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Zimbabwe says the proportion of HIV positive adults has fallen from a third to a fifth

BMJ 2005; 331 doi: (Published 29 September 2005) Cite this as: BMJ 2005;331:720
  1. Pat Sidley
  1. Johannesburg

    Zimbabwe's health minister tells Pat Sidley that drugs should be excluded from the international sanctions affecting his country

    Zimbabwe has a similar sized epidemic to that of its neighbour Botswana but is facing the additional problem of sanctions. Its deputy minister of health and child welfare, Edwin Muguti, claims that despite being “squeezed” by the international community the country has an antiretroviral programme up and running.

    The HIV and AIDS statistics are dogged by under-reporting in many African countries, Dr Muguti says, and in addition most countries have poor laboratory facilities, a low awareness of the epidemic, and inadequate access to health facilities.

    To monitor its epidemic Zimbabwe uses antenatal clinics, producing a sentinel survey, as well as looking at hospital inpatients and carrying out some random sampling.

    An awareness campaign uses the media as well as groups such as the churches, which, Dr Muguti says, initially denied the existence of the disease. They also used to sanction polygamy but have lately agreed to discourage the practice.

    Dr Muguti is hoping that 100 000 people will be taking antiretroviral treatment by the end of the year. This figure excludes those using the private healthcare system.

    “But Zimbabwe is under sanctions,” he said, and he believes it was “totally unfair” for the health sector to have become a victim of sanctions along with the political sector.

    The situation meant that almost no funding was available for programmes such as those needed to extend prevention or treatment of HIV. However, Zimbabwe had, he said, been able recently to persuade the Global Fund to Fight AIDS, Tuberculosis and Malaria to grant it some money.

    The “politics of health” internationally were determined by the attitudes of the United States and the United Kingdom and other EU countries, he said, adding that although it might be countenanced to “squeeze us for other reasons” health should be left out.

    Dr Muguti said four levels of healthcare facility existed in Zimbabwe: tertiary, provincial, district, and rural centres. The challenge was to get AIDS treatment programmes into the rural facilities.

    “The problem is with laboratory back-up. We don't have the capacity for a full set of the tests you normally want to do,” he said. “It will be many years before we can do this. Our coverage is still very limited.”

    Despite these drawbacks, the rate of HIV infection among adults had dropped from 34% to 21%, said Dr Muguti. “We think this is as a result of awareness as well as barrier methods,” he added. Zimbabwe distributes male and female condoms, some free and some at very low prices.

    Dr Muguti claimed that his country was experiencing good governance, citing as evidence the land reform programme, which seeks to redistribute land to the landless; what he called “a democratic government with a Westminster system of parliament”; and an active opposition. He had hoped that the land reform programme would, in the long term, produce better levels of nutrition and other health markers.

    The programme “definitely has a role to play in terms of health,” he said, but he conceded that it had also been the spur for sanctions. Donors had deserted. “We are under siege—being starved.” Drug companies were not making things easy either. Zimbabwe fulfils patent requirements, with no infringement, and manufactures some of its own antiretrovirals under licensing agreements with the bigger companies. “The patents are highly restrictive,” he said.

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