Many children under 15 in Zimbabwe discover their HIV status only when they fall critically ill later in life. Credit: Jeffrey Moyo/ IPS

By Jeffrey Moyo
HARARE, Jan 17 2015 (IPS)

Fifty-one-year-old Mateline Msipa is living with HIV. Her 17-year-old daughter, born after Msipa was diagnosed with the virus, may also have it, but she has never been tested.

“My daughter is not aware of my HIV status and with the stigma associated with the disease, it is hard for me to now open up to her about my status,” Msipa told IPS.“Talk of rejection, talk of stigma and discrimination about HIV-positive people here has rendered me confused on whether or not I should get tested for HIV/AIDS, although I don’t know what killed my parents." -- 13-year-old Tracey Chihumwe

Msipa’s daughter says she has never attempted to undergo an HIV test despite Zimbabwe’s revised testing guidelines allowing children of her age to get one without parental consent.

“I have no reason to get tested for HIV because I have never engaged in sexual intercourse before,” the 17-year-old told IPS.

Figures show that thousands of children in Zimbabwe are infected with HIV – presenting a major battlefield for government efforts to defeat the spread of HIV /AIDS nationwide.

The U.N. agency UNAIDS estimates that nearly 200,000 children from birth to age 14 have the virus but are not in treatment because they have not been properly tested. It is a trend that researchers term “suboptimal” counseling and testing in that southern African country.

“Children often get tested for HIV [only] when they fall critically ill, which usually doesn’t save them from dying,” Letwin Zindove, an independent health expert who works as an HIV/AIDS counselor here, told IPS.

The new estimate threatens to dash the southern African nation’s effort to meet a U.N. goal of reversing the incidence of infection in the population by 2015.

Older children – between six and 15 – who might have acquired HIV at birth are especially vulnerable to a major outbreak of full-blown AIDS. A study last year by the London School of Hygiene and Tropical Medicine found this group received inadequate access to provider-initiated HIV testing and counselling by primary care-givers.

Lack of clear national standards for HIV/AIDS testing leads to confusion and missed diagnoses in some cases. Credit: Jeffrey Moyo/ IPS

The study found health-care workers were reluctant to offer testing which could expose the child to abuse if he or she tested positive. On top of this, long waiting periods for appointments also hindered routine testing and counseling.

Last year, Zimbabwe launched its revised national guidelines for HIV testing and counselling with special emphasis on couples, children and adolescents as it stepped up efforts to halt the spread of the virus ahead of the 2015 deadline of the U.N. Millennium Development Goals (MDGs).

Under these guidelines, a child aged 16 years or older is eligible to give full consent for HIV testing and counselling.

However, the study found that many healthcare workers don’t fully understand the new guidelines.

“They expressed confusion about the age at which a child could choose to test him/herself, what type of caregivers qualified as legal guardians, and whether guardians had to undergo testing themselves first,” it said.

The appearance of a slow-progressing HIV disease among children has also contributed to dangerous delays in testing. New research has found that a substantial number of HIV-infected children survive to older adulthood. Delaying testing and diagnosis until symptoms appear results in a high risk of chronic complications such as stunting and organ damage.

Under the U.N.’s MDG Target 6A, countries should have halted new infections and begun to reverse the spread of HIV/AIDS by 2015.

Zimbabwe’s numbers of HIV incidence may be high (14.7 percent of adults) but the numbers are higher yet in South Africa (17.8 percent), Botswana (23 percent), Lesotho (23.6 percent), and Swaziland 25.9 percent.

Countries with low numbers are Mali, Guinea, Burkina Faso, Benin, Sudan, Senegal, Niger, Mauritania and Somalia – ranging from 1.0 percent to 0.7 percent.

While most countries are achieving a measure of success towards the U.N. goal, two have been a major health care disappointment.

Uganda, once hailed as a Cinderella success story, and Chad have seen a rise in infections. It is a disappointing turnaround from the 1990s when an aggressive public awareness campaign that urged medical treatment and monogamous sexual relationships led to a precipitous drop in infection rates in Uganda.

In 2012, H.I.V. infection rates in Uganda were seen to have increased to 7.3 percent from 6.4 percent in 2005. Over roughly the same period, the United States, through its AIDS prevention strategy known as Pepfar, or the President’s Emergency Plan for AIDS Relief, spent 1.7 billion dollars in Uganda to fight AIDS.

