The HIV and AIDS situation in

Zimbabwe

By

Kyamakya B. Moses
.
Institute of Statistics and Applied Economics
Makerere University
 Instructor
Prof. James P.M. Ntozi

April. 2010

Wordclay
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© Copyright 2010 Kyamakya Moses. All rights reserved.

No part of this book may be reproduced, stored in a retrieval system,

or transmitted by any means without the written permission of the
author.

First published by Wordclay on 8/27/2010.

Printed in the United States of America.

This book is printed on acid-free paper.

ii
 Table of contents
Table of contents ............................................................................. iii
List of Tables and Figures.............................................................. vi
Acronyms ........................................................................................ vii
Chapter One: Background ............................................................. 1
1.1 Introduction ............................................................................ 1
1.2 HIV/AIDS in General .............................................................. 1
1.2.2 AIDS ......................................................................................... 1
1.2.3 How HIV is spread ................................................................. 2
1.3 HIV and AIDS in Zimbabwe .................................................... 3
1.4 Demographic profile .................................................................. 4
1.5 Geographic location ................................................................... 4
Figure 1: Map of Zimbabwe and neighbouring Countries .......... 5
1.6 Summary .................................................................................... 6
Chapter Two: Routes of Transmission .......................................... 7
2.1 Introduction ............................................................................... 7
2.2 Most at Risk Populations (MARPs) ......................................... 7
Figure 2: HIV transmission mechanisms ...................................... 7
2.2.1 Heterosexual Sex ..................................................................... 8
2.2.2 Blood Transfusion and Blood Products ................................ 9
2.2.3 Injecting Drug Users (IDU).................................................... 9
2.2.4 Occupational Exposure ........................................................ 10
2.2.5 Mother-to-child transmission .............................................. 10
2.2.6 Men having sex with men (MSM) ....................................... 11
2.3 Summary .................................................................................. 11
Chapter Three: Levels, Patterns and Trends ............................. 12
3.1 Introduction ............................................................................. 13
3.2 Levels ........................................................................................ 13
3.2.1 Adult and Children HIV prevalence ................................... 13
Table 1: Adult and children HIV prevalence .............................. 13
Table 2: Estimated number of adults and children living with
HIV .................................................................................................. 14
3.2.2 Number of deaths.................................................................. 15
Table 3: Estimated number of deaths due to AIDS .................... 15
3.2.3 Number of orphans ............................................................... 16
Table 4: Estimated number of orphans (0–17) due to AIDS ..... 16
3.3 Patterns ..................................................................................... 16

iii
Figure 3: Patterns of HIV prevalence in Zimbabwe .................. 17
Figure 4: Pattern of estimated adult HIV prevalence of
Zimbabwe and neighbours ........................................................... 18
Figure 5: Trends in Adult HIV Prevalence, Zimbabwe 1970-
2015 ................................................................................................. 19
3.4.2 Young Male Adults ............................................................... 19
Figure 6: Trends in Male (15 -24) HIV Prevalence, Zimbabwe
1970-2015 ........................................................................................ 20
3.43 Young Female Adults ............................................................ 20
Figure 7: Trends in Female (15 -24 years) HIV Prevalence,
Zimbabwe 1970-2015 ..................................................................... 20
3.4.4 Antiretroviral Therapy ........................................................ 20
Figure 8: Trends in antiretroviral therapy coverage, 2004 - 2007
......................................................................................................... 21
3.5 Summary .................................................................................. 21
Chapter Four: Impact of HIV and AIDS .................................... 22
4.1 Introduction ............................................................................. 22
4.2 Health ........................................................................................ 22
4.3 Agriculture and Food security................................................ 22
4.4 Education .................................................................................. 24
4.5 Economy ................................................................................... 26
4.6 Orphans .................................................................................... 27
4.7 Gender ...................................................................................... 29
4.8 Summary .................................................................................. 31
Chapter Five: National Response ................................................. 31
5.1 Introduction ............................................................................. 31
5.2 National Policy ......................................................................... 31
5.2.1 Legal and Policy Instruments .............................................. 32
5.2.2 Human Rights and Vulnerable Populations ...................... 33
5.2.3 Macroeconomic policies ....................................................... 34
5.3 National Response.................................................................... 35
5.3.1 HIV Prevention Programmes .............................................. 35
5.3.2 Funding the Response .......................................................... 36
5.3.3 Health Sector Response ........................................................ 37
5.3.4 Provision of safe blood and blood products ....................... 38
5.3.5 Antiretroviral Therapy ........................................................ 39
5.3.6 Prevention of mother to child transmission of HIV
(PMTCT) ........................................................................................ 40
5.3.7 TB and HIV Collaborative Activities.................................. 41
iv
5.3.8 HIV Testing and Counseling Services ................................ 43
5.3.9 Orphans and Vulnerable Children ..................................... 44
5.4 Summary .................................................................................. 45
Chapter Six: Factors enabling and hindering decline of epidemic
......................................................................................................... 47
6.1 Introduction ............................................................................. 47
6.2 Factors enabling decline of epidemic ..................................... 47
6.2.1 Leadership and political commitment ................................ 47
6.2.2 Voluntary testing and counseling ........................................ 48
6.2.3 Decentralization of HIV and AIDS services ....................... 48
6.2.4 Life skills based HIV and AIDS education in schools ....... 49
6.2.5 Male Circumcision ................................................................ 50
6.2.6 Behavior Change and Communication (BCC) .................. 50
6.2.7 Interventions for Out-of-School Youths ............................. 51
6.2.8 Condom Distribution and Social Marketing ...................... 52
6.2.9 Monitoring and Evaluation (M&E) System ....................... 53
6.2.1.0 Development Partners support......................................... 54
6.3 Factors hindering decline of epidemic ................................... 55
6.3.1 Economic environment......................................................... 55
6.3.2 Human resources challenges................................................ 55
6.3.3 Limited Funding for the national HIV/AIDS response ..... 56
6.3.4 Weakened Health System..................................................... 56
6.3.5 Low reporting rates by implementing partners................. 57
6.4 Summary .................................................................................. 57
7.1 Introduction ............................................................................. 58
7.2 Summary .................................................................................. 58
7.3 Conclusions............................................................................... 58
Zimbabwe’s HIV and AIDS situation given chance of economic
stability and good leadership will be contained in the near future
given the fact that HIV trend has continuously declined. However,
the burden of orphans will increase the dependency burden on both
the community and the nation as a whole which will further
compromise national development. ................................................. 59
7.4 Recommendations .................................................................... 59
Appendix 1: AIDS spending categories ..................................... 61
Appendix 2: Financing sources and National funding matrix .. 62
Appendix 3: Selected achievements for some key OVC
indicators ........................................................................................ 62

v
Appendix 4: estimated number of deaths due to aids 1990 - 2007
......................................................................................................... 63
Appendix 5: Male condom consumption and distribution by
year .................................................................................................. 64
Appendix 6: Female condom consumption and distribution by
year .................................................................................................. 64
Appendix 7: Comparison of the PMTCT programme
performance, 2004-2008 ................................................................ 65

List of Tables and Figures

Table 4: Estimated number of orphans (0–17) due to AIDS ......................................................16

Table 2: Estimated number of adults and children living with HIV...........................................14
Table 3: Estimated number of deaths due to AIDS ....................................................................15
Table 1: Adult and children HIV prevalence ..............................................................................13

Figure 1: Map of Zimbabwe and neighbouring Countries ...........................................................5

Figure 2: HIV transmission mechanisms ......................................................................................7
Figure 3: Patterns of HIV prevalence in Zimbabwe ...................................................................17
Figure 4: Pattern of estimated adult HIV prevalence of Zimbabwe
and neighbours ............................................................................................................................18
Figure 8: Trends in antiretroviral therapy coverage, 2004 - 2007 ..............................................21
Figure 6: Trends in Male (15 -24) HIV Prevalence, Zimbabwe 1970-
2015 ............................................................................................................................................20
Figure 7: Trends in Female (15 -24 years) HIV Prevalence,
Zimbabwe 1970-2015 .................................................................................................................20
Figure 5: Trends in Adult HIV Prevalence, Zimbabwe 1970-2015 ...........................................19

vi
 Acronyms

AIDS Acquired Immuno-deficiency Syndrome

ANC Antenatal Care
ARVs Antiretroviral drugs
ART Antiretroviral therapy
BEAM Basic Education Assistance Module
BTSZ Blood Transfusion Services Zimbabwe
DfID Department for International Development
CSO Central Statistical Office
CIDA Canadian International Development Agency
DAC District AIDS Coordinator
DAAC District AIDS Action Committee
vii
EPP Estimation and Projection Package
ESP Expanded Support Programme
GFATM Global Fund to Fight against AIDS, TB and Malaria
HIV Human Immuno-deficiency Virus
HBC Home-based Care
IEC Information, Education Communication
JSI John Snow International
UNAIDS United Nations Joint Programme on HIV/AIDS
KAP Knowledge, Attitudes and Practice
M&E Monitoring and Evaluation
MoEASC Ministry of Education, Sport, Arts and Culture
MoF Ministry of Finance
MoHCW Ministry of Health and Child Welfare
MoLSS Ministry of Labour and Social Services
NAC National AIDS Council
NAP for OVC National Action Plan for Orphans and Vulnerable
Children
OI Opportunistic Infections
PSI Population Services International
PMTCT Prevention of Mother to Child Transmission
PCCs Primary care counselors
STIs Sexually Transmitted Infections
SIDA Swedish International Development Agency
TB Tuberculosis
UNICEF United Nations Children Fund
UNGASS United Nations General Assembly Special Session

viii
UNFPA United Nations Population Fund
USAID United States Agency for International Development
VCT Voluntary Counseling and Testing
ZAN Zimbabwe AIDS Network
ZBCA Zimbabwe Business Council on HIV/AIDS
ZDHS Zimbabwe Demographic and Health Survey
ZNFPC Zimbabwe National Family Planning Council
ZNNP+ Zimbabwe National Network for People Living with HIV
GOZ Government of Zimbabwe

ix
 Chapter One: Background

1.1 Introduction
This chapter comprises definitions of HIV and AIDS, how HIV and
AIDS is spread, over view of HIV and AIDS situation, demographic
profile and the geographic location of Zimbabwe.

