Promoting evidence based HIV Prevention Services
Zimbabwe has become the second country in Africa to register a decline in the HIV and AIDS epidemic after Uganda. HIV prevalence in Zimbabwe declined from 23.2% in 2003 to 14.3% in 2009. The decline is as a result of combined effects of behavior change interventions including sexual partner reduction and increased condom use, the impact of mortality and out migration. The 2009 National Survey of HIV and Syphilis Prevalence Among Women Attending Antenatal Clinics also showed a decline in prevalence in young women 15 to 24 years from 25.7% in 2002 to 16.1%. However, despite this decline Zimbabwe's prevalence rate is still high. A total of 1.2million (adults and children) are currently estimated to be living with HIV. There are 66 000 new infections in the 15-49 age group and 15 000 new infections among children.
Zimbabwe's epidemic is generalised, with the virus spreading through sexual contact (causes annually about 75% of new infections) and mother-to-child transmission (causes up to 25% of new infections annually). The epidemic is largely being driven by behavioral factors which include multiple partnering, concurrent partner relationships, inconsistent condom use, risk practices (age mixing, widow inheritance). However some of the underlying factors are gender imbalances, stigma and socio-cultural norms. Addressing gender roles and power dynamics between girls and boys, women and men, and how they impact on sexual relations and decision-making, is critical for effective HIV prevention.
Although HIV prevalence has declined in Zimbabwe there is need to continue accelerating prevention and treatment efforts in order to get maximum reduction on incidence that will significantly impact on HIV epidemic. Zimbabwe has put in place policies and strategies for a national HIV response. This include the National HIV policy and the Zimbabwe National HIV and AIDS Strategic Plan (ZNASP) and a National Health Strategy (2009 to 2013) which features prominently HIV related responses within the health sector. The first ZNASP ended in 2010 and the second will run from 2011 to 2015.
Implementation of these strategies is hampered by resource constraints, especially human and financial resources. The government is actively engaged in resource mobilisation both internally and externally. Internal strategies include the National AIDS levy whereby 3% of all taxable individual and corporate income funds HIV programmes and the introduction of a health worker retention scheme. However, the HIV response in Zimbabwe is heavily dependent on the availability of donor funding.
UNFPA in Zimbabwe works to scale up HIV prevention using rights-based and evidence-based strategies including attention to gender inequalities that fuel the pandemic. In collaboration with key national and international partners UNFPA is supporting decentralized behavior change promotion in all the 62 districts in Zimbabwe, the scaling up of safe and voluntary male circumcision services, male and female condom programming as well as HIV prevention amongst key affected populations.
The overall goal of the HIV prevention programme is to reduce the number of new HIV infections through increased adoption and maintenance of safer sexual behavior as well as increased utilization of HIV prevention services. The programme seeks to deliver in three aspects:
- Increased national capacity to develop and implement evidence - informed HIV prevention strategies.
- Effective behavior change promotion provided at district and community level.
- Increased availability of and demand for high quality prevention services (male and female condoms, male circumcision, STI control).
Achievements to date
1. HIV Prevention Behaviour Change Program. Supported, in partnership with the National AIDS Council (NAC) and 8 NGOs namely the Family Care Trust (FACT) Mutare, ZiCHIRe, Zimbabwe AIDS Prevention Service Organisation (ZAPSO), Batsirai Group, Regai Dzive Shiri (RDS), Matebeleland AIDS Council (MAC), World Vision and Midlands AIDS Service Organisation (MASO), an evidence-informed HIV prevention behavior change (BC) programme in 26 districts (799 wards). The programme recorded over 9.1 million person/exposures from 2007 to 2010 and about 284,700 individuals completed a comprehensive community course between 2008 and December 2010.
A Review of the effectiveness of promoting HIV Prevention Behaviour Change at community level conducted in 2009 described the programme as theoretically sound, culturally appropriate and impactful. Key components of the programme included sensitization and advocacy with district and community leadership, participatory action planning, participatory community training, outreach work by trained Behaviour Change Facilitators, community screening of films and distribution of evidence based IEC materials.
The major sources of funding for the programme are UNFPA, the Expanded Support Programme, the European Commission and the Global Fund Round 8. The National AIDS Council is responsible for the overall programme coordination while programming partners are the Ministry of Health and Child Welfare, UNFPA and UNAIDS.
Some of the key materials developed as part of implementation of the programme are:
The Love and Respect Manual
Loving with Respect: A guide for men who care
Loving with Respect: A guide for men who care brochure
Loving Carefully: A guide for women
Loving Carefully: A guide for women brochure
HIV & AIDS some questions and answers
HIV & AIDS Facts or Nonsense
HIV Facts. Whats New
One Partner is the right choice
2. Supported development and operationalization of the National Female Condom Strategy and public sector capacity development on condom programming with over 1,500 service providers trained. Female condom uptake increased from below 500,000 in 2005 to over 2.5 million in 2009.
3. Supported the Ministry of Health and Child Welfare in the development of the National Male Circumcision (MC) Policy and collaborated with Population Services International in the roll out of MC services (3,000 men circumcised in Zimbabwe's pilot phase up to Dec. 2009). A total of 17 400 have been circumcised by January 2011.
UNFPA also supported high level advocacy, which led to adoption of male circumcision by the combined uniformed forces.
4. In collaboration with UNAIDS, the NAC and MOHCW, supported the national ANC surveillance which is conducted every two years and the data is used to measure the national HIV prevalence rate; a national behavior change baseline survey; Zimbabwe's HIV decline study; a comprehensive behavior change review process; and a review of STI control aiming at improving evidence informed programming.
5. Initiated establishment of a sex worker referral clinic in Harare following a national sex work study and enrolled over 400 Sex Workers (SW).
Current key initiatives or interventions
1. National scale up of the BC programme to all 62 districts in Zimbabwe.
2. National scale up of a minimum package for SW service delivery including 2 main referral clinics, outreach clinical services in major SW settings and a network of peer educators.
3. National scale up of safe and voluntary male circumcision for HIV Prevention.
4. Continue supporting female condom programming