Activists say children are not immune to the deep-rooted stigma surrounding HIV/AIDS here — another barrier to testing.

“Zimbabweans are one huge community, closely-knit, and once a child is tested for HIV, it becomes difficult for it to remain confidential, resulting in any child tested becoming exposed to stigma,” Sifiso Mhofu, an affiliate of the Zimbabwe National Network of People living with HIV, told IPS.

This problem is very real for orphans like 13-year-old Tracey Chihumwe (not her real name) from Mabvuku, a high-density suburb of Harare, the Zimbabwean capital.

“Talk of rejection, talk of stigma and discrimination about HIV-positive people here has rendered me confused on whether or not I should get tested for HIV/AIDS, although I don’t know what killed my parents,” Chihumwe told IPS.

The Zimbabwean government is now struggling to ensure to that 85 percent of the population – including children and adolescents – knows their HIV status by the end of this year, in a desperate bid to meet the MDGs deadline in December.

But this will not be an easy task.

“Despite revised guidelines of HIV testing for children, pockets of resistance to get children tested for the virus exist from children themselves, parents and guardians as well,” a top government official, who requested to remain anonymous for professional reasons, told IPS.

Edited by Lisa Vives and Kitty Stapp

The budgets of many African countries reflect greater interest in arms deals than in managing the deadly HIV epidemic. Credit: Thomas Martinez/IPS

By Kanya D'Almeida and Mercedes Sayagues
JOHANNESBURG/NEW YORK, Aug 13 2014 (IPS)

They say there is a war on and its target is the deadly human immunodeficiency virus (HIV).   

This war runs worldwide but its main battleground is sub-Saharan Africa, where seven out of 10 HIV positive persons in the world live – 24.7 million in 2013. The region suffered up to 1.3 million AIDS-related deaths in the same year, according to the United Nations.

A ragtag army is fighting the war on AIDS. Sometimes it is comprised of well-dressed aid officials sitting in conference rooms allocating funds. At other times, it deploys shabby foot soldiers – community healthcare workers and AIDS activists – into desolate rural areas with no running water, let alone antiretroviral therapy.

With many competing health problems, funding for AIDS is a growing concern. Yet a look at the defence of budgets of several countries plagued by HIV portrays a startling picture of governments’ priorities, with huge military expenditures belying the argument that the key obstacle to winning the war against AIDS is money.

And, as the 2015 deadline for the United Nations Millennium Development Goals looms large – with donor countries tightening their purse strings – health experts worry about financing for HIV prevention and AIDS treatment after 2015.

New funding for AIDS in low- and middle-incoming countries fell three percent from 2012 to 8.1 billion dollars in 2013, says a joint report by the Kaiser Family Foundation and the Joint United Nations Programme on HIV/AIDS (UNAIDS) released in June.

Five of the 14 major donor governments – the U.S., Canada, Italy, Japan and the Netherlands – decreased AIDS spending last year.

And yet, while governments claim to be too cash-strapped to fight the AIDS war, funding for other wars seems much more forthcoming.

Spending on arms and on AIDS

Africa will need to do more with less to manage AIDS, concludes a 2013 UNAIDS report entitled Smart Investments.

In Kenya, a funding shortfall is expected soon, since the World Bank’s 115 million-dollar ‘Total War on HIV/AIDS’ project expired last month.

Meanwhile, the country’s defence budget is expected to grow from 4.3 billion dollars in 2012-2014 to 5.5 billion dollars by 2018, as the country stocks up on helicopters, drones and border surveillance equipment, according to the news portal DefenceWeb.

True, Kenya is under attack from Al-Shabaab terrorists. Still, five out of 10 pregnant Kenyan women living with HIV do not get ARVs to protect their babies.

Mozambique’s fighter jets

In Mozambique, a dearth of funding puts the country’s recent military expenditures into a harsh light.

Daniel Kertesz, the World Health Organization representative in Mozambique, told IPS the country’s six-year health program has a 200 million dollar finance gap per year.

Mozambique being very poor, it is difficult to see how the country – with 1.6 million infected people, the world’s eighth burden – will meet its domestic commitments.

“Today, Mozambique spends between 30 and 35 dollars per person per year on health. WHO recommends a minimum of 55-60 per person per year,” Kertesz said.

The same week, the government announced it had fixed eight military fighter jets, which it had discarded 15 years ago, in Romania, and is receiving three Embraer Tucano military aircraft from Brazil for free, with the understanding that purchase of three  fighter jets will follow.

