USG Response to Zimbabwe HIV/AIDS Crisis

UNCLAS SECTION 01 OF 03 HARARE 000757

SIPDIS

STATE FOR OES DAS CHOW, AF/FO AND AF/S
NSC FOR DWORKIN, JFRAZER
USAID/W FOR G/PHN A/A PETERSEN
AFR A/A NEWMAN, DCHA A/A WINTER
HHS FOR STEIGER
HHS/CDC JGERBERDING AND EMCCRAY
PRETORIA FOR CROWLEY
ROME PLEASE PASS TO FODAG


E.O. 12958: N/A
TAGS: KHIV TSPL OSCI TBIO KSCA US ZI HIV AIDS
SUBJECT: USG Response to Zimbabwe HIV/AIDS Crisis

1: Summary: The USG in Zimbabwe is implementing a
comprehensive response to the HIV/AIDS pandemic,
characterized by close coordination between USAID and
CDC programs. These joint efforts have established a
strong foundation aimed at HIV/AIDS prevention,
care/treatment and mitigation. The USG is now poised to
build on and expand these programs to achieve
significantly greater impact and, thereby, save
additional lives if we have sufficient resources.
Specifically, the USG in Zimbabwe is well placed to make
progress in high-priority areas, such as expansion and
integration of VCT and PMTCT programs, and pragmatic
models of ARV treatment. Some remarkable success
stories are emerging in Zimbabwe of what can be
achieved, even in the absence of strong political
leadership and in the midst of crippling socioeconomic
and political crises. USG progress on HIV/AIDS in
Zimbabwe, due to close teamwork among agencies at post
and partnerships with a range of public and private
actors, demonstrates that effective response to the
pandemic need not remain paralyzed while awaiting
political leadership. End Summary.


2. HIV/AIDS Epidemic in Zimbabwe: Over the past
several years, Zimbabwe has been wracked by a series of
profound and interlocking crises with humanitarian,
economic, social and political dimensions. The
generalized HIV/AIDS epidemic in particular has helped
propel the country towards a humanitarian crisis at both
household and national levels. An estimated 2,000
deaths per week are attributed to the epidemic. Many
deaths are due to curable conditions like tuberculosis.
Stigma remains a major obstacle to progress. It is
estimated that only 10% of HIV-infected Zimbabweans know
their HIV status. The once-strong national health
system, now crippled due to economic constraints and
massive out-migration of critical staff, is unable to
cope with the demands for care and treatment associated
with the epidemic. An estimated 2,300,000 adults and
children in Zimbabwe were living with HIV/AIDS in 2001,
including an estimated 34% of all adults aged 15-49
years (UNAIDS 2002). Given the high prevalence of
infection, mortality rates will escalate for many years
to come.


3. Synergistic Coordination: In the face of these deep-
rooted problems, the national response to HIV/AIDS moves
forward. Some remarkable success stories are emerging
in Zimbabwe of what can be achieved in progress against
HIV/AIDS, even in the absence of strong political
leadership and in the midst of crippling socioeconomic
and political crises. To a substantial degree, this
progress can be attributed to an unusually synergistic,
highly coordinated set of USG activities in Zimbabwe,
being implemented by USAID, HHS/CDC, the National
Institutes of Health (NIH),the Health Resources and
Services Administration (HRSA),private US companies and
NGOs. USG efforts have established a strong foundation
of programs aimed at HIV/AIDS prevention, care/treatment
and mitigation. We are now poised to build-on and
expand these programs to achieve significantly greater
impact and, thereby, save additional lives if sufficient
resources are available. In addition, both USAID and CDC
actively interact with GOZ and domestic and
international stakeholders on the programming,
monitoring and evaluation of funds pledged to Zimbabwe
by the Global Fund for AIDS, TB and Malaria (GFATM).


4. HIV/AIDS Prevention: A major aspect of USG
assistance is focused on prevention of HIV/AIDS among
youth and young adults. USAID (television) and CDC
(radio) have supported the production and broadcast of
long-running soap operas/serial dramas that model target
behaviors through the use of inspiring stories and
character role modeling. USG-sponsored behavior change
programming seeks to stimulate demand for key services
such as VCT and PMTCT, and takes direct aim at reduction
of stigma and support of people living positively.
USAID's television drama is now the highest-rated show
on TV in Zimbabwe, and is providing "product placement"
opportunities to the CDC-supported radio drama to
stimulate listening in the first few weeks of the
latter.


5. Voluntary Counseling and Testing (VCT): With a
nationwide network of 14 USAID-supported VCT centers in
place, large increases in demand for these services are
now being experienced, with some clinics seeing over a
hundred clients per day and 65,000 per year. Recently
piloted mobile VCT services, to reach additional
underserved areas of the country, have also resulted in
overwhelming demand. These achievements are
complemented by strong USAID-supported social marketing
campaigns through TV, radio and other media. As a
result, USAID is well positioned to expand support for
these services, in collaboration with faith and
community-based organizations, to keep up with this ever-
increasing demand. Knowledge of HIV status is the
cornerstone of prevention and behavior change as well as
the entry point for expanded HIV/AIDS care and treatment
programs. As such, the expansion of VCT services, in
traditional and new settings, is critical to realizing
an impact on the epidemic.