1.2 HIV/AIDS in General

1.2.1 HIV
Human Immunodeficiency Virus (HIV) refers to the virus that
causes Acquired Immunodeficiency Syndrome (AIDS). The virus
can be transmitted from one person to another when blood, semen,
vaginal secretions or breast milk come in make contact with broken
skin or mucous. In most cases, people infected with HIV are not
aware because the symptoms are not always visible. HIV, like most
viruses, can infect the body and multiply in many cells inside the
body without causing any noticeable damage. Until the later stages
of its natural history does the virus begin to multiply, creating
disease symptom. Depending on the progression and stage of the
virus, it may develop into AIDS.

1.2.2 AIDS
Acquired immunodeficiency syndrome is the last stage of the HIV.
It has strong effect on the immune system and nervous system,
leading to the weakening of the two. As HIV attacks the immune

1
system, other illnesses begin to develop and AIDS is diagnosed
when a person has developed at least one of the several diseases
associated with the virus. These diseases vary from dementia to
sarcoma; a form of skin cancer, a major difference between HIV and
AIDS. Ultimately, a diagnosis is not made until the virus has already
progressed to AIDS due to the absence of physical symptoms with
HIV. However, the development and progression of the virus into
AIDS amplifies in third-world countries, like Zimbabwe with
famine, poor health care, low education, making the immune system
more vulnerable.

1.2.3 How HIV is spread

HIV is transmitted only through the exchange of infected body
fluids, whereby a substantial quantity of virus gains access to the T4
cells in a susceptible individual. Although the virus occurs in saliva,
tears, cerebrospinal fluid, and urine, these fluids do not pose a
significant risk because of the low concentration of the virus and the
absence of a common mechanism for them to enter the blood of
another person.

HIV occurs in relatively high concentrations in the blood, semen,

and vaginal and cervical secretions of infected individuals.
Therefore, there is a significant risk of infection when these body

2
fluids are passed directly into another person's blood or anal or
genital tract. HIV is also present in breast milk, which is a possible
vehicle of transmission to infants.

There are only three significant routes of transmission for HIV:

i.from infected blood or blood products

ii.from infected sexual fluids

iii.From infected mother to baby during pregnancy and delivery

(if a pregnant woman is HIV-positive, the baby has a one in

3 chance of being infected).

1.3 HIV and AIDS in Zimbabwe

Zimbabwe first reported case of AIDS occurred in 1985. By the end
of the 1980s, around 10% of the adult population was thought to be
infected with HIV (UNAIDS, 2009). This figure rose dramatically in
the first half of the 1990s, peaking at more than 36% between 1995
and 1997 (UNAIDS, 2009). HIV prevalence has been declining
since, making Zimbabwe one of the first African nations to witness
such a trend characterized by very high mortality combined with
declining HIV incidence, related in part to behavior change. Of the
15.6% adult population; 1.5 million Zimbabweans were reported by
Ministry of Health (MOH, 2007) to be HIV positive compared with
18.1% reported by the 2005–2006 Demographic and Health Survey
(DHS) and 1.7 million infected people reported by UNAIDS at the
end of 2005. HIV prevalence among pregnant women was reported

3
to have declined significantly in the past few years from 26% in
2002 to 18% in 2006 (UNAIDS, 2009).
Surveillance data from several studies suggest a trend of declining
prevalence, which has also been observed among both men and
women in rural areas. The World Health Organization (WHO, 2008)
reports that average life expectancy at birth for women in Zimbabwe
is 34 years, now among the lowest in the world and estimated to be
37 years for men. Food shortages, impoverishment, forced removals,
and drought have compelled hundreds of thousands of Zimbabweans
to migrate in search of livelihood opportunities (UNAIDS, 2009).

1.4 Demographic profile

Zimbabwe’s total population in 2007 was estimated at 13.3 million
with population aged 15-49 at 6.9 million and 1.7 million female
population aged 15-24. The annual population growth rate between
2005 and 2010 was estimated at 0.6% and 37% of population is in
urban areas. The country has a crude birth rate (births per 1000
population) of 27.9 and crude death rate (deaths per 1000
population) of 18.5. Maternal mortality ratio (per 100 000 live
births in 2005) was estimated at 880, life expectancy at birth (years)
in 2006 at 43 years, total fertility rate (per woman in 2006) at 3.3
and infant mortality rate (per 1000 live births in 2006) at 55 years
(UNAIDS, 2008).

1.5 Geographic location

4
Zimbabwe is a landlocked country located in Southern Africa. The
terrain consists of high plateau, with mountains in the east. Major
rivers include the Limpopo, Lundi, Save and Zambezi. The
northwestern border is defined by the Zambezi River. Victoria Falls
is a popular tourist destination on the Zambezi. Inyangani is the
country's highest point at 2592 meters above sea level. The capital
city is Harare. Other important cities are Bulawayo, Mutare, Kariba,
Gweru and Hwange, (answers.encyclopedia.com/.../countries-
border-zimbabwe-303498.html)

Figure 1: Map of Zimbabwe and neighbouring Countries

5
Source: UNAIDS, 2008

Zimbabwe is bordered on the north by Zambia, on the northeast and

east by Mozambique, on the south by South Africa, and on the
southwest and west by Botswana.

1.6 Summary
The HIV and AIDS situation in Zimbabwe though reported to be
declining is still one of the most epidemics affecting the
6
Zimbabwean population. The fact that most of its population
comprises young adults and adults, (between ages 15 – 49 age) who
are most sexually active and most at risk of contracting HIV and
AIDS portrays the task ahead for the government in curbing down
the epidemic.

Chapter Two: Routes of Transmission

2.1 Introduction
This chapter explains the various modes in which HIV is transmitted
in Zimbabwe especially among the most at risk population including
but limited to heterosexual sex, blood transfusion and blood
products, injecting drug users, occupational exposure, MTCT and
men having sex with men.

2.2 Most at Risk Populations (MARPs)

MARPs in Zimbabwe include sex workers (SWs), cross border
traders, women, young people, men who have sex with men (MSM),
mobile populations, truckers, internally displaced people, uniformed
personnel (soldiers, police, game rangers, customs and immigration
officers), prisoners, the physically challenged, survivors of rape and
sexual abuse, illegal immigrants, Injecting Drug Users (IDU).

Figure 2: HIV transmission mechanisms

7
Source: NAC, USAID, 2004

Figure 2 shows that 84% of HIV transmissions passed through

sexual contact, 15% from mother to child transmission and 1%
transmitted through other routes.
2.2.1 Heterosexual Sex
The primary mode of HIV transmission in Zimbabwe is heterosexual
contact; women are disproportionately affected by the disease.
According to UNAIDS estimates, 2008, almost 60 percent of
Zimbabwean adults living with HIV at the end of 2006 were female
This gender gap is even wider among young people; young women
make up around 77 percent of people between the ages of 15 and 24
living with HIV. There is evidence from eastern Zimbabwe that
more women and men have been avoiding sex with non regular
partners and that consistent condom use with non regular partners
increased for women from 26 percent between 1998 and 2000 to 37

8
percent between 2001 and 2003 although not for men, (USAID
Zimbabwe, HIV/AIDS Health Profile, September 2008). High-risk
groups, including migrant laborers, commercial sex workers, and
girls involved in intergenerational sexual relationships, discordant
couples, and members of the uniformed services gear up
transmission of the epidemic through heterosexual sex.

2.2.2 Blood Transfusion and Blood Products

Blood products prior to 1985 were not screened for HIV in
Zimbabwe and recipients of such products before that time are at
risk for HIV infection. Although HIV antibody tests are highly
effective, there remains the very slight possibility that the blood was
donated during the window period, or the period before HIV
antibodies are detectable, and therefore would not test positive for
HIV antibodies. Blood products such as those used by hemophiliacs
can be heat treated which kills any virus, and so may be safer than
whole blood transfusions. However, there is limited statistics on the
number of AIDS transmissions resulting from blood transfusion and
blood products, (WHO, 2008).

2.2.3 Injecting Drug Users (IDU)

This route of transmission in Zimbabwe is done by sharing of drug
works (needles, syringes, cookers, cotton) that puts a person at risk
for HIV infection. A needle that was used for an injection can have
residual infected blood in it. The next person to use the needle will

9
directly inject this residual infected blood into her/his bloodstream
either through a vein or skin popping.
Injecting drug users who use new needles or who properly clean
their works with bleach, alcohol, or peroxide (including the needle,
syringe, and cooker) and do not use anyone else's cotton or water are
not at risk for HIV transmission from drug use. In Zimbabwe, IDU’s
are considered among the most at risk populations, (WHO, 2008)

2.2.4 Occupational Exposure

Of the thousands of occupational exposure studies, there are forty
cases of transmission documented by the Center for Disease Control
[CDC]. Twenty-four of these had a documented HIV negative test at
the time of their HIV exposure. Most were from sharp injuries
(needle sticks, cuts from surgical instruments, injuries from suture
needles). This has been identified as one of the modes of AIDS
transmission in Zimbabwe, especially among health workers, sex
workers, cross border traders, mobile populations, truckers, soldiers,
police, game rangers, customs and immigration officers and
prisoners, WHO, 2008.

