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VII. National and International responses to HIV/AIDS

Government response to HIV/AIDS

Zimbabwe has put in place some of the required policies as set by the United Nations General Assembly Special Session on HIV/AIDS in its declaration on HIV/AIDS and other international guidelines for an effective HIV/AIDS intervention strategy. However, not all the policies have translated into action.¹⁸¹

There has been little or no incorporation of international guidelines on HIV/AIDS into Zimbabwe’s domestic legislation. Zimbabwe’s National AIDS policy states, as part of its general human rights strategies that legislation which protects individuals against human rights violations and discrimination in terms of HIV/AIDS should be promoted and enforced.¹⁸² However, only labor legislation refers to HIV status as grounds for nondiscrimination. HIV/AIDS legislation is limited to criminal and labor law. Two pieces of legislation the Sexual Offences Act (Act 8 of 2001) and the Labor Relations (HIV and AIDS) Regulations of 1998 specifically address HIV/AIDS and PLWHA.¹⁸³

Zimbabwe’s response to the HIV/AIDS epidemic— which began in 1985— is currently led by the National AIDS Council (NAC), a coordinating body under the Ministry of Health and Child Welfare (MoHCW). NAC was established soon after the government adopted an official national HIV and AIDS policy on World AIDS Day, December 1, 1999 and declared AIDS as a national emergency. NAC was charged with managing funds from a newly created “AIDS levy” payroll tax which paid into a National AIDS Trust Fund (NATF).¹⁸⁴ 

While initially conceived as a coordinating body, NAC has also played a role in implementing AIDS interventions. NAC funds the purchase of ARV drugs, supports the Zimbabwe National Family Planning Council’s HIV/AIDS activities, Ministry of Health and Child Welfare, as well as directly funding program proposals submitted by NGOs, as well as the education sector (e.g., through the Basic Education Assistance Module (BEAM) for the payment of school fees), army, prison services and churches, and directly distributing food, blankets, home-based care kits, as well as conducting Information Education Communication (IEC) programs.¹⁸⁵

NAC has also set up Provincial, District, Ward and Village AIDS Action Committees, which coordinate the HIV/AIDS response through local government structures.¹⁸⁶ These participatory structures involve communities in identifying people infected and affected by HIV/AIDS, including orphans to enable them to access resources from NAC. Provincial governors and traditional leaders are involved in these structures. Within the government all ministries are included in the committees, including the Ministry of Health and Child Welfare, the Ministry of Education, Sports and Culture, the Ministry of Higher and Tertiary Education, Ministry of Youth, Gender and Employment Creation, Ministry of Local Government and National Housing as well as the Ministry of Public Service, Labour and Social Welfare (MPSLSW). NGOs and faith based organizations are involved at all levels of the NAC. In February, NAC disbursed more than Z$210 billion (US$2,100,000) to the country’s more than 90 district AIDS action committees¹⁸⁷ and the purchase of ART (NAC reportedly spends US$250,000 every month on ARVs (US$3,000,000 or Z$300 billion annually).¹⁸⁸

In 2000, the National AIDS Coordination Program (NACP) — also established in 1985 by the MoHCW - released a National HIV and AIDS Strategy Framework for the period 2000-2004.¹⁸⁹ The strategy emphasized the importance of protecting and promoting human rights as ‘Key Principles’ of the national response.¹⁹⁰  One of the key principles in the national response was that comprehensive, cost effective and affordable care should be made available to PLWHA.¹⁹¹

During this time period further plans for specific prevention, treatment and care strategies and for different economic and social sectors were developed. For example in 2001-2 a “Plan for the Nationwide Provision of ART” called for a detailed implementation strategy to be developed for all aspects of ART.¹⁹² It recommended that ART be introduced initially at a limited number of central sites and gradually decentralized to the provinces as more health personnel receive in-service training.¹⁹³  Availability, affordability and accessibility of ARV drugs were identified as an important gap in HIV/AIDS programming in the country. The MOHCW started its roll out plan in April 2004 and by May 2005, 27 public health institutions were offering ART services.¹⁹⁴

In 2005 UNAIDS reported that the overall coordination of the national response was fragmented due to “inconsistent National AIDS Council leadership, a difficult donor government relationship, and the existence of a multitude of topic specific coordination and partnership bodies” but that the situation was improving.¹⁹⁵ 

Although NAC has made extensive efforts to involve NGOs in its activities, local HIV/AIDS organizations interviewed by Human Rights Watch questioned the extent to which their participation translated into actual influence over HIV/AIDS – policy and programs.¹⁹⁶ They expressed concern about what they perceived was a lack of consultation and proper coordination by NAC. A number pointed out that NAC was highly centralized and that they felt unable to question some of NAC’s proposals.

