Wheelchair-bound, her body now skeletal from full blown AIDS, disabled 38-year-old Melisa Chigumba attempts to wave away a swarm of flies hovering around her face as she sits outside her home in Chachacha, a remote area in Shurugwi, 278 kilometers south of the capital, Harare.

Shown in the photo donning a red dress, is Zipha Moyo, a disabled HIV/AIDS activist recently making a presentation Harare, the Zimbabwean capital on the exclusion of People with Disabilities in HIV and AIDS programs. Credit: Jeffrey Moyo/IPS

The couple’s three children, who were born infected with HIV, died in their infancy.

Melisa is a prime example of the millions of people here living with disabilities bearing the brunt of HIV/AIDS.

Her sister-in-law Meagan, according to the Zimbabwean culture is her aunt, now looks after her at their remote home, the only inheritance left for her by her husband.

According to the National Association of Societies for the Care of the Handicapped (NASCOH), Zimbabwe has a population of almost 1.8 million people living with disabilities.

Amongst this population, are the deaf and mute who have not been spared by HIV/AIDS.

This is despite Zimbabwe making huge strides in reducing HIV/AIDS prevalence from 29 per cent in 1997 to approximately 13. 7 per cent now.

Many battling physical disabilities like Melisa here say they have apparently been left out in combating the disease in their circles.

“I have not heard of any efforts being made to help disabled HIV-positive persons like myself. There are no special government programs for us, and just like all able-bodied persons, we also queue for treatment drugs at clinics,” Melisa told IPS.

The HIV/AIDS plight affecting people living with disabilities in this southern African nation worsens at a time the rest of the world commemorated the International Day of Disabled Persons earlier this month.

The global day for the disabled was proclaimed in 1992 by the United Nations and aims to promote an understanding of disability issues and mobilize support for the dignity, rights and well-being of persons with disabilities.
But Zimbabwe’s disabled HIV/AIDS activists claimed there was no assistance in combating the virus.

“Although we are sexually active as well as vulnerable to rape and other forms of sexual abuse, as disabled people we are overlooked in national HIV prevention strategies because policymakers do not regard us as sexually active,” Agness Mapuranga, a Shurugwi-based disabled HIV/AIDS activist living with the virus, told IPS.

“We are the country’s least covered and engaged population by HIV/AIDS service organisations despite the fact that many of us also battle with the virus,” added Mapuranga.

To make matters worse, there are no recorded statistics from the country’s Ministry of Health and Child Care on how many people with disabilities are accessing HIV treatment drugs.

A top government official from the Ministry of Health and Child Care confessed the government’s shortcomings in fighting AIDS amongst people with disabilities.

“Government’s health delivery system lacks policies or programmes to equip HIV/AIDS caregivers with the skills and knowledge needed to effectively assist disabled people in HIV prevention,” the government official, told IPS on condition of anonymity for professional reasons.

Meanwhile, it is Zimbabwe’s hearing and visually impaired population that face the greatest HIV/AIDS threat, according to lobby groups here.

“A glaring example of the worst HIV/AIDS sufferers here are the hearing impaired and the visually impaired, where information is not available in formats accessible to them; that is in sign language and braille. No one can stand up and produce or show a comprehensive program on prevention, treatment and care for these two disability categories,” Farai Mukuta, Advocacy and Knowledge Management Advisor for the Disability, HIV and AIDS Trust (DHAT) and the Deaf Zimbabwe Trust (DZT), told IPS.

DHAT is a non-profit regional organization which was registered in Zimbabwe as a Trust in 2007 with the aim of promoting the rights and capacity building of Persons with Disabilities having cervical cancer, tuberculosis, infected and affected by HIV and AIDS.

Mukuta’s remarks resonate with other pro-disabled lead activists.

“Deaf people are faced with challenges regarding access to information. Sign language is the medium of communication for deaf and hard-of- hearing people and they need information in formats they understand,” Barbra Nyangairi, the DZT Executive Director, told IPS.

Nyangairi’s remarks are true for HIV positive Liberty Hungwe, who is deaf living in Shurugwi’s Tongogara area.

“For me, testing for HIV has been a challenge because service providers do not have sign language, and owing to that, when we went for testing, people like myself were just tested and there was no counselling either post or pre-test counselling, which are barriers for us in accessing HIV/AIDS services,” Hungwe told IPS through the aid of a sign language interpreter.