2.2.5 Mother-to-child transmission

In Zimbabwe, more than 17,000 children are infected with HIV
every year, the majority through mother-to-child transmission. The
provision of drugs to prevent MTCT rose from 4% in 2006 to 29%
in 2007, (www.avert.og). Although this is an encouraging scale-up,
the provision of PMTCT services remains severely limited by a lack

10
of funding, and access to nevirapine remains low. Around 120,000
children are living with HIV in Zimbabwe, most of who became
infected through mother-to-child transmission, (www.avert.og).
Infants born to HIV positive women will test HIV antibody positive
at birth due to passive immunity; being born with some of their
mother's antibodies. There have also been a small number of
documented cases of transmission from mother to child through
breast milk. In one such case, the mother was infected by a blood
transfusion after her child was born and passed the virus to the child
through breast-feeding. Risk from breast-feeding when a mother is
infected prior to pregnancy is however unclear.

2.2.6 Men having sex with men (MSM)

This has been identified as one of risky groups through which AIDS
is transmitted. An assessment of patterns, meeting points, behaviors
and size estimates of Men who have Sex with Men are yet to be
carried out in Zimbabwe.

2.3 Summary
The most frequent route of HIV transmission in Zimbabwe is sexual
contact (heterosexual) followed by mother to child transmission. The
other reported routes like blood transfusion, men having sex with
men, occupational exposure and injecting drug users are still of low

11
magnitude. Women, young, traders and sex workers are the most at
risk population in Zimbabwe.

Chapter Three: Levels, Patterns and

Trends

12
3.1 Introduction
This chapter reveals the levels, trends and patterns of HIV and AIDS
in Zimbabwe.

3.2 Levels
Zimbabwe is one of the countries in Sub-Saharan Africa that have
been worst affected by the HIV and AIDS epidemic with a projected
population of 12 million people (USAID, 2009). The estimated HIV
prevalence among adults 15 years and above was 14.3% according
to the National HIV Estimates of 2010. There were an estimated
1,187,822 adults and children that were living with HIV and AIDS
in 2009. Meanwhile, an estimated population of 389,895 adults and
children were in urgent need of antiretroviral therapy by the end of
2009, (USAID, 2009).

3.2.1 Adult and Children HIV prevalence

According to Table 1, the adult HIV prevalence was 16.1 % in 2007
and has decreased to 15.1% in 2008 and decreased to 14.3% by the
end of 2009.

Table 1: Adult and children HIV prevalence

13
Source: UNAIDS, 2009
Prevalence among males of ages 15 – 24 decreased to 3.2% in 2009
from 3.3% in 2007 and as well decreasing among females to 6.9% in
2009 from 7.6% in 2007. Prevalence among children of ages 0 – 14
decreased to 3.1% in 2009 from 3.3% in 2007, (table 1).
From 2001 to 2007, the estimated number of adults and children
with HIV was as follows; 1.3 million adults aged 15+ and children
in 2007 from 1.9 million in 2001. Only adults aged 15+ in 2007
were estimated at 1.2 million from 1.7 million in 2001. Children
aged 0 – 14 were estimated at 120,000 in 2007 from 130,000 in
2001. The adult rate (15 - 49) was estimated at 15.3% in 2007 from
26% in 2001. As well, women aged 15+ were estimated to be
680,000 in 2007 from 1 million in 2001, (table 2).

Table 2: Estimated number of adults and children living with

HIV

14
Source: UNAIDS, 2009

The estimates presented on child prevalence in table 2 are based on

PMTCT data inputs and may underestimate prevalence due to
insufficient data inputs. These estimates include all people whether
or not they have developed symptoms of AIDS

3.2.2 Number of deaths

According to Reuters 2009, a new maternal mortality study names
HIV and AIDS as the cause of one in four maternal deaths in
Zimbabwe. From table 3, we learn that an estimated 140,000 adults
and children died of AIDS compared with 150,000 deaths from
AIDS in 2001(see also appendix 4).

Table 3: Estimated number of deaths due to AIDS

15
Source: Source: UNAIDS, 2009

3.2.3 Number of orphans

The National HIV/AIDS Estimates 2010 estimated HIV/AIDS
orphans to be 923,862 in 2007, 923,477 in 2008 and 903,564 in
2009. Table 4 reveals that in 2007, the current living orphans were
estimated at 1 million in 2007 compared with 720,000 estimated in
2001.

Table 4: Estimated number of orphans (0–17) due to AIDS

Source: Source: UNAIDS, 2009

Table 4 shows the estimated number of children who have lost their
mother or father or both parents to AIDS and who were alive and
under age 17 in 2001 and 2007.

3.3 Patterns

16
In figure 2, Masvingo has a total prevalence of less than 15.2%,
Midlands and Bulawayo with a total prevalence of between 15.2%
and 16.7%, Harare, Mashional East with a prevalence of between
16.8% and 18.4%, followed by Manicaland, Mashional Central,
Mashional West and Matabele North with a [prevalence of between
18.5% and 19.7% and Matabele South recording the highest
prevalence of above 19.7%.

Figure 3: Patterns of HIV prevalence in Zimbabwe

Source: UNAIDS 2008

South Africa counts more than one thousand new infections a day,
the highest in the world, while in Botswana, Lesotho, Namibia,
Swaziland and Zimbabwe at least one in five adults carries HIV, (the
issues for Africa, 2008). From figure 3, we learn that Zimbabwe,
Lesotho, Swaziland and Botswana had the highest prevalence of
above 20% among adults aged 15 – 49 in 2006 followed by South
17
Africa, Namibia, Zambia, Mozambique and Malawi with a
prevalence of between 10% to 20%.

Figure 4: Pattern of estimated adult HIV prevalence of

Zimbabwe and neighbours

Source: the issues for Africa, 2008

3.4 Trends
Though reported to be declining overtime, the overall HIV
prevalence in Zimbabwe is still high.

3.4.1 Adult Prevalence

The adult HIV prevalence was estimated at 0.01% in 1973, 0.05% in
1977, and 0.29% in 1981, continuously increasing to 1.62% in 1985,
7.69% in 1989, 20.7% in 1993, 26.48% in 1997, and then
continuously reducing to 23.71% in 2001, 18.43% in 2005, 14.26%
in 2009 and estimated to further reduce to 12.31% in 2013 (figure 4).

18
Figure 5: Trends in Adult HIV Prevalence, Zimbabwe 1970-
2015

3.4.2 Young Male Adults

Among the males aged between 15 and 24, the HIV prevalence was
estimated at 0.01% in 1973, 0.04% in 1977, 0.18% in 1981, 0.93%
in 1985, with a remarkable continuous increase of 4.17% in 1989,
10.03% in 1993 and recording a continuous decrease of 9.56% in
1997, 5.92% in 2001, 3.77% in 2005, 3.28% in 2009 but estimated
to increase to 3.69 in 2013.

19
Figure 6: Trends in Male (15 -24) HIV Prevalence, Zimbabwe
1970-2015
Source: UNAIDS, 2009
3.43 Young Female Adults
The HIV prevalence among young females of ages 15 to 24 was
estimated at 0.05% in 1977, 0.31% in 1981, 1.92% in 1985,
registering a sharp increase of 9.52% in 1989 through 1993 at 23.9%
then slightly reducing to 23.69% in 1997, 14.72% in 2001, 8.94% in
2005, 6.87% in 2009 and estimated to be 6.72% in 2013 (figure 6).

Figure 7: Trends in Female (15 -24 years) HIV Prevalence,

Zimbabwe 1970-2015
Source: UNAIDS, 2009

3.4.4 Antiretroviral Therapy

According to figure 7, antiretroviral therapy coverage from 2004 to
2005 was estimated at 0 – 4%, 4 – 12% from 2005 to 2006 and 12 –
19% from 2006 to 2007.
20
Figure 8: Trends in antiretroviral therapy coverage, 2004 - 2007
Source: WHO, February 2009

3.5 Summary
The levels of HIV and AIDS are high among females than males,
young adults and adults of ages 15 -24 and 25 – 49. Access to
antiretroviral therapy is reportedly on the increase. Within southern
Africa, Zimbabwe is one of the countries with the highest
prevalence. The epidemic is concentrated mostly in the southern part
of Zimbabwe, followed by south west, north, north west and north
east. Lower cases of the epidemic are reported in the central region.

21
 Chapter Four: Impact of HIV and AIDS

4.1 Introduction
This chapter explains the effect of HIV and AIDS in Zimbabwe on
health, agriculture and food security, education, the economy,
orphans and gender.

4.2 Health
The health sector is hit particularly hard by the epidemic. The
treatment of opportunistic infections resulting from AIDS is
expensive and is straining the delivery of all health services in the
country. According to the NAC 2004, HIV and AIDS patients
command a disproportionate share of beds at health centres and
hospitals. Increasing expenditures on AIDS has diverted spending
from other health care needs (see appendix 2). As early as 1998,
MOHCW estimated that the costs of conventional care for HIV and
AIDS-related illnesses would increase the budget by about 60
percent (NAC, 2004). Health providers are also affected. Some
become infected themselves and large numbers suffer from the
intense physical and emotional strain of dealing with AIDS patients.
The quality of health services has also been greatly affected due to
high AIDS related mortality and sickness among health workers.

4.3 Agriculture and Food security

22
Zimbabwe has been suffering from serious drought and food
shortages. This situation is aggravated by the HIV and AIDS
epidemic. According to the 2002 census, about 51% of the
population lived in the communal areas, while another 7% lived in
the resettlement areas and on small commercial farms. About 21%
of adults were HIV infected in these areas. The chronic illnesses that
accompany deterioration of the immune system have depleted
household assets, reduced labour, and led to reduced crop
production. In Zimbabwe, one survey found that agricultural output
declined by nearly 50 percent among households affected by AIDS
illnesses and deaths. Frequent funeral attendance has also affected
land use and agricultural productivity (NAC, 2004).

