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in neighbouring countries.

The conditions are not favourable when the employer knows that one does not have the requisite papers so she is on the receiving end in most cases. She works for long hours and has to stay indoors most of the time to avoid deportation.

In a recent interview at her home in Mabvuku she said she finds herself between a hard place and a rock.
“I have been a cross-border trader for 19 years and have been able to raise my children that way. With the opening up of the economy, flea markets are now found almost in every street making hawking business unviable.

It appears everyone is selling the same goods, so bringing in clothes for resale now takes long as one ends up selling them on credit. I have now resorted to only bringing goods for customers who with specific orders unlike during the olden days when I brought anything for resale,” she said.
Rutendo has resorted to finding work as a domestic help every time she goes to South Africa.

“I have two families that I work for in the Cape Province. One of them is a girl who grew up in our neighbourhood in Mabvuku, but is now based in Cape Town. I work for her as and when she needs me. I have to live in with her family to avoid being deported. It’s unfortunate that when one knows that you are desperate, they end up paying you peanuts,” she said.

Rutendo said she was referred to the second family by the same employer and they, too, pay low rates.
“The other family I work for are friends to this girl I grew up with. They seem to have agreed on what to pay me because they pay me exactly the same amount. I work long hours and at one time worked as a nurse aide.

The second family’s mother-in-law was diagnosed with cervical cancer and I had to be there with them for eight months when she received treatment. I am glad I saved someone’s life and the mother-in-law got well and left for KwaZulu Natal where she lives,” said Rutendo.
Rutendo said her main worry is when she fails to come back home on time to collect her ARVs.

“There have been times I have failed to collect medication on time. In 2011, when I stayed in Cape Town  for eight months as  nurse aide I ran out of medication. I am given three months’ supply each time I visit the clinic so imagine the five months that I was not on medication. I was stressed and when I finally came back home the doctor at my clinic was not amused,” she said.

Local health facilities have a trackdown scheme but usually due to financial and human resources constraints this is not feasible.
The hospitals have a system where one is booked and on that particular day, all booked patients have their files out and if one remains unclaimed on the desk,  that means the patient has not turned up for review.

A nurse speaking on condition of anonymity said that they have a flow-up tracking system, but due to financial constraints they at times fail to track down defaulters.

“We do have a system where we can track defaulters when they fail to pick up their ARVs. It’s easy because we end up with the files on the desks and each file has a contact number so we are required to phone the patient to remind them that they have missed treatment.

However, this does not always happen, we do not have enough airtime to phone all defaulters so we miss some through the network loopholes,” said the nurse.

She said another painful issue was when as health practitioners they seemed to be opening up old wounds after phoning a family only to find out that the patient is deceased.
“We have at times opened up healing wounds when we phone a number and we are told that the owner is now late. The family starts to grieve again and it’s so sad to pass condolences on the phone like that so it’s a difficult situation but track down patients we have to,” said the nurse.

In Rutendo’s case, she has been moved onto second line regimen.
When one defaults the medication that one was using no longer works so the patient has to be moved to a more efficacious regimen.

“When I came back after my eight months sojourn in Cape Town, although I was not ill, the doctor was not amused. He asked the nurse that I be taken for counselling sessions again before I was commenced on second line medicine. I was informed that the new ARVs cost 10 times more and were I to default again that was now at my own peril,” said Rutendo.

Rutendo has had problems securing three-month supplies as was the case when she was on first line therapy when she got three months supply.
“The new ARVs I use are expensive and the clinic does not have enough to give three-month supplies. I end up being given a month’s supply. I have therefore told them of my problem and now have my sister collecting on my behalf when I am away and she sends them through courier service,” she said.

National records are still manual and one has to have a card but the National Aids Council moots that by 2015 positive living will be enhanced through centralised data. This means that one is able to collect medication from any centre nationwide.

Mr Amon Mpofu, the monitoring and evaluation director, said that this would cut down on defaulters and would see adherence going up.
“We have had cases of defaulters because our population is highly migratory. A person fails to collect medication on the said date because they have to go back to their health centre. So as a way to overcome this challenge, we will by 2015 have a centralised data system where a patient will be able to pick up medicine anywhere in Zimbabwe,” he   said.

He said the above scheme needs proper planning and stocking as we can end up with some centres receiving more patients than the others depending on location.
“The system will be run on a trial basis and see which centres end up receiving the bulk of migratory patients. We therefore have to manage medication stockouts as a priority area,” he said. The 2011-12 Zimbabwe Demographic Health Survey saw some provinces recording a decline in HIV prevalence but some going up.

This has been so due to a number of reasons. The population is migratory, people on ART are now living longer, so life has generally improved and less people are now dying due to Aids-related illnesses.

As seen in the graph, Matabeleland South HIV prevalence remains high and this has been a cause of concern. It could be due to the fact that it is a migration hub as many people in the province work in neighbouring countries.

Debate is open as readers can send in their opinions on the trends in each province. [email protected]