Paidamoyo Chipunza Senior Health Reporter
The launch of the Zimbabwe Population-based HIV Impact Assessment (Zimphia) in Harare by Government last week left many uneasy and unsure of how they will react should they be among the 15 000 households targeted for testing.
Heated debates ensued on different social media groupings, commuter omnibuses and even at workplaces where many wondered why Government needs door-to-door HIV testing particularly now when other statistics are showing a decline on the burden of HIV versus an upsurge of non-communicable diseases.
Some of the questions that were asked are as follows:
“What happens to a person’s right to choose when and where to get tested?”
“Should I turn out to be HIV positive, then what?”
“If prevalence rates should turn out to be much higher than currently believed does the country have the capacity to provide treatment and support services to all those who need it?”
The responsible ministry seems to have recognised that stigma is the number one enemy and has gone onto social media platforms to fight it.
A Facebook page – BEAT AIDS Project Zimbabwe – has created a space asking for people to actively join the war against stigma.
“Fighting HIV Stigma in Zimbabwe with Dr Owen Mugurungi, Ministry of Health and Child Care’s Director of AIDS and TB, and Dr Tapuwa Magure, CEO of the National AIDS Council and BEAT AIDS Project Zimbabwe’s HIV Equal anti-stigma initiative. What do you feel is the best way(s) to reverse and fight HIV stigma?” reads a recent post.
The comments reveal that people are not denying the existence of stigma with some giving explanations and offering solutions to the problems:
“Sex and its equipment is still a hush hush topic in African communities. Sexual organs are still a taboo area to talk about, in about any circles. Therefore ditto all the STIs, including HIV/AIDS. As long as this is the case, STIs will never lose their stigma,” observes one Kennedy Chiramba.
He goes on to suggest that Zimdancehall artistes be engaged to pen songs dealing with stigma, something that the page administrator says is already in the pipeline.
But in their personal space many Zimbabweans appear to be dismissing Zimphia as a misplaced priority.
Health and Child Care Minister Dr David Parirenyatwa said it is a key tool in fighting HIV and everyone should appreciate that although considerable progress has been recorded with regards to reducing the burden of HIV in Zimbabwe, the country remains saddled by a high burden of the disease.
Dr Parirenyatwa said there was still need for continued leadership and resources in order to reduce the impact of HIV on households and the country as a whole. Thus Zimphia offers the country an opportunity to understand the pandemic and to design more effective interventions.
“As a nation, it is imperative that we understand the pandemic and its dynamics so that we better position ourselves to deliver it a killer blow by 2030,” said Dr Parirenyatwa.
He said the wide range of data variables to be measured during the survey was also strategic for the country as it will provide new information for use by the national response.
He said previous surveys such as the Zimbabwe Demographic Health Survey (ZDHS), the Multiple Indicator Cluster Survey (MICS) and the yearly national HIV estimates did not provide the same level of data as Zimphia.
In October 2014 director of Aids and TB Unit in the Health and Child Care Ministry Owen Mugurungi said that 11 000 people had not collected their results out of the 196 000 people who were tested for HIV in 2013.
He also said that Government wanted to increase the percentage of Zimbabweans aware of their HIV status from 58 to 85 percent by 2015.
Zimphia chief of party Dr Godfrey Musuka whose organisation will be partnering Government in conducting the survey said during the rollout, individuals retain their right to know their status as appropriate consents would be obtained. Thus people have a right to agree to get tested or reject the overture.
Dr Musuka said survey teams will collect demographic, clinical (including blood samples from the arm, finger or heel to perform HIV testing), and behavioural information.
“Tablet computers will be used to collect the information via face to face interviews and computer-assisted self interviews,” he said.
He said trained nurses will provide HIV counselling and testing while rapid test results for HIV and syphilis would also be returned to participants on the same day.
Dr Musuka said additional same day results for some individuals would include CD4 cells counts and growth monitoring.
“Those who test positive for HIV and or syphilis will be referred for care to existing health facilities,” said Dr Musuka.
Head of Aids and Tuberculosis Unit in the Ministry of Health and Child Care Dr Owen Mugurungi said the main objectives of Zimphia were to estimate new HIV infections at national level and estimate provincial prevalence of suppressed HIV viral load in HIV infected adults.
Suppressed HIV viral load means the virus would have been suppressed to undetectable levels in HIV positive individuals.
Dr Mugurungi said the survey will also measure HIV knowledge and attitudes including behaviours related to risk of HIV transmission such as sexual activities and alcohol use.
“The results from Zimphia can be used to inform social services planning related to reducing HIV infections as recorded under the Social Services and Poverty Eradication Cluster Matrix of the ZimAsset,” said Dr Mugurungi.
National Aids Council, Zimbabwe National Statistics Agency, Biomedical Research and Training Institute are some of the organisations taking part in the survey, which is expected to last for six months.
PHIA surveys will be implemented in 20 other countries, mostly in sub-Saharan Africa.
According to other surveys such as the ZDHS (done after every five years) and yearly national estimates, the HIV burden in Zimbabwe continues to decrease with latest statistics showing decreases in national HIV incidence, new infections and the number of children getting infected through mother to child transmission.
The country’s prevalence rate, however, remained static at 15 percent while the number of people on anti-retroviral treatment is pegged at 63,4 percent for adults and 55 percent for children. About 1,2 million are estimated to be living with HIV and Aids.
At least $8 million has been set aside for the ground breaking survey, with substantial financial support from the United States President’s Emergency Plan for AIDS Relief (PEPFAR), $5 million of which will go towards boosting 16 laboratories dotted across the country.
Additional resources have also been availed by Government and the Global Fund.
ZIMPHIA at glance
To estimate HIV incidence (new HIV infections) at the national level,
To estimate the provincial prevalence of suppressed HIV viral load in HIV infected adults
It will measure: HIV prevalence in adults and children
Distribution of CD4 cells counts among people living with HIV
Prevalence of antiretroviral drug resistance
Prevalence of syphilis among adults
Coverage of antiretroviral therapy in the country
Nutrition in HIV positive children, based on weight and height for age
Behaviours related to risk of HIV transmission, including sexual activity and alcohol use
HIV knowledge and attitudes
Zim HIV stats
Aids-related deaths declined by 57 percent in the country from 2005 to 2013
A 34 percent reduction in new HIV infections occurred between 2005 and 2013.
HIV prevalence declined from a peak of 28 percent in 1997 to 15 percent in 2013.
Reduced Parent To Child Transmission rate from 30 percent in 2009 to 5,5 percent in 2014.
Estimated drop of new HIV infections from 62 830 for 2015 to 48 999 in 2016.
Zimbabwe accounted for 3 percent of all new HIV infections globally.
Zimbabwe accounted for 5 percent of the global total of people newly accessing antiretroviral therapy between 2010 and 2013
Of 10 Sub-Saharan countries studied Malawi had recorded the highest reduction at 65 percent, Tanzania (46 percent), Zambia (41), South Africa (39), Nigeria (35), Cameroon (29), Mozambique (27), Uganda (21) while Kenya had the lowest decline at 16 percent.
19 million of the 35 million people living with HIV globally do not know their HIV-positive status.
Source: UNAids report on Zimbabwe released in advance of the International Aids conference in Melbourne, Australia, in July 2015.