Women-headed households are particularly vulnerable. This

vulnerability is especially important because women in rural areas
are 1.35 more times likely to be infected than men, and they
constitute the majority of infections (NAC, 2004). This situation has
negatively affected agricultural production because women provide
the bulk of agricultural labour. When a family member becomes ill
with AIDS-related opportunistic infections, it is usually the woman
who cares for the sick person. Women in rural areas are faced with
competing demands to maintain crop production, care for family
members suffering from AIDS and protect their health. Adult deaths
from AIDS have often led to a loss of traditional knowledge of

23
agricultural practices. Skills have not been transferred to either
children or relatives which has negatively implications for food
production. When mothers die, children are usually forced to take
the place of adults in the subsistence economy which has led to
increase in dependency burden (see appendix 3), child labour and
low productivity. Over time, HIV and AIDS has contributed to
declines in land use, crop yields, and crop variety.

4.4 Education
HIV and AIDS are causing considerable turbulence in the education
sector as the epidemic has affected the supply of educational
services, the demand for education, and the overall management of
the system. A Ministry of Education, Sports and Culture (MOESC)
study in 2002 reported that four out of five school heads say that the
epidemic is seriously undermining the provision of quality
education. The MOESC report revealed that teachers are at a high
risk of HIV infection. Estimates made as part of this study showed
that about one in every three teachers is HIV-infected (NAC, 2004 ).
AIDS among teachers is resulting in increased absenteeism and poor
quality of instruction by infected and/or affected staff. Training costs
for teachers (and other education officers) are rising to replace those
lost to the epidemic. Experienced teachers who die as a result of
AIDS are often replaced by untrained teachers. Overall, less public
finance is available to the schools than would otherwise be the case,
in part because public funds need to be used to address the manifold
impacts of the epidemic. The School attendance has declined from

24
85% in 2007 to less than 20% in 2009 (www.sooperarticles.com).
The student turn-out is low as a majority of public schools have
pegged school fees to match the running costs.

The epidemic has also affected the demand for educational services.
Over time, high levels of mortality among reproductive age adults,
and high levels of mother-to-child transmission resulted in a smaller
school age population than would have been the case in the absence
of the epidemic. Because an AIDS death (see appendix 4) to an adult
results in the loss of household labour and income, children are often
required to leave school and remain at home or go to work to
compensate for losses and to avoid schooling costs. A study
conducted in 2000 in commercial farming areas revealed that 48% of
primary school orphans and nearly all secondary school orphans
dropped out of school due to the illness of parents or after their
deaths (NAC 2004). For social and cultural reasons, girls are often
asked to leave school more often than boys to care for sick family
members. Orphans have often lost the necessary financial, material,
and emotional support that they need for successful schooling. The
HIV and AIDS epidemic has equally affected management of the
educational system. When key managers such as school heads,
planning officers, and executive staff are absent, underperforming,
or die, the functioning of the system is disrupted as well. HIV and
AIDS has caused considerable disruption and turbulence in the
education sector. Large investments in education are being lost
forever and fewer children will be able to break the cycle of poverty.

25
4.5 Economy
Although the HIV and AIDS epidemic has affected the overall
economic growth, its economic consequences have been more often
considered in terms of its impact on household poverty, on the
economic success of firms, and on government revenue and
expenditures. Studies show economic setbacks in households that
have experienced an AIDS-related death or that have a family
member(s) suffering from AIDS-related chronic illnesses (NAC,
2004). An adult illness or death has led to loss of household
productivity and income. Expenditures for medical care have
increased substantially, especially after the development of full-
blown AIDS. Funeral and mourning costs have often consumed a
major portion of family savings, leaving the household ill-equipped
for the future. A 2003 study in eastern Zimbabwe looked at the
consequences for households of adult terminal illnesses and death.
About four out of five of those who died were primary household
income earners, and three out of five lost their jobs during their
illness. In addition, one in seven caregivers had to give up
employment to provide care for the sick family member, and about
one in four households had to relocate soon after the adult death
(NAC, 2004).

AIDS has also had a significant impact on some firms both by

increasing expenditures and reducing revenues. Expenditures
increased for employee health care costs (including antiretroviral

26
treatments in some cases), burial fees, and recruitment and training
of replacement employees. Revenues decreased because of
absenteeism due to illness and attendance at funerals and times spent
on training. Labour turnover has led to a less experienced labour
force with lower productivity. Studies from the mid-1990s indicated
that medical costs were the single largest AIDS-related expenditure
for Zimbabwean firms (NAC, 2004). The HIV and AIDS epidemic
has also affected government revenues and expenditures (see
appendix 1). Revenues dropped because of the declining
productivity in the economy. At the same time, expenditure demands
increased to deal with the multi-sectoral impacts of the epidemic.
The economic impact of HIV and AIDS resulted not only from high
mortality but also from the fact that AIDS-related deaths have
concentrated among people in their most productive working ages,
15 to 49. AIDS has killed those on whom society relies to work in its
factories, mines, and farms, to run its schools and hospitals, and to
serve many other economic functions.

4.6 Orphans
One of the most serious consequences of the HIV and AIDS
epidemic has been the rapid increase in the number of orphans. The
standard definition of an orphan now used by the United Nations
Children’s Fund (UNICEF); a child under the age of 18 who has lost
one or both parents. The total number of orphans has risen
dramatically in the country, largely as a consequence of the HIV and
AIDS epidemic. By 2003, nearly four out of every five orphans in

27
the country had lost one or both parents to AIDS (NAC, 2004). The
need to provide care and support for the large number of orphans is
placing considerable strain on social systems (see appendix 3). At
the family level, the extended family, which has the traditional
responsibility to care for orphans, is under ever-increasing pressures.
Many grandparents are being left to care for young children. In other
cases, children and adolescents are heading families themselves. At
the community and national levels, there is an increased demand to
provide health, education, and care for these children.

According to the HIV Estimates 2009, the number of orphans has

declined from 1,060,396 in 2007 to 1,030,400 in 2009 (UNAIDS,
2009). More than a million innocent children are orphaned or
abandoned to live on roads in Zimbabwe due to the devastating
effects of HIV/ AIDS crisis (MOHCW, 2008). These kids have lost
their both parents and all elders in family to the AIDS pandemic and
experts fear that 1 out 5 children will become orphan by the end
2010 in Zimbabwe. 90 % of these children are raised through
extended families and not in orphanage. Efforts to provide basic
food, education and health facilities to these children are getting
hampered because of the current political, economic and
humanitarian crisis in Zimbabwe. These children are facing triple
threat of cholera, Influenza A H1N1 and measles outbreaks while
Zimbabwe is having second highest monthly inflation rates in the
history of Mankind. Every 1 of the 7 living in the age group 15-40
years is suffering from AIDS in Zimbabwe. More than half of

28
adolescents are in fear of getting infected with HIV virus in a few
years of time (www.sooperarticles.com).

4.7 Gender
Women are disproportionately affected by the HIV and AIDS
epidemic. In Zimbabwe, women are about 1.35 times more likely to
be infected than men (NAC, 2004). This imbalanced sex ratio has
occurred in part because women are more biologically prone to
infection than men during unprotected sexual intercourse. Similarly,
women are more vulnerable to other sexually transmitted infections,
the presence of which greatly enhances the risk of HIV transmission.
Older men having sexual relations with younger women have also
contributed to higher rates of infection among young women
(UNAIDS, 2004). Inequality and power imbalances between
women/girls and men/boys in Zimbabwe has heightened the
vulnerability of females to infection. In Zimbabwe, women are often
taught from early childhood to be obedient and submissive to males.
In sexual relations, women are often taught not to refuse sex to their
husbands, regardless of whether he has other partners or whether he
is willing to use condoms. They are not taught or empowered to
negotiate condom use. Because of their low social and economic
status, women and girls have more limited access to HIV and AIDS-
related information, prevention, treatment, care, support,
commodities and services than men and boys. Women have often
lacked equal protection under statutory and customary law.
According to the 2010 HIV estimates, HIV prevalence among young

29
women aged 15 to 24 years of age was 3.3% in 2007, 3.3% in 2008
and 3.2% in 2009. Among young men (15-24) HIV prevalence was
7.6% in 2007, 7.2% in 2008 and 6.9% in 2009 (UNAIDS, 2009).
HIV prevalence among women aged 15 to 24 attending ANC was
19.9% in 2002, 17.0% in 2004 and 12.5 % 2006 and 11.6% in 2009
(UNAIDS, 2009).

Sexual violence has been the worst manifestation of gender power

imbalances that has exposed women/girls to HIV infection. In the
YAS, 24% of women ages 15–29 reported being forced to have sex
at some time in their lives (MOHCW, 2004). Certain cultural and
traditional practices, such as widow inheritance, have increased the
risk of HIV transmission by contributing to the subordination of
women and undermining safe sex practices. Poverty rates are higher
among women in Zimbabwe than among men. Exchange of sex for
money or gifts is a coping strategy for dealing with poverty. At the
same time, the burden of care for sick and ailing family members
has fallen on women who usually lack the resources and training to
provide adequate home-based care. Rural women have increasingly
faced competing demands to maintain crop production, care for
family members suffering from opportunistic infections, and
protecting their own health. For social and cultural reasons, girls are
asked to leave school more often than boys to care for sick family
members. Women have also been called upon to nurture the growing
number of orphaned children, the majority of whom are survivors of
AIDS-affected households.

30
4.8 Summary
The event of HIV and AIDS has remarkably affected negatively all
spheres of Zimbabwean society. The most affected have been the
children, women with the economy, health, agriculture and
education taking its toll.

