situation has been exacerbated by the current foreign currency issues. Procurement of medicines, test kits and other necessities requires foreign currency, which is in short supply in the country.
While funding is one of the major challenges for the HIV response in Zimbabwe, the donor community led by the Global Fund, and countries like the United States have made significant contributions to the HIV cause.
Through the United States President’s Emergency Plan for Aids Relief, the US has committed millions of dollars in aid to Zimbabwe for HIV prevention, care and treatment over the years.
Mpofu said NAC has capitalised on opportunity gains and integrated HIV testing with screenings for common non-communicable diseases, sexually transmitted infections, TB and others in a one-stop shop approach.
According to the Global Aids Monitoring Report, the goal of ending the Aids epidemic in Zimbabwe by 2030 is within reach, provided there is continued expansion of HIV treatment programmes and targeted HIV-testing, in the wake of Covid-19.
“There was an increase in the MTCT [mother-to-child transmission] rate between 2019 and 2020, and this may be as a result of decline in PMTCT coverage that was caused by disruption of services due to Covid-19,” Madzima said.
“Both targets for male (100m) and female (5.5m) condoms were missed and this attributed to service disruption as a result of Covid-19.
“Implementation of VMMC [voluntary medical male circumcision] was affected by the Covid-19 pandemic leading to the revision of 2020 VMMC annual procedures target from 358 000 to 90 850.”
The NAC boss said there is need to integrate HIV and Aids prevention and treatment programmes with emergencies such as Covid-19.
He said NAC was now developing electronic and print information education communication materials to raise awareness on Covid-19 and HIV as well as facilitating Covid-19 procurement of personal protective equipment.
According to Mpofu, in pursuit of the goal to achieve the 2030 target, Zimbabwe was now prioritising and scaling up high impact HIV prevention services, with particular focus on most at risk and key affected populations, including sex workers, youths, prisoners and cross-border truck drivers, as well as adolescents and young women.
Public health expert Johannes Marisa said there was need to maintain the scale-up trajectory that existed before the advent of Covid-19.
“There is need for government to stick to its pre-Covid era HIV prevention and treatment programmes. There should not be diversion of HIV resources to the Covid-19 response, otherwise we end up reversing all the gains of the HIV and Aids intervention programmes,” Marisa said.
For Runhare, she hopes there won’t be any more Covid-19 travel restrictions when she takes her now six-month-old son for medical appointments.