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ish Mafundikwa Correspondent
In 1981 a lethal disease was reported among men who have sex with men in New York, Los Angeles and San Francisco in the United States of America. Reports of the disease, which weakened the immune system leading to opportunistic infections such as Kaposi’s sarcoma and pneumocystis pneumonia and certain death, appeared in the media including here in Zimbabwe.

Former Minister of Health and now Presidential Advisor on Health Dr Timothy Stamps says it did not raise the alarm here because it was perceived to be a “gay thing”.

“The disease was exotic and affecting gay men. The Americans called it Gay Related Immune Disorder (GRID) so people here felt it was not a matter to be concerned with.” But the notion that AIDS was an expressly gay problem was turned on its head in July/August 1985 when the National Blood Service Zimbabwe (NBSZ) which supplies hospital blood banks with blood donated by members of the public started testing for the virus that causes AIDS.

Researchers had determined that the virus was transmitted through body secretions in including blood. The virus was then known as Human Lymphotropic Virus Type 3 (HTLVIII).

The tests revealed that there were Zimbabweans who were HTLVIII or HIV-positive. Dr Jean Emmanuel is the Medical Director of the NBSZ. He says Zimbabwe was one of the first countries to test all collected blood for the virus responsible for causing HIV/AIDS.

“Every blood donor found to be HTLVIII positive was rechecked and a confirmatory test was carried out on a second sample and all confirmed positive tests resulted in the patient being confidentially notified, counselled and recommendations made on life style changes and precautionary measures to prevent passing the virus to others, especially through intimate sexual contact,” said Dr Emmanuel.

But even after this scientific revelation, some politicians refused to acknowledge the gravity of the problem. Dr Emmanuel: “Unfortunately sensitivity on the issue of HIV/AIDS, through denial, fear and stigmatisation has taken many years to overcome and persists in many quarters even today.”

Dr Stamps was appointed Minister of Health in 1990 and immediately set about confronting the AIDS issue head-on, unlike some of his predecessors who had dithered in the face of mounting evidence that AIDS was a growing problem in Zimbabwe.

“The minister before me, Dr Felix Muchemwa, downplayed the prospects of AIDS becoming a problem,” DR Stamps says. He added that there was also the theory about HIV being the result of jealous husband using “runyoka”, a “central locking system” that causes a lover who has sex with his wife inexplicable and painful illnesses that often lead to death.

His outspokenness riled many including the late Members of Parliament Sydney Malunga and Gibson Munyoro.

Addressing Parliament during a debate on rape, spouse battering and AIDS on October 23, 1990, Malunga accused Dr Stamps of being alarmist; “Talking too much (about AIDS), wastes too much time and chases tourists away. When tourists see the figure of 400 000 about to die of AIDS, how do you hope to attract tourists into the country?”

Munyoro chimed in; “The nation of Zimbabwe understands very well the problems involved and that it is a killer disease and it is no use keeping on saying it . . . do not be alarmist”.

He blamed rape on the unemployed, “ . . . what do you expect a person who is lying under the flyover to Highfield, unemployed, what do you expect him to do?” The fact that he was ordered to shut up albeit in parliamentary language by the Speaker of the House when he went on a tangent about “ . . . this zebra crossing where pedestrians are being terrorised by motorists . . ” exposed the level of a lack of appreciation of the gravity of the subject he was supposed to be addressing.

Others also used Parliament as a platform to suggest summary action against HIV-positive people. In August, 1994 Chief Nathaniel Mutoko suggested murder as a solution; “If a pregnant woman is found to have AIDS, she should be killed so that the AIDS ends there with her,” he said.

Though there clearly was a political conspiracy of denial and downplaying the problem, Dr Stamps says President Robert Mugabe was not a part of it. “I still remember as if it was yesterday the President saying ‘Pasi neAIDS!’ at St Theresa’s Makoni when I went on a tour of mission hospitals with him.”

The late Vice President Dr Joshua Nkomo also broke the mould when he attributed the death of his son to AIDS in 1996 albeit with the appendage that the disease was “harvested by whites to obliterate blacks. … (But) it backfired and they, too, are dying of it, but still they have the knowledge of its origins and how it can be cured. But they just do not want to share that knowledge.”

This at a time when most people who were suspected of dying from AIDS euphemistically died after “a short or long illness.” The other reason why AIDS remained largely under the radar was the lack of infected people publicly declaring their status because of the stigma attached to it. However, a few brave people did “come out”.

Two of the most prominent ones are Auxillia Chimusoro and Lynde Francis, who both went on to become AIDS activists. Chimusoro was diagnosed with HIV in 1987 and revealed her status on national television in 1989.

She died in 1998.