Chapter Five: National Response

5.1 Introduction
This chapter presents the national response to the HIV and AIDS
epidemic, focusing on the national policy and national response
strategies. Among these are legal and policy instruments, human
rights, macroeconomic policies, HIV prevention programmes,
funding and health sector response, provision of safe blood and
blood products, antiretroviral therapy, PMTCT, TB and HIV
collaborative activities, VCT and OVC’s response.

5.2 National Policy

The government of Zimbabwe has continued to demonstrate
commitment and leadership on the national response to HIV and
AIDS. The country still has a National AIDS Council (NAC)
established by an Act of Parliament in 1999, which has a broad-
31
based mandate to provide for measures to combat the spread of HIV.
In 2008, changes were made to the inclusive 14-member NAC
Board to include representation from labour, business sector and
People Living with HIV (PLHIV) and increase representation of
women from two to three, (UNAIDS, 2009). The country’s response
continues to have an enabling environment which permits HIV and
AIDS advocacy. The Zimbabwe AIDS Network (ZAN) is leading
over 400 civil society organizations which are involved in advocacy
and implementation in some programme areas. In 2008 and 2009,
Zimbabwe saw a growth in the voice of networks of people living
with HIV and AIDS, (UNAIDS, 2009).

5.2.1 Legal and Policy Instruments

Zimbabwe has over the years crafted and passed bills that help
uphold the rights of the most vulnerable people in the country. For
example the Criminal Procedure and Evidence Amendment Act No.
8 of 1997 was drafted in response to the increase in numbers of
cases of sexual abuse of minors, (UNAIDS, 2009). Consequently,
Victims Friendly Courts were created to ensure that sexually abused
minors testify freely without fear. In a related development, the
Criminal Procedure and Evidence Amendment Act and the Sexual
Offences Act of 2000 that criminalizes the willful transmission of
HIV even between husband and wife were amended. A stiffer
penalty of 20 years for rapists convicted of raping and infecting their
victims with HIV was included in the Sexual Offences Act of 2000,
(UNAIDS, 2009). In 2007 the Government of Zimbabwe enacted the

32
Domestic Violence Act, which criminalizes all forms of violence
such as psychological, physical and sexual. The Child Adoption Act
(2006) allows for HIV testing in children up for adoption. The
legislation to date has been aimed at protecting those who are often
vulnerable in society, including women, children, orphans and
people with disabilities, (UNAIDS, 2009).

5.2.2 Human Rights and Vulnerable Populations

Discrimination of HIV positive people is prohibited by GOZ under
National HIV and AIDS Policy of 2000 and the Statutory Instrument
(SI 202) of 1998, (UNAIDS, 2009). Instances that help explain this
policy are where HIV screening for purposes of employment is
prohibited and protocols for AIDS research are reviewed by the
national Medical Research Council of Zimbabwe (MRCZ) and other
appropriate review ethics committees. Nonetheless, these policy and
regulatory guidelines are unclear in terms of protecting sub-
populations such as men having sex with men (MSM), intravenous
drug users (IDU) and commercial sex workers (CSW). Hence, these
groups have no legal status in Zimbabwe. Protection for non-
consenting men who are forced to have anal sex is provided for
under the Sodomy Act, (UNAIDS, 2009). Whilst sex work and
homosexuality is illegal in Zimbabwe, these groups have not been
denied access to health services as a result of a specific law or
policy. Despite the current lack of legal frameworks to support
targeting of high risk groups such as Sex Workers, Prisoners, MSM
and IDU with prevention activities, Zimbabwe has allowed the

33
existence of informal lobby groups for these populations. This
includes organizations representing gays and lesbians living in
Zimbabwe and organizations working with sex workers. Within the
context of the Zimbabwe National HIV and AIDS Strategic Policy
2006-2010, one of the guiding principles is that the needs of
vulnerable populations including mobile and migrant populations
should be prioritized and addressed. A major highlight of the ESP is
the support to the International Office of Migration (IOM) for
purposes of mitigating the impact of HIV and AIDS and providing
humanitarian assistance to migrant workers in the agricultural,
mining, uniformed services, construction and transport industries, as
well as cross-border traders and mobile and vulnerable populations
(MVPs), (UNAIDS, 2009).

5.2.3 Macroeconomic policies

Zimbabwe has adopted a number of macroeconomic policies in the
last two years which have contributed to mitigation of the effects of
HIV and AIDS. The National Economic Development Priority
Program (NEDPP) of 2005-2007 was replaced by the Zimbabwe
Economic Development Strategy (ZEDS) 2007-2008 developed to
stimulate economic growth and reduce poverty. However, before
ZEDS was launched, it was replaced by the Short Term Economic
Recovery Plan (STERPI) in 2009 which covered the period from
February 2009 to December 2009. This strategic economic
framework was then followed by a medium term (3 years) economic
recovery plan (STERP II) that will cover the period 2010 to 2012.

34
STERP II seeks to achieve sustainable, balanced and robust
economic growth and development, oriented towards poverty
reduction and the integration of previously marginalized groups of
people. This strategy also looks at ways of revitalizing the health
sector in order for Zimbabwe to meet its regional and global targets,
especially those related to reduction of the burden and impact of
HIV and AIDS.

5.3 National Response

Though government’s response to HIV and AIDS has ultimately
been compromised by numerous other political and social crises that
have dominated political attention and overshadowed the
implementation of the national AIDS policy, a number of strategies
have been put in place and implemented to help address the
epidemic.

5.3.1 HIV Prevention Programmes

Prevention of new HIV infections remains the cornerstone of the
national response. In the absence of a national prevention strategy,
the National Behavioral Change Strategy (NBCS) 2006-2010 was
developed to consolidate HIV prevention and accelerate the
country’s goal to reduce the HIV prevalence to less than 10% by
2010, in line with the MDGs, (UNAIDS, 2009). The NBCS is to
guide systematic and strategic programming in the area of promoting
behavioral change in terms of preventing HIV transmission. The
hope is that the ZNASP and the NBCS will guide and strengthen the

35
implementation of HIV prevention from a multi sectoral perspective.
In 2007, behavior change promotion was launched within 16 ESP
funded districts. Furthermore, the program “Engendering HIV
prevention” was commenced in 10 European Commission funded
districts in 2007, (UNAIDS, 2009). District action plans were then
developed for the 26 districts. This Created an enabling environment
mainly through community leaders’ involvement and gender
equality were some of the main activities. Meaningful Involvement
of People openly living with HIV and AIDS (MIPA) was undertaken
in order reduce stigma. In the district structures, professionals
meeting these criteria are being assimilated into key positions.
Adoption of safer sexual behaviours, risk reduction and increased
utilization of HIV prevention services (Testing and Counseling
including post test support, PMTCT and PEP) are the aims of this
strategy.

5.3.2 Funding the Response

Various funding mechanisms enabled Zimbabwe to fund its HIV and
AIDS response. The GOZ raised funds through the national budget
and National AIDS Trust Fund (NATF). NATF is a 3% levy
collected from taxable income from all sectors to mitigate the impact
of HIV and AIDS and is channeled to NAC by the Ministry of
Finance. For instance, the GOZ through the national budget
contributed US $ 10,596,393 in 2007, US $ 354,661 in 2008 and US
$ 7,491,453 in 2009 towards HIV and AIDS programs, (UNAIDS,
2009). The bulk of the funds are channeled to the Ministry of Health

36
and Child Welfare and the rest to other government ministries for
their workplace programmes. The AIDS levy contributed
US$8,1487 in 2008 and US$5,143,108.8 in 2009. At least 50% of
these funds were used for procurement of ARVs whilst the rest goes
to other programmes and administrative support for coordination.
The bilateral and multilateral partners as well as international
foundations contributed US$35,351,861.84 in 2007,
US$24,987,127.00 in 2008 and US$37,796,697.00 in 2009 towards
HIV and AIDS programs, (UNAIDS, 2009).

5.3.3 Health Sector Response

The health sector in Zimbabwe includes organized public and
private health services (health promotion, disease prevention,
diagnosis, treatment and care). Non governmental organizations,
community groups, professional associations, pharmaceutical
industry teaching institutions also contribute the healthcare system.
Zimbabwe has a diverse health sector that is composed of the
following health institutions; state funded public health institutions,
private not-for-profit including mission health institutions run by
Faith based organizations, private for-profit health facilities, and
allopathic practitioners (Traditional and Alternative medicine),
(UNAIDS, 2009). Records from the Health Professions Council for
the year 2009 indicated that there were approximately 2,800
registered health institutions in the public sector clinics and
hospitals, private general and specialist practices, industrial, mining
and agricultural clinics, hospitals and pharmacies, mission clinics

37
and hospitals, emergency rooms and trauma centers, ambulance
services, x-ray service facilities and laboratories among others,
(UNAIDS, 2009).