NAC’s role coordinating the distribution of funds raised from the AIDS levy has also been the subject of criticism in the past. There have been reports by HIV/AIDS organizations of irregularities in spending of AIDS Levy funds¹⁹⁷ and lack of inclusiveness (eg farm workers) of projects supported.¹⁹⁸  The government has responded to some of these criticisms with investigations into expenditures of AIDS Levy funds in the past.¹⁹⁹ Nevertheless local and international NGOs that spoke to Human Rights Watch believe that the investigations have not resulted in any changes in the way funds are disbursed and that the government needs to do much more to ensure transparency.²⁰⁰  More recently spending of Global Fund Grants has also been questioned by local HIV/AIDS organizations.²⁰¹

In May 2006, the government produced a draft of a new medium term plan, the Zimbabwe National AIDS Strategic Plan for dealing with the epidemic for 2006-2010.²⁰² This draft plan, like the others,²⁰³ lacks specific operational or implementation details. For example the plan fails to specify responsible agencies, outputs, timelines, and budgets, providing instead broad-based objectives and a limited number of objectives and key indicators, with ambitious targets for 2010.

The plan includes 4 main strategies: (1) HIV prevention, with a focus on behavior change promotion; (2) increased access and utilization of treatment and care services; (3) improved support for individuals, families and communities infected and affected by HIV and AIDS; and (4) effective management and coordination of the national HIV and AIDS response.²⁰⁴

The plan presents targets related to each strategy: (1) the reduction of HIV prevalence among 15-24 year olds from the current 17% to single digits; (2) a coverage of 75% of those in need with opportunistic infection treatment and ART; (3) coverage of at least 50% of OVCs and affected households with a basic package of support services; and (4) a “fully operational” NAC with “coordination, partnership, resource tracking, M&E (monitoring and evaluation) and strategic information functions” including “costed annual work plans, including all funding streams”.²⁰⁵ The document states as the baseline for the fourth strategy that the NAC has a functional monitoring and evaluation department and NAC work plans.

Zimbabwe has set itself ambitious targets through its national HIV/AIDS policies and strategies but as yet it is not clear how these targets will be reached. The 2000-2004 national strategic framework mentions human rights as part of the strategy against HIV/AIDS while the latest draft plan refers to improved support for PLWHA and families affected by HIV/AIDS. On the other hand as this report has highlighted, the government’s own policies and practices violate the human rights of many PLWHA and threaten to worsen the HIV/AIDS pandemic. Negative political and economic policies, as well as poor relations with human rights organizations and international donors have also had a particularly detrimental effect on the government’s response to the epidemic.

International response to HIV/AIDS

In the past six years donors – who blame the government for the country’s social and economic crisis - have suspended direct aid to the government of Zimbabwe citing political violence, state repression and abrogation of the rule of law.²⁰⁶ The largely negative image of the Zimbabwean leadership among key western donors, including opposition to Zimbabwe’s human rights record and its controversial land reform program, seem to be key factors that have led to the exclusion of Zimbabwe from large scale donor schemes, such as the US President’s Initiative on HIV/AIDS, the President’s Emergency Fund for AIDS Relief (PEPFAR) that provide for a substantial contribution to donor funding for AIDS treatment in other countries in the southern African region such as Zambia, South Africa, Botswana, Namibia, and Mozambique.

In comparison to the mid 1990s, donor funding has been sharply reduced and is mainly limited to humanitarian assistance in response to recurrent drought and food shortages and the widespread HIV/AIDS crisis. Donor assistance to the Ministry of Health and Child Welfare, for instance, fell from US$71.27 million in 1997 to only US$6.68 million in 2002. ²⁰⁷ This has had a debilitating impact on the health sector and the government’s HIV/AIDS interventions. 

Bilateral funding for HIV/AIDS and other social programs has continued, directed almost entirely at NGOs.  At the same time bilateral donors have supported the national ART program through UNAIDS and the Zimbabwe National AIDS Council. Major ART partners include the US government with imminent scale up of technical support and funding expected from the European Union (EU) and the UK government’s Department for International Development (DfID).²⁰⁸