Francis who was diagnosed in 1986 died in 2009. A public debate was also going on and because during those early years a lot of people did not know anyone who was HIV positive or had died of AIDS, many dismissed the issue with some saying AIDS stood for American Ideas to Discourage Sex and a ploy to stop Africans from having sex and multiplying.

While condom use was being encouraged and promoted by the likes of Dr Stamps, a lot of people remained sceptical and kept having unprotected sex.

But it did not take too long before the mounting death toll convinced people that AIDS was not a product of somebody’s fertile imagination and condom use increased. In 1992, a company led by businessman Mr Stalin Mau Mau started installing condom vending machines in strategic places such as bars, hotels and in both male and female public toilets.

“Demand for condoms spiked but they were mostly available in pharmacies and most people were really inhibited and would not walk into a pharmacy to ask for condoms. The first machines were imported but then we decided to manufacture them locally,” he recalls.

Mr Mau Mau says business was very good until the economy’s accelerated downward spiral. “The Zimbabwe dollar was losing value. Our machines took the dollar coin and suddenly we were not making any money, we even tried to make some tokens instead of using cash but this made it more expensive for us, so we abandoned the project.”

Unlike in the United States, the AIDS virus in Africa is spread primarily through heterosexual sex just like any other sexually transmitted infection. But in any sexual network, the chance of exposure to the virus that causes AIDS is increased by having multiple and frequent sexual contacts.

Consequently, those who have the most frequent sexual contacts such as people who sell sex and their clients are most at risk. Women can also pass the virus on to their unborn babies. When AIDS hit Africa it, snowballed like an out of control savannah fire.

This led some western countries to blame the rapid spread on the mythical cavalier primitive sexual tendencies of Africans. As a result, some African leaders took a defensive stance and blamed the allegations on Afro-pessimism.

Dr Evaristo Marowa, a local venereologist, who like Dr Stamps took an early interest in AIDS when it became a health issue in the United States, says there was significant political denial in Zimbabwe.

“A number of politicians did not want to talk about it as it was characterised as a disease of promiscuity, gay people and also there was that notion from the West that it started in African monkeys and jumped species to humans.” This, he said, was interpreted by some as an insinuation that Africans were having sex with monkeys.

Dr Marowa was an STI specialist with the City of Harare when the first cases of AIDS were reported in the United States.  He was invited to head the newly formed National Aids Control Program (NACP) in the Ministry of Health and Child Welfare in 1988. He says while there was clarity in the medical fraternity, because of lack of knowledge and information, some people ended up politicizing the issues while others looked at it more scientifically so there were those two opposing forces.

There was and still is also the element of traditional healers and religion which both play a major role in the lives of Zimbabweans the majority of whom claim to be Christian but are more syncretic in practice. In the 1990a many traditional healers claimed they could cure AIDS. These claims drew the ire of Dr Stamps who accused them of giving people false hope by treating symptoms of AIDS and falsely claiming they could cure the disease.

He however accepts that they do have some knowledge which can be used to deal with opportunistic infections. “They have natural herbs, more than that they are part of the community so nobody should be excluded and they have knowledge which they impart to their community and we should listen to what they say and not dismiss them as ignorant peasants.”

Dr Marowa also observed that despite the advances in medical science, many Zimbabweans still consult traditional healers and soothsayers for various reasons including HIV. “It’s always difficult because the two have fundamental differences and the situation has been worsened by prophets who claim they can treat people with water but I think a great effort has been made in trying to bridge that gap, trying to establish some collaborative platform, how there can be synergies and complementarity because traditional healers are very key in society.”

He added that religion is also in the mix with some prophets and sects urging their followers not to take ARVs but to drink water that has been blessed by the prophet instead. The Roman Catholic Church also discouraged people from using condoms.

There were also drugs like the Chinese Mocrea and Kenyan Kemron whose manufacturers claimed could cure AIDS. The former was championed by former Deputy Minister of Health and Child Welfare Ms Tsungirirayi Hungwe who called for clinical trials of the drug and urged the government to remove duties on the drug to make it affordable. Kemron was hailed for improving the health of people with HIV with claims that some had HIV entirely cleared from their blood. But international scrutiny by the World Health Organization among others dismissed the claims of its efficacy.

While policy makers were trying to work out how to deal with the AIDS issue medical personnel were dealing with seeing people dying without being able to do much about it.Dr Owen Mugurungi who is now the Director of the AIDS and TB Unit in the Ministry of Health and Child Care was a young GP in Wedza district when he came across AIDS. “The early years of AIDS were very depressing as we just watched people die. There were no ARVs and we just treated people for the opportunistic infections but in the end people just died,” he recalls.

He moved to Goromonzi as District Medical Officer in 1991 and it was the same story. At that time he was involved in a number of activities which included surveillance, information, education and communication and training people and health workers on the basics of HIV.

