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By September 2015, 781 884 adults and 60 488 children were receiving lifesaving drugs

ish Mafundikwa Review Writer
By establishing the AIDS Levy to fund the country’s AIDS response and the National AIDS Council in 2000 to administer it and spearheading the multi-sectoral battle against the pandemic, the Zimbabwean Government showed that it was taking the threat posed by AIDS very seriously. But the narrative of the country’s AIDS response would have been different if then Finance Minister Dr Simba Makoni had succeeded in his attempts to scrap the AIDS Levy.

According to then Health Minister Dr Timothy Stamps, the then finance minister wanted to turn the money collected up to then into a bequest.

“In 2001 I spent two weeks with the then minister of finance Dr Simba Makoni who wanted to abolish the AIDS Levy Act and convert money collected up to then into a bequest because people were being taxed too much. I had a very hard time convincing him not to go that route and fortunately the president sat in and said no.”

Asked for comment Dr Makoni agreed that he wanted the tax scrapped.

The difference between him and Dr Stamps is merely semantic as he says he wanted it converted into an endowment.

“As far as I can recall the AIDS Levy was never meant to be permanent; it was not the idea to tax people in perpetuity. The idea was to turn whatever had been collected into an endowment that would generate interest which would fund the AIDS response.”

He conceded that the original endowment could have been “wiped out” during the hyperinflationary years.

The director of the AIDS and TB Unit in the Ministry of Health and Child Care Dr Owen Mugurungi concurs with Dr Makoni.

“People thought it, like the drought levy before it, was temporary.”

For some reason however, the mining companies were exempted from paying the levy when it was set up.

The former Health minister who is now Presidential adviser on health Dr Stamps said: “The mines were not taxed, they did not pay until Minister of Finance Patrick Chinamasa found out in 2014 and included it in the budget.”

The mines started contributing to the national AIDS response in 2015.

Zimbabwe set about organising NAC structures from district, provincial to national level thus giving people ownership of the programme and the right to decide how the response was to be conducted.

“This broke down the conspiracy of silence; debate was inevitable and it also helped with the reduction of stigma,” says Dr Mugurungi.

And, having realised that rather than have the health ministry deal with AIDS solely, there was a need for a multisectoral front against the epidemic.

The NAC board is made up of people who represent the interests of health care providers, women, youths, religious groups, organisations that protect the interests of persons infected with HIV and AIDS, industry, commerce, information media and trade unions.

By the early 2000 ARVs were already available locally but in the private sector and only for those who could afford them, according to Dr Mugurungi.

“People could buy the drugs but at about $150 per month’s supply, they were beyond the reach of the majority.”

Even for those who thought they could afford it was not sustainable, he added.

“Sometimes there was no money to buy the drugs so adherence, which is a must for treatment to be effective, became an issue.”

In 2002 the Government applied for funding from the Global Fund to fight AIDS, tuberculosis and malaria to pilot an ARV treatment project. That money took a while coming but by the time it was availed at the end of 2004, Health minister Dr David Parirenyatwa had given the go-ahead for Zimbabwe to start treatment at five centres nationwide.

“We started providing ART in the public sector with resources from the AIDS Levy which was only enough for 10 000 patients,” recalls Dr Mugurungi.

When Zimbabwe launched its treatment programme, donors were sceptical because the drugs were still too expensive, health workers were leaving and the country was facing economic challenges.

However, Government showed its determination and using a standardised public health approach, the Ministry of Health and Child Welfare implemented a robust and successful ART programme.

By the end of 2004, 11 000 clients were on ART. As a result of its success, the programme attracted donor support.

In subsequent years the ministry was able to attract partnerships and donor support from the Expanded Support Programme, the United States President’s Emergency Plan for AIDS Relief (Pepfar), Medicine San Frontieres (MSF), the Global Fund to fight AIDS Tuberculosis and Malaria, and the Children Investment Fund (CIFF) which complemented domestic funding from the fiscus and the AIDS levy.

To further support treatment, in 2007 Cabinet ordered that 50 percent of the money raised through the AIDS Levy be directed towards treatment.

Zimbabwe’s ART programme has grown exponentially and has been a success.

The number of persons on ART rose from 11 000 in 2004 to 60 000 by 2006 and 220 000 were on treatment by 2009. By September 2015, 781 884 adults and 60 488 children were receiving lifesaving drugs. Treatment has been decentralised from five sites in 2004 almost 1 400 of the targeted 1 666 health facilities.

Prevention of Mother to Child Transmission (PMTCT) service which started as a pilot project in 1999 was rolled out country wide in 2002.

Today all health facilities offering maternal and child health services offer PMTCT services.

Zimbabwe also launched some non-biomedical interventions primarily voluntary medical male circumcision (VMMC) in 2009.

Apparently circumcision reduces the chances of one contracting HIV by 60 percent.

“The plan was to circumcise 1,3 million men aged between 15 and 29 (who are HIV negative) which is the target group at highest risk, in five years,” says Dr Mugurungi.

The target has not been met but as of September 2015, 500 000 men have been circumcised.

But the failure to reach the targeted number is not viewed as a disaster by UNAIDS Zimbabwe country director Mr Michael Bartos.

“Circumcision is not a perfect protection. If it were the case and you could tell men that they had no risk of getting HIV once they are circumcised people would be breaking down the doors to be circumcised! So because it’s a risk reduction and not elimination and you still have to or can use condoms for protection, I think many men have done their risk equation and say ‘well why should I go through a procedure which may be uncomfortable (if it does not eliminate the risk)?’”

Zimbabwe’s AIDS response has been a success but not an unqualified one according to NAC chairperson Dr Evaristo Marowa who says a lot of issues still need attention.

“There is no doubt that stigma issues continue, there is also no doubt that now we are seeing people who are developing resistance to first line who go on to second line (treatment).

There is still that inadequacy of the actual cohesion universally for the HIV/AIDS response.

“There are some sectors who say it’s a health sector problem, I think our private/public partnership has been interfered with because of the socio-economic difficulties we have gone through,” he said.

But he was quick to add that despite the socio-economic crises of the mid to late 2000s and which have been recurring since, the AIDS response has remained reasonably intact.

“I think that’s also credit to Zimbabwe and the international donors and those who provide technical support like the UN, financial support like the Global Fund and others.”

He further says he feels that there is need to re-emphasise prevention.

“We need to keep our eye on the ball, we need to continue to hammer the message and especially even though there is treatment, HIV remains a significant problem and people should continuously be alert and vigilant with themselves and others and should continue to use protection. I think at some point we end up focusing more on treatment than prevention,” said Dr Marowa.