6. Prevention of Mother to Child Transmission (PMTCT):
CDC and the Elizabeth Glazer Pediatric AIDS Foundation
(EGPAF),a private U.S. NGO, have been two principal
drivers working to jump-start the national PMTCT
program. This has resulted in an energized national
PMTCT partnership of key stakeholders who now support
this critical intervention in approximately 80 clinics
and hospitals. Almost 10% of pregnant women nationwide
are now reached by PMTCT, up from fewer than 1% just 2
years ago, with dramatic expansion of coverage possible
in the near future. The result is that more and more
new mothers are tested, preventative interventions are
undertaken, and risk of HIV transmission to newborns is
significantly reduced. In order to meet the growing
demand and opportunities for PMTCT services, additional
resources will be required.


7. VCT and PMTCT Integration: Building on these two
programmatic pillars, USAID and CDC are collaborating
closely on integrating VCT and PMTCT programs. Our
objectives are to increase the cost-effectiveness of
each program, to use limited human resources
efficiently, and to satisfy the rapidly increasing
demand for expanded HIV counseling and testing services
among pregnant women, their partners and families.
Because the national PMTCT program is principally run
through the public health system, integrating VCT and
PMTCT programs would require USAID to join with CDC in
working with public health authorities. Integrating
these programs, and constructing a robust nationwide
counseling and testing service that functions in a
variety of settings, will provide a firmer foundation on
which to construct the delivery of broader care and
treatment programs, including ARVs, to pregnant women,
their partners and families.

Opportunities: For an additional $2 million/yr, USG
efforts could scale up substantially, possibly reaching
25% of 15-49 yr olds with knowledge of HIV serostatus
(through combined PMTCT and VCT) by the end of 2004,
rather than the projected increase to 15%.


8. Care/Treatment and Mitigation: The landscape of
HIV/AIDS care, treatment and crisis mitigation programs
in Africa is rapidly changing, and Zimbabwe is no
exception. Hundreds of organizations are at work
providing palliative, curative and/or psychosocial care
to those infected, affected and/or orphaned by this
epidemic. CDC and USAID are collaborating on efforts to
improve the design, implementation and coordination of
care and mitigation programs so that successful models
can be replicated on a broad scale. This includes major
efforts to expand successful models for HIV/AIDS care
developed by Mission and Church hospitals through CDC's
innovative Network for HIV/AIDS Care, Prevention, and
Positive Living (CHAPPL) among church-related hospitals.
Mission and Church hospitals provide in excess of 50% of
all health care services to rural Zimbabweans, as purely
government facilities face continued shortages of staff,
medicines and other supplies. As for mitigation, USAID
has set in place a robust 4.5 million grant program
designed to strengthen the capacity of communities and
NGOs to better support the needs of orphans and children
affected by HIV/AIDS.


9. ARVs: Access to anti-retroviral (ARV) drugs is an
evolving issue, on which USG agencies have collaborated
extensively and developed a broad set of public-private
partnerships. There are existing institutions that are
already providing ARVs on a small scale, and still
others that have the capacity but only lack access to
the drugs. CDC has worked with the GOZ and leading care
specialists to develop guidelines and protocols for ARV
treatment as well as to prepare for the laboratory
associated treatment requirements. USAID has performed
a key comprehensive assessment to examine logistical
constraints and required approaches to ARV delivery on a
broad scale. CDC has successfully brokered arrangements
between Pfizer and the GOZ for the initiation and rapid
expansion of the Pfizer Diflucan Donation Program for
the life-saving treatment of two significant
Opportunistic Infections (OIs) within public and mission
hospitals. CDC has brought in expertise from HRSA to
assist with training needs for HIV care and ARVs, and is
working with NIH-funded grantees from the University of
California at San Francisco to share technical expertise
in such areas as lab quality assurance for CD4+ and
viral load testing, and training for ARV treatment.

Opportunity: For $3 million/yr, the USG could support
pragmatic, well-designed, intensively evaluated highly
active anti-retroviral therapy (HAART) programs
sustaining perhaps between 3,000 and 5,000 persons with
advanced HIV infection.


10. Surveillance/Information/Advocacy/Research: CDC
has supported 3 consecutive years of increasingly high-
quality HIV surveillance, plus Africa's first combined
behavioral and biologic national household survey of
young adults. CDC's work has improved understanding of
the epidemic, and established baselines on which to
measure, monitor and evaluate progress of the national
response. USAID and CDC have worked successfully to
stimulate improved communication, information
dissemination and advocacy efforts among key Zimbabwean
organizations, including the initiation of programs to
boost the capacity of NGOs to formulate and advocate for
improved HIV policies and programs. NIH funded research
activities focus primarily on testing and evaluation of
behavioral and clinical interventions. However, USAID
and CDC work closely with NIH researchers on the ground
to incorporate synergies between research and program
activities, where and when possible.


11. Human Capacity Development and Retention: For an
annual expenditure of less than $1 million, CDC has
supported the strengthening and expansion of the Masters
of Public Health and the Masters of Clinical
Epidemiology programs at the University of Zimbabwe. In
2002-3, more than 40 masters-level students in Zimbabwe
are being supported by these programs. Additionally,
support to the faculty for teaching, research, and
HIV/AIDS services has had a profound and positive effect
on retention of national leaders in their faculty posts.

Opportunity: For an additional $1 million a year, the
field training facilities and related distance learning
infrastructure could be strengthened, additional
partnerships and exchange programs with US universities
and other institutions could be facilitated, and the
program could be expanded regionally within southern
Africa. SULLIVAN