5.3.4 Provision of safe blood and blood products

The donation of blood is governed by the Anatomical Donations and
Post-Mortem Examinations Act, Chapter 15:01 whose
administration falls under the MoHCW, (UNAIDS, 2009). All blood
used in Zimbabwe is provided by the National Blood Services of
Zimbabwe (NBSZ), an independent private registered non-profit
organization. The NBSZ has the sole responsibility and mandate for
collecting and distributing blood and blood products in the country.
The purpose of the NBSZ is to provide adequate blood and blood
products that are safe and free from microbial contamination by
HIV, Hepatitis B and C viruses and syphilis. Blood is collected,
processed and distributed in Harare and Bulawayo and at satellite
stations in Mutare, Gweru, and Masvingo, (UNAIDS, 2009). The
NBSZ has been designated a WHO collaborating centre for Southern
Africa. It also attained ISO certification in 2007. In an effort to
encourage rational use of blood and reduce the risk of transmission
of HIV and other blood-borne infectious agents the NBSZ with the
support of the National AIDS Council (NAC) has developed a
guideline document “Prescribing Blood, 2005”. Similar guidelines
are also contained in the Essential Drug List in Zimbabwe (ELDIZ).
The main strategic priority is to sustain the current high standards of
blood safety. This entails maintaining stringent donor selection

38
procedures as new donors are continuously recruited and adopting
the latest testing technologies (MoHCW, 2006),

5.3.5 Antiretroviral Therapy

The MOHCW introduced the OI/ART programme in April 2004 and
‘Plan for the Nationwide
Provision of ART’ was finalized in December 2004 covering the
period (2005-2007).
As part of its strategy to scale-up OI/ART services towards universal
access in 2010, the MOHCW commissioned a review of the OI/ART
programme. According to the ‘Review of the National HIV and
AIDS Treatment and Care Programme (OI/ART) 2004-2007, ART
coverage increased from about 5,000 to over 100,000 (29%) by
December 2007, (UNAIDS, 2009). Findings of this review
contributed immensely to the development of the ‘Plan for the
Nationwide Provision of Antiretroviral Therapy 2008-2012.
The numbers of adults and children accessing ART were 148,144
(39.7%) in December 2008 and 215,109 (56.8%) in November 2009.
Guiding the scale up of paediatric ART is the detailed plan for
Pediatric HIV and AIDS care that was finalized in the last quarter of
2006. Meanwhile, the number of children accessing ART was 8,627
(24.8%) in 2007, 13,287 (38.7%) in 2008 and 20,003 (57.1%) in
2009, (UNAIDS, 2009). The trend observed above was mainly
attributed to the scale up and decentralization of the OI/ART
programme associated with an increase in OI/ART initiation and
follow up as well as training of healthcare workers. The Government

39
made efforts to subsidize local manufacture of ARVs through
provision of foreign currency for purchase of raw materials and
waiver of duty on raw materials for local production of ARVs and
imported ARVs in 2008. Consequently, the supply of ARVs
improved in 2009 with minimal number of sites experiencing drug
stock outs.

5.3.6 Prevention of mother to child transmission of HIV

(PMTCT)
The PMTCT program has been one of the strongest pillars of the
HIV and AIDS responses in Zimbabwe. It is integrated within the
broader framework of reproductive health service provision. The
country has demonstrated high level commitment in developing and
utilizing policy guidelines on and the expansion of the PMTCT
programme (see appendix 7). A multi sectoral national PMTCT
Partnership Forum (PPF) was established to improve coordination of
the programme. The existing national PMTCT protocols were
amended in 2008 in line with the WHO recommendations (revised
2006). The revised treatment guidelines were distributed to all
Provincial Medical Directors, City Health Directors, ZACH, ZINA,
ZIMA and other relevant implementing partners. As a result of the
efforts made to expand the PMTCT programme, the country has
seen an increase in uptake of PMTCT by pregnant women.
Figure 3 below shows the comparison of the PMTCT programme
performance over 5 years; 2004-2008.

40
Until recently, the comprehensive PMTCT services were based on
the single dose Nevirapine (sdNVP) to reduce mother-to-child
transmission (MTCT). By December 2008 the country had started
rolling out a multiple dose PMTCT regimen. Comprehensive
PMTCT sites increased from 710 in December 2007 to 920 in
December 2008 and 960 in 2009. Consequently, PMTCT coverage
increased from 22% in 2007 to 42.6% in 2008, (UNAIDS, 2009).
Early HIV infant diagnosis was introduced in 2008 using the HIV
DNA PCR testing at the National Medical Reference Laboratory. In
2008, 76 Primary Care Counselors were trained on PMTCT,
counseling and infant feeding. In promoting optimal and safer infant
feeding practices, 6,797 infants exposed to HIV were provided with
alternative feeding in 2008, (UNAIDS, 2009). The MoHCW
nutrition department and ZVITAMBO conducted campaigns on
exclusive breast feeding to encourage both HIV positive and
negative women to stick to this practice. The PMTCT and
reproductive health departments worked in collaboration with PPF
partners to revise the ANC card to include information on HTC
including HIV status so as to enhance tracking of children born to
HIV infected mothers.

5.3.7 TB and HIV Collaborative Activities

Zimbabwe ranks 17th of 22 countries that the WHO has designated
high burden; countries that together report 80% of the total number
of TB cases in the world. New TB cases (incidence rate) in
Zimbabwe in 2007 were 782 per 100 000 people per year, compared

41
to 97/100,000 in 1990, (UNAIDS, 2009). The reason for the
resurgence of TB is the onset of HIV/AIDS pandemic which has
been devastating in Zimbabwe and other Sub-Saharan African
countries. It is encouraged that all TB patients are offered an HIV
test while suspect TB cases will also be able to access HIV testing.
Tools to capture this data were pilot tested in 2007. The number of
TB/HIV patients that received HIV testing were 7373 (10.2%) in
2007 and 9371 (13.2%) in 2008. Among TB/HIV co-infected
patients 5,824 (8.1%) in 2007 and 7,566 (10.7%) 2008 received
cotrimoxazole prophylaxis, (UNAIDS, 2009). TB patients who are
HIV positive are being given priority in the commencement of ART.
Furthermore, the Zimbabwe National TB Control Guidelines of
2007 and the Zimbabwe National TB-HIV Guidelines of 2009 have
clear indications on when to start ART in TB-HIV co-infected
patients. According to the Strategic Plan for the Nationwide
Provision of Antiretroviral Therapy 2008-2012, the strategic
framework for TB/HIV co-infection will be to increase access of TB
patients to ART (and vice versa) by strengthening TB/HIV
collaborative activities. Furthermore, these activities include
establishing collaborative TB/HIV committees at different levels
(district, provincial and national) of health delivery system and
conducting joint training for HIV and TB at all levels. The other
activities planned include intensifying TB case finding among
people with HIV infection, strengthen or establish infection control
measure in health care settings and to develop a national policy on
INH Preventive Therapy (IPT).

42
5.3.8 HIV Testing and Counseling Services
The ZNASP and the Health sector HIV Prevention Strategic
Framework have both identified HIV Testing and Counseling (HTC)
as an important component of the national response. The Zimbabwe
National HIV Testing and Counseling Strategic Plan (ZNHTCSP)
2008-2010 was launched in 2008. Broad objectives of this strategic
plan emphasize the need to increase the percentage of Zimbabwean
population who know their HIV status, from 20% to 85% by 2010;
and to expand HTC services using PITC and Client- Initiated
Counseling and Testing (CITC), formerly VCT, (UNAIDS, 2009).
The ZDHS of 2005/06 reported that 5.9% women and men (15-
49years) had been tested and received their HIV results in the 12
months prior to the survey. The country has set a target to increase
the percentage of people who know their status from 20% in 2007 to
85% by 2010 in line with Millennium Development Goals (MDG).
A variety of HCT materials and guidelines for trainings and
guidance were developed between 2008 and 2009.

Geographic coverage of testing and counseling services expanded to

reach all populations during the period 2006-2007. The number of
stand-alone and integrated testing and counseling sites increased
from 547 sites in 2006 to 649 at the end of 2007. HCT services were
further decentralized and expanded through the PMTCT program in
which more than 920 health facilities were actively providing HCT
services by the end of 2008, (UNAIDS, 2009).

43
The number of clinics registered to provide testing and counseling in
combination with mobile service delivery increased over the year.
The HIV testing and counseling services have expanded to rural
areas. Mobile counseling and testing units visit rural sites through
outreach.
The total number of clients who received testing and counseling in
Zimbabwe were 579,767 (314,464 public sector, 265,303 PSI) in
2007; 1,035,168 (769,125 public sector, 266,043 PSI) in 2008, and
1,071,740 (710,385 public sector, 361,355 PSI) in 200,944. In
addition to HTC, clients receive information on behavior change,
referrals for care, treatment and psychosocial support. An analysis of
VCT attendees by sex suggests that CITC (formerly VCT) in 2008
showed that women were in the majority by 30%. VCT services
reach the whole country through networks with various stakeholders
and outreach programs. Comprehensive and quality care is
guaranteed through a strong referral system for other medical
conditions such as STI, TB and family planning.

5.3.9 Orphans and Vulnerable Children

Zimbabwe continues to have a huge burden of Orphaned and
Vulnerable Children. National HIV/AIDS Estimates 2010 estimated
HIV/AIDS orphans to be 923,862 in 2007, 923,477 in 2008 and
903,564 in 2009, (UNAIDS, 2009). The Government developed a
National Action Plan for Orphans and Vulnerable Children (NAP for
OVC) through the Ministry of Public Service Labor and Social
Services in 2005 to increase reach to OVC with basic services. The

44
NPA aims to reach 25% of orphans and other vulnerable children
through various interventions, including educational, medical, legal,
and psychosocial assistance, in line with the UNGASS goals 65, 66
and 67 which directly target OVC, (UNAIDS, 2009).

Since commencement of implementation of the NAP for OVC

program in 2007 and the initiation of the Program of Support,
systems have been developed to directly provide children with basic
services through the efforts of 33 civil society organizations working
with over 155 sub-grantees. Some CSO provide block-grants to
schools, a system which has an advantage of eliminating stigma and
discrimination of OVC as well as bringing about community
development. The Basic Education Assistance Module (BEAM) had
an impact in providing block grants for tuition, levies, building fund,
and examination fees up until 2007. It ceased to provide the
necessary school education fund as a result of hyperinflation which
(in 2008) rendered contributions irrelevant. The BEAM programme
was resuscitated in 2009 and 517,315 out of 625,000 OVC were
assisted. The NAPOVC programme managed to help 393,197 OVCs
in 2009 and this constituted about 30% of the target group,
(UNAIDS, 2009). Meanwhile, the thrust of the National Orphan
Care Policy is to strengthen the community care method through
extended families. Table 4 shows some of the achievements made on
some of the key OVC indicators from 2006 to 2009.