According to a 2014 report by the Economic Intelligence Unit, Mozambique’s spending on state security is expected to rise sharply, partly owing to the acquisition, by the ministry of defence, of 24 fishing trawlers and six patrol and interceptor ships at the cost of 300 million dollars – equal to half the 2014 national health budget of 635.8 million dollars.

 The same week the refurbished fighter jets landed at Maputo airport, the press reported that the main hospital in Mozambique’s north-western and coal-rich Tete province went for five days without water.

Indeed, the country’s public health system is in such dire straits that the United States President’s Emergency Plan for AIDS Relief (PEPFAR) meets 90 percent of the health ministry’s annual AIDS budget.

“The state budget for social programmes is not increasing at the same level as military, defence and security spending,” Jorge Matine, a researcher at Mozambique’s Centre for Public Integrity (CIP), told IPS.

“We have been pushing for accountability around the acquisition of commercial and military ships for millions of dollars,” he said.

A coalition of NGOs has requested the government to explain “its decision to spend that money without authorisation from Parliament when the country is experiencing severe shortages of personnel and supplies in the health sector,” Matine explained.

The coalition argues that, if defence spending remained as it was in 2011, the country would save 70 million dollars, which could buy 1,400 ambulances (11 per district, when many districts have only one or two) or import 21 percent more medicines.

A similar pattern unfolds across the continent where, according to the Stockholm International Peace Research Institute (SIPRI), military spending reached an estimated 44.4 billion dollars in 2013, an 8.3 percent increase from the previous year. In Angola and Algeria, high oil revenues fuel the buying spree.

The South Africa-based Ceasefire Campaign reported recently that arms deals with private companies are also on the rise in Africa, with governments expected to sign deals with global defence companies totalling roughly 20 billion dollars over the next decade.

Credit: Marshall Patstanza and Nqabomzi Bikitsha/IPS

Failing Abuja 

At the same time, the 2001 Abuja Declaration, whose signatories committed to allocating at least 15 percent of gross domestic product to health, has “barely become a reality”, Vuyiseka Dubula, general-secretary of the South Africa-based Treatment Action Campaign, told IPS.

 “Regardless of our calls, very few countries have even come close to 12 percent, including some of the richer African countries such as South Africa and Nigeria,” Dubula said.

Between 2000-2005, she added, “almost 400,000 people died from AIDS in South Africa; during that same period we spent so much money on arms we don’t need, and one wonders whether that was a responsible [use] of public resources.”

Mozambique is a sad example of Abuja failure. Back in 2001, Mozambique’s health budget represented 14 percent of the total state budget, tailing the Abuja target. It declined to a low of seven percent in 2011 and clawed to eight percent since.

“Financing mirrors the priorities of the government,” Tedros Adhanom Ghebreyesus, Ethiopia’s minister of foreign affairs and former minister of health, told IPS. “We have seen that in countries that had the political will to turn around their health sectors, they upscale finance and really invest in the health sector.”

If this is true, the budgets of many African countries reflect greater interest in arms deals than in managing the deadly HIV epidemic.

Edited by: Mercedes Sayagues

COUNTDOWN SNAPSHOT: HOW MOZAMBIQUE IS COPING WITH AIDS

By Mercedes Sayagues
MAPUTO, Aug 12 2014 (IPS)

Mozambique struggles to contain the HIV epidemic with one in ten among its 24 million people infected. Helping them is not easy when only 60 percent of people have access to health services.

There are five doctors and 25 nurses per 100,000 people. In neighbouring South Africa, the ratio is 55 doctors and 383 nurses.

Recently, the United Nations ranked Mozambique 178 among 187 countries in human development. Quick stats:

• 50 years: life expectancy
• 3: mean years of schooling
• 70 percent: number of people living in poverty
• 40 percent: number of women who give birth at home
• 56 000: number of women infected with HIV annually

Excessive dependence on donors is another problem, with 90 percent of the health ministry’s HIV/AIDS budget paid by theUnited States President’s Emergency Plan for AIDS Relief (PEPFAR). The overall health budget is just eight percent of the total state budget, far from reaching the 2001 Abuja commitment to allocate 15 percent to health.

Nonetheless, Mozambique is doing quite well in preventing mother to child HIV transmission. Infection rates among children have plummeted, but remain too high at 12,000 in 2013. The good news is that this number is half of what it was five years ago.

Sources: UNAIDS, UNICEF