In 1997 Dr Marowa invited Dr Mugurungi to join the National AIDS Control Program (NACP) as STI control manager in charge of IEC, condom promotion, behaviour change and treatment of opportunistic infections. He became director of NACP in 1999 when DrMarowa left.

Professor Inam Chitsike was part of the ministry of health team that piloted Zimbabwe’s first PMTC project which was launched in late 1999 at three ante-natal clinics in Harare, Chitungwiza and Bulawayo. The aim was to pilot  the feasibility of implementing interventions for prevention of mother to child transmission of HIV ( PMTCT) in routine maternal, newborn and child health services.

The drug used at the time was single dose nevarapine which had been shown to prevent the transmission of HIV from an infected mother to her unborn baby. The project was based on an opt-in approach  where expecting mothers would receive intensive pre- test counselling before deciding whether they wanted to be tested for HIV or not.

“This method proved to be too labour intensive with low uptake as a large proportion of women declined testing after counselling and some of those who agreed to be tested did not return for their results,” says Professor Chitsike.

The opt-in approach at the time was acceptable as most women who tested positive had no access to comprehensive HIV treatment and it was of ethical concerns for a pregnant women to know her status when there was no treatment offered to her.  When more effective ARV regimens were accessible for PMTCT and also for the mothers, knowing the HIV status was beneficial both as PMTCT intervention and by treating the mothers, keeping the mother alive. HIV testing was then offered as part of routine care approach to pregnant women. This, according to Professor Chitsike, resulted in significant acceptance of HIV testing.

Other activities of the pilot project included review of policies including breast feeding policies, training of health workers, improving the health information system to include new health indicators, advocacy, community mobilisation, partner coordination as there were many partners who were interested in supporting the government in the roll out of PMTCT. The pilot project achieved its aims and was integrated as a full programme in the health system.

DrMugurungisays initially the ministry of health’s response and warning of the public about AIDS was rather crude and meant to shock people, “It was if they did not protect themselves they would die. While this was true frightening people was not the idea. There were concerns that tourists and investors would stay away from Zimbabwe if we admitted that we had a problem.

The first decade was about denial and branding AIDS a gay problem so we went from denial, fear, anger and finally acceptance. I am sure a lot of lives would have been saved if we had accepted we had a problem earlier.”

However, by 1998 the government further acknowledged it had a crisis on its hands when it sent a delegation to then AIDS ravaged Uganda“to study the prevalence, combating and control of HIV/AIDS in that country.”  Current Minister of Health and Child Care Dr David Parirenyatwa who was then Deputy Minister of Health and Child Welfare was part of that delegation.

Unfortunately Dr Parirenyatwa was not available to furnish details of that visit and other AIDS related issues but parliamentary records show that the visit took place from July 4th to 11th. According to the report,by the end of 1997 more than 300 000 Zimbabweans had full-blown AIDS and 700 people “may be dying per week as a result of AIDS.”

The creation of the National Aids Council(NAC) in 1999 through an Act of parliament marked a sea change in government’s handling of what had by then become a global health threat.The establishment of the AIDS levy whereby companies and the formally employed were taxed 3 percent of their taxable income also showed that government was finally taking AIDS seriously.

Though the AIDS levy started in January 2000 the NAC secretariat only came into being in September of the same year. The early years of AIDS were very depressing as we just watched people die. There were no ARVs and we just treated people for the opportunistic infections but in the end people just died.

The current Country Director for UNAIDS in Zimbabwe Mr. Michael Bartos was a researcher in Australia’s national HIV research programme in the 1990s. Reflecting on Zimbabwe’s experience of that period he observed that “Timing is crucial. Australia’s HIV epidemic was just a few years behind that of the US, but we were able to learn from the successes and especially the mistakes that had been made there.

There were also few direct parallels Zimbabwe’s explosive heterosexually-driven epidemic could look to. Undoubtedly, if more was done earlier the epidemic would never have peaked at such high rates, because once HIV is set in a growth spiral it is immensely hard to control, partly because people are more infectious when they are in the early stages of infection, so the more people there are newly infected the more they are likely to infect others.”

Nevertheless with most international donors at the beginning of the century still refusing to fund antiretroviral treatment for developing countries because they doubted treatment programmes could be managed properly, many lives would still have been lost.

ZIMBABWE AIDS FACTS AND FIGURES BY THE YEAR 2000 15 years after first cases were detected

Adult HIV prevalence…26.5%

Life expectancy….43.92 down from down from 56.0 in 1975

Cumulative number of children orphaned by AIDS…549 100 730

Children orphaned by AIDS that year….145

People on treatment (ART) … 0

Male to female ratio of PLHIV….1:1.27