5.4 Summary

45
Zimbabwe is implementing a comprehensive multisectoral response
to HIV and AIDS. The Government declared HIV and AIDS a
national emergency in 2002. The overall HIV prevalence in
Zimbabwe's adult population has decreased from an estimated
24.6% in 2003 to an estimated 20.1% in 2005 of the adult population
(ages 15-49) according to ZNASP, 2006 – 2010. Through successive
initiatives and time-bound plans from 1987 to the present (following
the reporting of the first HIV and AIDS case in Zimbabwe in 1985),
the Government has put in place a multisectoral response
coordinated by NAC (National AIDS Council Act 1999). However,
the response must be urgently intensified to sustain this decline, and
to address the sharply rising impacts of increasing AIDS-related
OVC, and morbidity and mortality in all economic and population
sectors.

46
Chapter Six: Factors enabling and hindering
decline of epidemic

6.1 Introduction
This chapter explains the factors influencing the fight against HIV
and AIDS in Zimbabwe.

6.2 Factors enabling decline of epidemic

These include but not limited to leadership and political
commitment, VCT, decentralization of services, life skills education
in schools, male circumcision, BCC, out of school youths
intervention, condom distribution and social marketing, M&E
system and support from development partners

6.2.1 Leadership and political commitment

The Government of Zimbabwe continues to demonstrate a strong
political commitment to respond to the HIV and AIDS epidemic.
The country has held national commemorations of the World AIDS
Day annually at all levels national to district level. Each year the
head of state has made state of the nation address on HIV/AIDS and

47
featured HIV/AIDS in other period addresses. In the Behaviour
Change (BC) programme there is high involvement of traditional,
opinion leaders, political leaders, business persons and religious
leaders in promoting open dialogue and speaking against risky
behaviors and negative cultural practices that fuel HIV infection,
(UNAIDS, 2009). As a result, there were reports of a reduction in
practices that may fuel the HIV and AIDS epidemic.

6.2.2 Voluntary testing and counseling

The Provider Initiated Testing and Counseling (PITC) has led to a
dramatic increase in clients tested for HIV, (UNAIDS, 2009). This
has been achieved through a large number of healthcare workers
trained and health facilities providing testing and counseling
services.

6.2.3 Decentralization of HIV and AIDS services

Most HIV and AIDS services have been decentralized to clinics thus
improving access and coverage to services in both urban and rural
settings. Increase in the number of sites offering HTC, PMTCT and
OI/ART is linked to a decentralized strategy.
The family approach to HIV and AIDS Services creates linkages and
increases entry points for services like VCT, PMTCT, OI/ART &
TB/HIV. Under the PMTCT Programme for example, there were a
number of male partners that were subsequently tested for HIV after
their female counterparts booked for maternity and underwent PITC,
(UNAIDS, 2009).

48
6.2.4 Life skills based HIV and AIDS education in schools
The MoEASC policy on Life skills based HIV and AIDS education
in schools (Circular 16 of 1993) is that all schools should provide
life skills based HIV and AIDS education to pupils in schools.
Consequently a pre-service training on life skills based HIV and
AIDS education has been introduced for all student teachers since
1994. Most colleges allocate 1 to 2 hours weekly and make sure that
every student teacher goes through the program. All teachers’
Colleges have either a full time coordinator or a team of trained
lecturers to teach the subject. An integrated training package was
introduced in 2005 focusing on the issue including learner-centered
HIV and AIDS participatory methodologies so that every teacher
who is trained is able to support both the cognitive and psychosocial
needs of children, (UNAIDS, 2009). The Ministry of education
hopes that all teachers (100%) give lectures on life skills HIV and
AIDS education about 2 hours a week. However, this may not be the
reality. Hence, the need to carry out regular school based surveys to
ascertain whether life skills based HIV and AIDS education is being
carried out as well as checking on the quality of the education
provided.
A total of 2,471,605 school pupils were exposed to life skills HIV
and AIDS education in 2006 through school based programs. A total
of 22,790 school based peer educators were trained in 2006,
(UNAIDS, 2009).

49
6.2.5 Male Circumcision
Male circumcision was identified in the ZNASP as one potential
service-based HIV prevention intervention strategy. Research was
proposed to assess feasibility and acceptability of large scale male
circumcision and pilot the initiative in some selected geographical
areas. Zimbabwe is mostly a non-circumcising country but has
traditionally circumcising ethnic and religious communities such as
the Xhosa, VaRemba, Chewa, Tshangani, Tonga (parts) and
Moslems, (UNAIDS, 2009). The ZDHS (2006) noted self reported
MC prevalence at 10%.

A national training of trainers (TOT) was conducted for 18 national

trainers comprising surgeons, nurses and counselors. The MC
strategy received a boost in November 2009 when the MC Policy
was launched as a component of the overall HIV/AIDS prevention
strategy. As of December 2009, 2800 men recruited through the HIV
counseling and testing sites (mainly PSI) were circumcised,
(UNAIDS, 2009). Latent demand can be described as very high as
most males have volunteered to be circumcised when offered
through HCT centers. MC surgery is conducted by medical doctors,
using sterilized pre-packed MC kits and guided by the minimum
standards operating procedures (SOPs) for safe male circumcision
developed for Zimbabwe. There is a back up service to address
complicated cases and any adverse events that may occur.

6.2.6 Behavior Change and Communication (BCC)

50
In the absence of a comprehensive prevention strategy, Zimbabwe
has a National Behavior Change Strategy 2006-2010 whose main
objective is reducing sexual transmission of HIV. Focus of the BC
strategy is to address the behaviour related key drivers and
underlying factors of the HIV and AIDS epidemic such as multiple
concurrent sexual partnerships, age-different sexual relations and
long term discordant couples. The strategy provides a streamlined
approach to addressing issues of leadership at all levels, gender
imbalances and stigma associated with HIV as well as specific
cultural practices. The BC component is being implemented in 16
districts with ESP support and a further 10 districts with European
Commission (EC) support. The component is supported and
coordinated at national level by UNFPA in collaboration with the
NAC, which is responsible for the National BC Program, and
implemented at district level by 8 NGOs contracted by UNFPA,
(UNAIDS, 2009). The key aspects of the National BC Strategy are
creation of an enabling environment and adoption of safer sexual
behaviors and reduction of risk behaviors through community
mobilization and interpersonal communication. Model used includes
community assessment, working through community leaders and BC
facilitators (selected from community opinion leaders) and
promoting community dialogue.

6.2.7 Interventions for Out-of-School Youths

51
HIV prevention interventions for youths out of school have been
supported by Global Fund. Services are provided through Youth
Friendly Corners and Centers. Through European Union funding, the
country has established a Young People’s Network, which provides
a platform for advocacy by young people, (UNAIDS, 2009).

6.2.8 Condom Distribution and Social Marketing

The main objective of the ZNASP 2006 -2010 under condom
distribution is to make more widely available both re-branded public
sector and socially marketed condoms in rural and remote areas.
Condom promotion and distribution is spearheaded by both the
public sector (MoHCW and Zimbabwe National Family Planning
Council (ZNFPC)) and civil society (Population Services
International (PSI)). The National Female Condom Strategy 2006 to
2010 was developed and is currently being implemented (see
appendix 5 and 6). NAC in collaboration with partners secured and
distributed 100 female and 1000 male genital models for condom
education and demonstrations in 2008, (UNAIDS, 2009). Under this
strategy, the ZNFPC’s Depot Holders and Community Based
Distributors program was strengthened through capacity
development with technical support from DFID and UNFPA.

In terms of condom distribution, there has been a gradual increase in

number distributed over the years. The numbers of male condoms
distributed were 86,562,348 in 2007, 95,463,490 in 2008 and
89,956,552 in 2009. Female condoms distributed were 3,557,476 in

52
2007, 5,276,705 in 2008 and 4,491,916 in 2009, (UNAIDS, 2009).
The targets set in the National Female Condom Strategy 2006 to
2010 highlight that 2.4 million, 2.5 million and 2.8 million should
have been distributed from 2006 to 2008 respectively, (UNAIDS,
2009). Thus, the 2008 total of 4,678,212 female condoms distributed
surpassed the set target. Female condom distribution increased 31%
in the social sector, 7% in the public sector and 23% overall
according to the NAC Annual Report 2008. Compared to 2007, both
male and female condoms distributed rose in 2008 and 2009.

6.2.9 Monitoring and Evaluation (M&E) System

Monitoring and Evaluation framework of the “three ones” principles
has been operationalised giving the National AIDS Council (NAC)
the mandate to coordinate and maintain the one national M&E
system. Most national programs and partner projects are linked to
the national system. A multisectoral and multi-disciplinary National
M&E Advisory Group (MEAG) is in place which provides technical
advice in the development and operationalization of the national
M&E system. A national M&E plan was developed in 2009 in
accordance with the “Three Ones” principle, (UNAIDS, 2009). The
plan enables Zimbabwe to systematically monitor implementation of
the national HIV/AIDS strategic plan and gauge progress towards
the achievement of both national targets and international
commitments in the fight against HIV and AIDS. Several population

53
surveys form part of the national M&E system to provide a tracking
system for outcome and impact indicators. The surveys periodically
conducted in Zimbabwe include antenatal clinic sentinel
surveillance, behavioral Surveillance, Demographic Health Surveys
(DHS), Census, Special health facility surveys and other national
level programme-based surveys.

