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I. Summary

My husband left when I fell sick. He now stays with another wife. Before my husband left I was on medical aid and then he left and I had nothing. My husband doesn’t pay any maintenance and he took my property away. We were together for 13 years … My relative who I stay with doesn’t know that I am HIV positive. There are three other families in the same household and the others suspect that I am HIV positive and they aren’t comfortable with me. If they knew they would chase me. I don’t work. I do some embroidery but business isn’t going well. I have had to sell some of my clothes to meet expenses. I just manage to pay the rent. We only have one meal a day in the evening. It’s tough. Sometimes you just think that maybe if you die, things will get better. I have to find transport to get my ARVs and when I don’t have the money I walk to get the ARVs. I am so stressed. I nearly committed suicide because things are so tough. There’s no bright future because when you don’t know what you are going to eat tomorrow, there’s no future.
—Cecilia M., 40, living with HIV/AIDS

Zimbabwe has been widely hailed as a success story in the fight against AIDS since reporting in October 2005 a decline in HIV prevalence among adults from 25% in 2001 to 20% in 2004. In the face of the devastating impact of HIV/AIDS on the country, a declining economy, growing international isolation, decreased funding from international donors for HIV/AIDS prevention and treatment, and a disintegrating public health sector, Zimbabwe’s achievement was indeed significant.

Despite the positive news, however, the HIV/AIDS epidemic in Zimbabwe remains a serious crisis with some three hundred and fifty thousand of the 1.6 million people carrying the virus in immediate need of life-saving antiretroviral (ARV) drugs and another six hundred thousand in need of care and support. With an HIV prevalence rate of 20%, Zimbabwe still has one of the highest prevalence rates in the world.  Of greatest concern is that the progress gained so far could be undermined by Zimbabwean government policies and practices that violate the rights of people living with HIV/AIDS (PLWHA) and those most at risk of infection. These violations threaten their rights to health, information, work, equal protection before the law and nondiscrimination.

Zimbabwe’s health and social welfare policies have resulted in the denial of access to healthcare for tens of thousands of Zimbabweans living with HIV/AIDS in immediate need of HIV/AIDS-related treatment.

Thousands of PLWHA are unable to access HIV/AIDS-related treatment and care services because they cannot afford the high costs of user fees for health services. The government has established a system of exemptions or waivers for health user fees to assist in equitable access to health care for the poor and vulnerable. However, lack of information on the criteria and availability of the exemptions, combined with a failure to have an enforceable and standardized assessment process by which all social welfare officers administer the exemptions, leads to their subjective and ultimately arbitrary application. The result is unnecessary obstacles for vulnerable and poor PLWHA who urgently need access to healthcare, leaving them at risk of fatal deterioration in their health.

A lack of public information on antiretroviral therapy (ART) policies also restricts access to treatment for thousands of people in desperate need of life-saving antiretroviral drugs.  Failure to provide sufficient  information to public sector physicians, AIDS service organizations and networks of PLWHA on national standards for ART , and  specifically on the necessity and role of CD4 tests (a marker of immune system function) in the eligibility criteria for ART, has led to thousands of people being turned away unnecessarily from access to ART.

The repressive political environment in Zimbabwe has prevented activism and debate on HIV/AIDS and human rights among civil society and PLWHA. NGOs working on HIV/AIDS report that they face difficulties advocating for the human rights of PLWHA and the political and economic aspects of the pandemic because government officials and members of the government’s Central Intelligence Organization (CIO) regularly intimidate and harass them when they try to do so.  Restrictive legislation has also curtailed the ability of NGOs, including those working on HIV/AIDS to work freely around the country.

Tens of thousands of PLWHA continue to suffer from the catastrophic consequences of the government’s program of mass evictions and demolitions (Operation Murambatsvina) which has disrupted their lives and access to HIV/AIDS treatment, care and support.

Further, the government’s economically ruinous policies towards informal traders and the informal economy have increased the risk of infection for thousands while further imperiling the lives of those already infected with HIV. Economic restrictions on informal trading put in place by national government authorities, pose a significant obstacle to the ability of PLWHA to earn a livelihood and afford HIV/AIDS -related treatment and care.  These restrictions have also narrowed the livelihood strategies of a significant part of the population which relies upon the informal sector most, such as women and other poor and marginalized individuals. As a result of these policies and discrimination against women in the workforce generally, women in particular are left with few choices and often engage in high risk behaviors and strategies such as “survival sex” which put them at greater risk of HIV infection. The report also documents the plight of women who bear the brunt of the epidemic and are often economically insecure. Women continue to face overlapping abuses of their human rights including domestic violence, discriminatory legislation and violations of property and inheritance rights which leave them vulnerable to HIV infection or unable to alleviate the consequences of living with HIV/AIDS.

The report also examines the role of the international donor community, which has significantly pulled back direct assistance to Zimbabwe since 2000. Given the enormity of the HIV/AIDS epidemic in Zimbabwe, a substantial increase in donor funding is crucial. Increased funds from the British and US governments, and from the Global Fund against HIV/AIDS, Malaria and Tuberculosis, are now imminent. It is imperative that the international donor community not allow well founded concerns about the state of democracy in Zimbabwe to block the provision of much needed assistance for HIV/AIDS programs in the country. At the same time international donors should continue to call on the government of Zimbabwe to respect human rights and provide an environment that is conducive to effectively addressing the crisis.

The 2001 U.N. General Assembly Special Session (UNGASS) declaration of commitment on HIV/AIDS recognized that the realization of human rights is essential to reducing vulnerability to HIV/AIDS and that protecting human rights empowers people living with HIV/AIDS. 

The government of Zimbabwe risks a reversal in the progress achieved thus far in the fight against HIV/AIDS unless it takes serious steps to address violations of human rights and creates an environment that is conducive to free expression and activism on human rights and HIV/AIDS. Human Rights Watch calls on the government of Zimbabwe to meet its international obligations and respect the rights of its citizens including PLWHA to information, employment, freedom of expression, association and assembly, nondiscrimination, and health. It must show its commitment to fighting the HIV/AIDS pandemic by ensuring equitable and nondiscriminatory access to health care for all its citizens, reversing economic policies that have the effect of further impoverishing its poor and vulnerable citizens, ceasing policies that prevent and restrict advocacy on the part of people living with HIV/AIDS, and supporting the efforts of international and local organizations working with and providing treatment and care to PLWHA.