Even in the NGO sector, Zimbabwe is under funded for HIV services in comparison to countries in the region. For example, according to UNICEF, Zambia received $187 in international aid for every HIV-positive citizen in 2004, whereas Zimbabwe's strained relations with some donors meant that it received just $10 per person.²⁰⁹  Further, despite the world's fourth highest rate of HIV infection, and the greatest rise in child mortality in any nation, Zimbabweans were receiving just a fraction of donor funding compared to other countries in the region.²¹⁰ UNICEF also noted that in 2004-05 Zimbabwe received little or no HIV/AIDS funding support from the main donor initiatives. The World Bank estimates that Zimbabweans receive US $14 per capita from both development assistance and aid - less than one-quarter of what Namibians ($68) receive, and around 12 percent of those in neighboring Mozambique ($111).²¹¹

Donor funding to local and international HIV/AIDS NGO programs amounts to about US$70million.²¹²  Significantly, in a welcome reversal of the trend of the past five years, funding is likely to increase in the coming two years to address gaps in funding for HIV/AIDS programs. In April 2005, the Global Fund to Fight AIDS, Tuberculosis and Malaria allocated US$10.3 million to Zimbabwe to fight HIV/AIDS.²¹³  The previous year, the Global Fund had rejected Zimbabwe's application for a five-year, US$218 million HIV/AIDS program citing unspecified technical reasons.²¹⁴ The government of Zimbabwe accused it of politicizing funds for HIV/AIDS programs in the country.²¹⁵  In 2005, the fund finally approved a US$62.4 million grant for the next five years; although the first installment of US$35.9 million is yet to be released. An agreement for the release of the funds is yet to be signed as the Global Fund is waiting to receive relevant documents from the government.²¹⁶

US official assistance for HIV/AIDS in Zimbabwe accounted for US$24 million in the 2005 fiscal year.²¹⁷ On February 16, the US government pledged a further US$26 million to support the Zimbabwean government in the fight against HIV/AIDS.²¹⁸  On the other hand as already indicated, Zimbabwe has received no funding from PEPFAR.

DfID one of the biggest donors of HIV/AIDS projects in Zimbabwe is working on a proposal for £25m over 5 years to address the rising mortality rate in mothers and newborns through its underlying cause: HIV/AIDS.²¹⁹ This is in addition to £18m over three years on prevention and treatment, £20m over 5 years on behavior change and condom social marketing and £22m over 4 years on programs for orphans and vulnerable children. Since 2000, DfID's aid framework in Zimbabwe has doubled to £38 million in 2005/6.²²⁰  In a parliamentary session on May 3, 2006, the UK government indicated that DfID was at an advanced stage in developing a new phase of support, jointly with other donors, which would include scaling up AIDS treatment in Zimbabwe. The aim was to establish a U.N.-managed multi-donor fund for procurement of anti-retroviral drugs, including pediatric formulations that would be delivered through the public health service.²²¹

In spite of all these funding initiatives, key donors such as the UK and the US governments have made it clear that they will continue to withhold direct funding to the government, unless the political situation improves and the government engages in serious steps to redress the declining economic and social conditions in the country.²²² For example, despite DfID’s involvement in U.N.-led technical discussions with the Zimbabwean Ministry of Health and Child Welfare, over its new HIV/AIDS funding initiatives, at the parliamentary session on May 3, the government reiterated that no DfID funding would go directly to the government of Zimbabwe.²²³ More recently the EU and US governments pledged to uphold sanctions and restriction on visas for government of Zimbabwe officials until the political and economic situation improved.²²⁴

The stance of the international donor community has often angered the government of Zimbabwe which has accused donors of politicizing aid to Zimbabwe.  In a recent speech at a high level meeting on HIV/AIDS in New York, the Minister of Health Dr. David Parirenyatwa, claimed that there had been an apparent politicization of HIV/AIDS in Zimbabwe by international donors and said, “The international isolation of Zimbabwe has not helped the situation irrespective of the humanitarian situation of HIV/AIDS.”²²⁵ The government also blames its declining healthcare system and ARV drug shortages on economic sanctions imposed by developed countries which it describes as ‘illegal’. In March, Deputy Minister of Health, Edwin Muguti was quoted by the state Herald newspaper as saying, “sanctions kill…as can already be seen by their effects on our livelihoods as a people…look at fuel, look at drug supply and even ARVs.”²²⁶

Donor concerns about the government’s poor human rights record and flawed economic policies are indeed justified. Nonetheless, given the enormity of the HIV/AIDS epidemic in Zimbabwe, a substantial increase in donor funding is crucial. Zimbabwe desperately needs international aid and technical assistance to effectively address the HIV/AIDS crisis. Thousands of Zimbabweans remain in need of ART and opportunistic infection treatment and the prevention programs need bolstering.  In such circumstances the needs of the population must take precedence over political tensions between the government and the international community.  At the same time in providing such assistance, international donors also have a key role to play in ensuring that the states they are assisting comply with their international human rights obligations.