6.2.1.0 Development Partners support

During the last 3 years, Expanded Support Program (ESP), Program
of Support (PoS), US Government (USG), GFATM, and some
bilateral agencies have made significant contributions to the national
HIV/AIDS response. The ESP and PoS are both baskets funding by
a group of development partners. The ESP contributed US$50
million in the 3-year period of the project, (UNAIDS, 2009). This
funding supported ART in 16 districts, prevention programmes,
coordination as well as retention scheme for health workers involved
in the ART program. The PoS contributed US$84 million in 3-years
funding for the National Action Plan (NAP) for OVC, supporting
OVC with education, healthcare, birth registration HIV/AIDS
prevention and treatment, (UNAIDS, 2009). The GFATM and the
ESP have been the main source of funding for many districts; the
funding is enabling these districts to outperform other districts
especially those receiving support from GoZ only. The GFATM
Round 8 awarded a 5-year (2009-2013) US$296 million grant for the
HIV/AIDS response in Zimbabwe for interventions in all areas of
the response and for building the capacity of NGOs.

54
Human resources are critical to the success of the project and about
7% of the grant provides funds to meet the cost of some essential
staff for the project. With this funding ZNASP 2006-2010 modest
target of US$65 million was surpassed, (UNAIDS, 2009).

6.3 Factors hindering decline of epidemic

These comprise poor economic environment, human resource,
limited funding, weak health system, low rates of reporting among
implementors among others.

6.3.1 Economic environment

The country received limited donor funding in the period 2007-2009
and this affected the coverage of most HIV and AIDS preventive,
treatment and care programmes. The inflationary pressures arising
from the drought, low economic growth, high fuel prices on the
international market, sanctions and high HIV and AIDS disease
burden have negatively affected the effective response to HIV and
AIDS in Zimbabwe. Consequently, the economic challenges
encountered in the period 2000-2008 led to poverty, unemployment
and international migration among the general population to levels
that were unprecedented. Most women then engaged in cross border
trading exposing themselves to sexual and other forms of abuse
during the course of their work, (UNAIDS, 2009).

6.3.2 Human resources challenges

55
Many health facilities in Zimbabwe were seriously and chronically
short of staff as a result of low remuneration not commensurate with
the prevailing economic conditions in 2008. This was also coupled
with massive exodus of staff to neighboring Southern African
countries and abroad. The challenges associated with staff attrition
in the health sector have impacted on the quality and coverage of
HIV and AIDS health programs. The shortage of equipment also
made work in the health sector non-conducive leading to low
morale.

6.3.3 Limited Funding for the national HIV/AIDS response

The global and local economic meltdown; politically-induced
tension, anxiety, and uncertainty in the country and less than optimal
external donor support especially to the public sector contributed to
the inadequate funding needed for the national response in 2008 and
2009.
For instance, many PLHIV eligible for ART were on the waiting list
for ART in 2008 and 2009, (UNAIDS, 2009). This is severely
hindering the implementation of the ZNASP and achievement of
UNGASS targets. Thus, there is need for domestic and international
resource mobilization to cover the existing funding gaps.

6.3.4 Weakened Health System

The economic challenges that the country has gone through over the
years have severely dented the country’s health system. The
country’s health facilities are riling under severe shortage of

56
essential supplies such as lab equipment, reagents, drugs, HIV and
HBC test kits. Health facilities are suffering from frequent
breakdowns of essential lab equipment such as CD4 machines,
hematology and chemistry machines which are essential for
provision of quality HIV/AIDS service. Hospitals have poor
transport and communication facilities making referral of patients a
challenge, (UNAIDS, 2009).

6.3.5 Low reporting rates by implementing partners

Just over 50% of implementing organizations were submitting
National Activity Report Forms (NARF) on monthly basis to NAC
Districts Offices in 2008. This improved to 70% in 2009, (UNAIDS,
2009). Thus the challenge is to achieve 100% in registration and
reporting by implementers. Challenges faced in data quality are
incompleteness due to low reporting rates and inconsistencies in
reporting by implementers, lack of capacity to develop and maintain
M&E systems at primary data collection levels and delays in
reporting by implementers. The health sector data is affected by lack
of training and supervision among staff collecting and capturing
data. Some sectors do not have sufficient M&E tools to guide and
facilitate collection of indicator data, (UNAIDS, 2009). Generally,
there is low capacity for data triangulation, validation and
verification in the country.

6.4 Summary

57
Inspite of the economic slow down of the country, the government in
support with development agencies is doing all it can to address the
HIV and AIDS epidemic. However, policy implementation is still
lacking and more funding is direly required to overcome the
epidemic.

Chapter Seven: Summary and

Recommendations

7.1 Introduction
This chapter gives the summary, conclusions and recommendations
of the study.

7.2 Summary
The leading route of HIV transmission in Zimbabwe is sexual
contact (heterosexual) followed by mother to child transmission. The
levels of HIV and AIDS are high among females than males, young
adults and adults of ages 15 -24 and 25 – 49. The epidemic is
concentrated mostly in the southern part of Zimbabwe. The event of
HIV and AIDS has remarkably affected negatively the economy,
culture, social development among others. Inspite of the economic
slow down of the country, the government in support with
development agencies is doing all it can to address the HIV and
AIDS epidemic.

7.3 Conclusions

58
Zimbabwe’s HIV and AIDS situation given chance of economic
stability and good leadership will be contained in the near future
given the fact that HIV trend has continuously declined. However,
the burden of orphans will increase the dependency burden on both
the community and the nation as a whole which will further
compromise national development.

7.4 Recommendations
Development partners need to work with the GOZ in identifying
funding gaps for HIV/AIDS programmes. Following this,
coordinated mobilization of resources should be undertaken by the
development partners on behalf of the GOZ. Meanwhile,
Development partners should prioritize the human resource
component when mobilizing for financial resources. When it comes
to HIV/AIDS programmes implementation, the Development
Partners need to work with the GOZ in a coordinated way so that
there is no duplication of activities and setting up of parallel
structures. Generally, Development partners will improve the
possibility of attaining UNGASS targets by covering financial gaps,
channeling resources in a streamlined way and implementing
coordinated activities at site level through collaboration with the
GOZ.

There is a need to conduct a thorough and comprehensive national

M&E system assessment to ascertain the functionality of the
national M&E System at all levels, carrying out a Know Your

59
Epidemic /Response and size estimation study as well; need to
enhance the use of evidence and results based approaches in the
planning process including planning for the ZNASP 11 to be
developed covering 2011-2015; need to undertake a Size estimation
and Behavioral Surveillance study survey for Most at Risk
Populations to collect key outcome indicators for them; need to
collect Private Sector and Workplace baseline data to plan and
monitor the stages of development of HIV and AIDS Workplace
Programs; need to strengthen capacity of sites by implementing
partners (MOHCW, Local Private & NGOs) and NAC through
provision of computers, printers, printer cartridges & stationery for
M & E; need for improvement of communication through provision
of transport (motorbikes), telephone, fax, broadband internet
connectivity, radios, satellite phones and cell phones. Broad
bandwidth connectivity is needed at provincial and district levels.

There is need for a strategic plan guiding HIV and AIDS Life Skills
in schools. For instance, HIV and AIDS Life Skills Strategic Plan
for the period 2006 to 2010 was developed and finalized in 2008
with support from UNICEF but was not endorsed by the MoEASC
(UNAIDS, 2009). There is also need of strengthening coordination
of youths’ programs and addressing absence of focal persons to
focus on implementation of HIV prevention activities in tertiary
institutions. Inspite of the presence of a number of organizations
working within school youths such like UNESCO, Saywhat, SHAPE
Zimbabwe, and Students’ Partnership Worldwide, there is still need

60
to create a network for the institutions to exchange information and
experiences.

Appendices
Appendix 1: AIDS spending categories

61
Source: UNAIDS, 2009
Appendix 2: Financing sources and National funding matrix

Source: UNAIDS, 2009

Appendix 3: Selected achievements for some key OVC

indicators

62
Source: NAC Annual Monitoring and Evaluation Report, 2009.

Appendix 4: estimated number of deaths due to aids 1990 - 2007

Source: WHO, February 2009

63
Appendix 5: Male condom consumption and distribution by
year
Source: WHO, 2009

Appendix 6: Female condom consumption and distribution by

year
Source: WHO, 2009

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Appendix 7: Comparison of the PMTCT programme
performance, 2004-2008
Source: (UNAIDS Report, 2009, - (estimated to be 80% complete)).

References

1. UNAIDS Zimbabwe Epidemiological Fact Sheet, Update

2008)
2. Ministry of Health (MOH, 2007)
3. National HIV and AIDS Strategic Plan (ZNASP) 2006 -
2010
4. UNICEF Zimbabwe
5. WHO Epidemiological Fact Sheet Update on HIV and AIDS
Zimbabwe, February 2009

65
6. Munodawafa D, Gwede C, “Patterns of HIV/AIDS in
Zimbabwe: Implications for health education”
7. Government of Zimbabwe, Ministry of Health and Child
Welfare: www.mohcw.gov.zw/
8. Zimbabwe National AIDS Council (NAC):
www.nac.co.zw/21
9. Zimbabwe AIDS Network (ZAN): www.zan.co.zw/
10. Women and AIDS Support Network (WASN):
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12. UNAIDS Zimbabwe: www.unaids.org.zw/
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identity dilemma of child headed households in rural Zimbabwe
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16. United nations general assembly special session Report on
HIV and aids, Zimbabwe country report January 2008 to
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zimbabwe-303498.html

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19. National AIDS Council, Zimbabwe Ministry of Health and
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20. Zimbabwe Ministry of Higher and Tertiary Education, 2005,
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21. www.avert.org
22. www.sooperarticles.com

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23.