Based on findings by DHAT, HIV/AIDS challenges affecting people with disabilities stem from commonly held notions among health personnel that handicapped persons are not sexually active.

In a baseline study in 2012, the United Nations noted that Zimbabwe’s people with disabilities often lack confidentiality at HIV/AIDS voluntary counselling and testing centres due to the presence of interpreters.

A 2012 study by the UN said HIV/AIDS and disability was an “emerging issue” and “cause for concern” as people living with disabilities were at greater risk of exposure to HIV infection due to social exclusion and rejection.

“People living with disabilities are at great risk of acquiring HIV, while empirical evidence has also demonstrated that people with sensory impairments – the deaf and the blind – are more vulnerable than others, due to their special communication needs,” the UN report said then.

The UN report also noted the general absence of literature and media images that “incorporate the HIV and AIDS information needs of people with disabilities, especially the deaf and blind.”

Even leading activists for people living with disabilities here agree with the UN.

“The prevailing view in society is that PWDs are not sexually active and do not warrant inclusion in HIV and AIDS interventions. Consequently, there have been no deliberate efforts to address the issue of AIDS among people with disabilities and to incorporate them within the rubric of the national response,” Mukuta, told IPS.

“The reality is that disabled people are just as sexually active as the rest of the society and are even more at risk of infection because of the obvious barriers that they encounter in accessing vital information on HIV/AIDS,” added Mukuta.

Mukuta said Zimbabwe’s success story in combating HIV/AIDS excludes HIV positive people with disabilities (PWDs).

“Our country boasts of the fast falling rates of HIV infections, but in all this, people with disabilities have been systematically sidelined from all HIV and AIDS intervention programmes in the country, on the erroneous assumption that they are not sexually active,” Mukuta told IPS.

Despite the hurdles faced by many disabled HIV positive people like Shurugwi’s speech-impaired Hungwe, other lobby groups here brag they have played their part in combating HIV/AIDS spread among such minority groups.

“As Deaf Zimbabwe Trust, we have trained 20 deaf people as peer educators in order to provide accurate information to the deaf community and we intend to train more peer educators who are deaf so that they can cascade information while we are in the process of creating a support group for people who are deaf and living with AIDS,” Nyangairi told IPS.

But now hit with full blown AIDS, disabled and wheelchair-bound Chigumba is pessimistic.

“I just wait for my time to die and evade this pain,” Chigumba told IPS as she winced with pain.

Writer can be contacted at moyojeffrey@gmail.com

Zimbabwe struggles to contain maternity deaths. Here in this southern African nation, the number of women dying in childbirth continues to rise. Credit: Jeffrey Moyo/ IPS

By Jeffrey Moyo
HARARE, Jan 30 2015 (IPS)

For 47-year-old Albert Mangwendere from Mutoko, a district 143 kilometres east of Harare, the Zimbabwean capital, transporting his three pregnant wives using a wheelbarrow to a local clinic has become routine, with his wives delivering babies one after the other.

But these routines have not always been a source of joy for Mangwendere.

“Over the past twenty years, I have been ferrying my pregnant wives to a local clinic using a wheelbarrow because I have no (full size) scotch cart and we have lost 12 babies in total while traveling to the clinic,” Mangwendere told IPS.

Mangwendere’s case typifies the deepening maternity crisis in this Southern African nation.An estimated 3,000 women die every year in Zimbabwe during childbirth and at least 1.23 percent of gross domestic product (GDP) is lost annually due to maternal complications – United Nations issue paper on 'Maternal Mortality in Zimbabwe', 2013

An estimated 3,000 women die every year in Zimbabwe during childbirth and at least 1.23 percent of gross domestic product (GDP) is lost annually due to maternal complications, according to Maternal Mortality in Zimbabwe, a United Nations issue paper released in 2013.

In fact, the United Nations found that maternal mortality worsened by 28 percent between 1990 and 2010. The major causes were bacterial infection, uterine rupture (scar from a previous caesarean section tearing during an attempt at birth), renal and cardiac failure, as well as hyperemesis gravidarum (condition characterised by severe nausea, vomiting and weight loss during pregnancy).

