UNCLAS SECTION 01 OF 02 HARARE 000758

SIPDIS

FROM AMBASSADOR SULLIVAN FOR:
STATE, FOR AF A/S KANSTEINER AND OES DAS CHOW,
USAID/W FOR ANNE PETERSON AND AFR A/A NEWMAN,
HHS FOR SECRETARY THOMPSON AND WILLIAM STEIGER,
WHITE HOUSE FOR DR. J. O'NEILL,
NSC FOR AFRICA SR DIR JFRAZER AND JDWORKIN,
ROME FOR AMB HALL,
PRETORIA FOR CROWLEY
ALSO PASS TO CDC/JGERBERDING

E.O. 12958: N/A
TAGS: KHIV TSPL OSCI KSCA ZI US HIV AIDS
SUBJECT: USG HIV/AIDS PROGRAMS IN ZIMBABWE: POISED FOR
FURTHER PROGRESS

REF: HARARE 757


1. I call your attention to reftel which outlines the
progress the US has made in HIV/AIDS prevention,
care/treatment and mitigation in Zimbabwe, perhaps the second
most affected country in the world. I believe it critical
that the USG continue to give priority attention to
Zimbabwe's enormous public health crisis now, building on the
success of our current efforts and taking advantage of
opportunities for more progress. As noted in the Mission
Program Plan(MPP), we need to work where we can be most
effective in saving lives -- in Mission and Church Hospitals
in many cases, in the public health system, and with
faith-based and other NGO's. We also need to take advantage
of opportunities that we have helped put in place to save
lives now, since delay will only assure that the HIV crisis
and Zimbabwe's other related crises worsen for years to come,
making the task of Zimbabwe's eventual recovery under future
governments that much more difficult. This telegram and the
referenced telegram point out several opportunities to build
on our success. I appeal to addressees and to the
interagency group that reviews the MPP to assure that US
HIV-AIDS programs for Zimbabwe receive the resources
necessary to continue their progress. (In this context, I am
not concerned about whether Zimbabwe makes up part of any
priority list, but that the USG dedicate the resources
necessary to build on our current progress and take advantage
of real opportunities to save more lives now.)


2. Background: Zimbabwe has been wracked by a series of
profound and interlocking crises with humanitarian, economic,
social and political dimensions. The once strong national
health system is now crippled due to economic constraints and
emigration of staff and the effects of the epidemic which
affects an estimated 2,300,000 of the twelve million
Zimbabweans. Notw

ithstanding the difficulties, US agencies,
including USAID, HHS/CDC, NIH, and HRSA, together with
private US companies and NGO's have collaborated closely for
maximum effect to establish a strong foundation for programs
aimed at prevention, treatment and mitigation.

3.. Examples of Integrated Programming and Additional
Opportunities

USAID has supported an increasingly successful Voluntary
Counseling and Testing(VCT) network of 14 centers, while CDC
together with the Elizabeth Glazer Foundation have
jump-started a national Prevention of Mother to Child
Transmission(PMTCT) program at some 80 clinics and hospitals,
which already reaches 10 per cent of pregnant mothers. USAID
and CDC are now collaborating closely on integrating the VCT
and PMTCT programs to satisfy the rapidly increasing demand
for expanded HIV counseling and testing services among
pregnant women, their partners and families. Because the
PMTCT program is principally run through the public health
system, integrating VCT and PMTCT programs will require USAID
to join CDC in working with public health authorities.
Integrating these two programs will also 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.

Opportunity: Resources will determine our reach. Current USG
resources will enable us to reach 15 percent of seropositive
mothers, while an additional two million per year would
enable us to reach about 25 per cent of seropositive mothers.


4. ARVs: CDC has worked with the GOZ to develop guidelines
and protocols for ARV treatment and to prepare for the
laboratory-associated treatment requirements, while USAID has
performed a comprehensive assessment of logistical factors
for ARV delivery on a large scale. CDC has also brokered
arrangements between Pfizer and the GOZ for the initiation
and expansion of the Pfizer Diflucan Donation Program for
treatment of two significant opportunistic infections. Both
CDC and USAID actively interact with the GOZ and domestic and
international stakeholders on the programming, monitoring and
evaluation of funds pledged to Zimbabwe by the Global Fund.

Opportunity: For approximately three million dollars per
year, the USG could support a pragmatic, well-designed,
intensively evaluated highly active anti-retroviral
therapy(HAART) program sustaining between 3,000 and 5,000
persons with advanced HIV infection.


5. Bottom line: We are making real progress in Zimbabwe in
laying the foundation for a broad and effective HIV-AIDS
intervention. Our programs are totally consistent with our
policy of support for the Zimbabwean people, even as we
differ with the GOZ. Notwithstanding Zimbabwe's current
crises, the population, health sector and civil society,
including faith-based organizations, possess the fundamental
conditions for major progress in prevention, treatment and
mitigation. The HIV-AIDS crisis in Zimbabwe is so severe
that waiting is not an option. I urge that the USG commit to
providing all possible assistance to attacking the disease
now.
SULLIVAN