This year, the government has allocated 301 million dollars to the health sector for a country of 13.5 million, according to the local NewsDay publication, which concluded: “This is to say that the government intends to spend on average just over 22 dollars on an individual this year. Compare this with 650 dollars for South Africa, 90 dollars for Botswana, 390 dollars for Botswana and 200 dollars for Angola.”

On top of a barely adequate public transportation system, user fees for delivering pregnant women that are charged in healthcare centres are also at fault, say civil society activists.

“In 2012, the government crafted and adopted a policy that saw user fees for maternity services being scrapped,” Catherine Mukwapati, director of the Youth Dialogue Action Network, a grassroots organisation, told IPS.

“But despite this policy, some facilities still charge indirect service fees, which is scaring away many pregnant women from hospitals and clinics, leaving them in the hands of less skilled midwives.”

Zimbabwe’s local authority clinics say they have resisted scrapping maternity fees despite the official directive, claiming that they are not reimbursed as promised by the government.

28-year-old Chipo Shumba pictured here holds her only child after she lost six others while giving birth over the past few years, a crisis health experts in Zimbabwe say is on the rise. Credit: Jeffrey Moyo/IPS

“Council clinics have no choice but to charge the council-subsidised 25 dollars for maternity since they haven’t received money from government,” Harare city director of health services, Stanley Mungofa, told IPS.

The actual cost of providing maternity services in council clinics has been pegged at 152 dollars, Mungofa said. At public hospitals like Parirenyatwa in Harare, the cost of a normal delivery is 150 dollars while a caesarean section costs as much as 450 dollars.

In a bid to lower the high maternity fees of public hospitals and council clinics, a group of donors pledged 435 million dollars for the nation’s health system for the period 2011-2015. The fund – the so-called Health Transition Fund – was led by the health ministry and managed by the U.N. Children’s Fund (UNICEF).

Importantly, the Health Transition Fund is helping to retain skilled workers by raising low wages. Underpaid doctors make up a large part of the country’s “brain drain” and there are now just 1.6 doctors for every 10,000 people.

Maternal fees may not apply in Zimbabwe’s countryside, where many like Mangwendere and his wives live, but other obstacles present an equally insurmountable barrier to obtaining care. Clinics and referral hospitals are often far away from people needing help, a major cause of maternity deaths there.

Finally, the tentacles of systemic corruption have reached into the health care systems. According to Transparency International, one local hospital was found to be charging mothers-to-be five dollars every time they screamed while giving birth.

A staggering 62 percent of Zimbabweans reported having paid a bribe in the previous year, the group stated in its 2013 report on global corruption.

Zimbabwe’s health sector was one of the best in sub-Saharan Africa in the 1980s, but it nearly collapsed when an economic crisis caused hyper-inflation of more than 230 million percent in 2008. Over the following years, chronic under-investment made a bad situation worse.

The increase in maternal mortality is being witnessed despite the U.N. Millennium Development Goal (MDG) for maternal health, under which countries should reduce the maternal mortality ratio by three-quarters between 1990 and 2015.

A 2012 status report on the MDGs asserted that Zimbabwe was unlikely to meet its mandate of reducing the maternal mortality ratio to 174 per 100,000 live births.

In research conducted in 2013 to address causes of maternal death, Zimbabwe’s Ministry of Health and Child Care blamed excessive bleeding after childbirth and unsafe abortion as the major causes of death, although no information was provided to back the claim.

“Statistics on maternal deaths often leave out sad realities of these similar deaths in unreachable remote areas where pregnant women and infants die daily without these cases being recorded anywhere,” said Helen Watungwa, a midwife at a council clinic in Gweru, the capital of the Midlands province, 222 kilometres outside the capital.

“But in any case, with the limited resources we have as nurses, we are doing all we can to save lives both of delivering mothers and infants,” Watungwa told IPS.

“It is truly a miracle that we continue to survive a series of pregnancies while battling to give birth often on the way to the clinic, bleeding heavily without any skilled persons to attend to us, with only our husband tottering with each one of us to the village healthcare centre using a wheelbarrow,” 28-year-old Mavis Handa, one of Mangwendere’s wives, told IPS.

Edited by Lisa Vives/Phil Harris