User:MargaretGarry/sandbox

HIV and AIDS in Zimbabwe is a major public health issue as the country is reported to hold one of the largest recorded numbers of HIV/AIDS cases in Sub-Saharan Africa. The virus is estimated to have been present in the country since about 40 years ago. However, evidence suggests that vast levels of underreporting occurred at the start of the spread of the virus due to a variety of factors such as prejudice and discrimination. In recent years, the government has agreed to take action and implement treatment target strategies in order to address the prevalence of cases in the epidemic. Notable progress has been made as increasingly more individuals are being made aware of their HIV/AIDS status, receiving treatment, and reporting high rates of viral suppression. As a result of this, country progress reports show that the epidemic is on the decline and is beginning to reach a plateau. International organizations and the national government have connected this impact to the result of increased condom usage in the population, a reduced number of sexual partners, as well as an increased knowledge and support system through successful implementation of treatment strategies by the government. Vulnerable populations disproportionately impacted by HIV/AIDS in Zimbabwe include women and children, sex workers, and the LGBTQ+ population.

Origins and Background

The beginning of the HIV/AIDS epidemic in Zimbabwe is traced back to the mid-1980's when recorded cases faced an increase by more than sixty percent. However, these numbers are considered vastly underreported. This is due to the fact that in addition to a number of socio-cultural restraints, scientists report that individuals can be asymptomatic for up to two decades before they experience the symptoms that necessitate a diagnosis and treatment. As of today, discrimination towards those living with HIV/AIDS in the country remains prominent in everyday life. This is evidenced through the findings in the Zimbabwe 2018 Human Rights Report filed by the U.S. State Department which reports that a substantial number of citizens living with HIV/AIDS continue to experience societal discrimination through stigma and employment, regardless of any existing legislation. Additionally, in a sample by the Demographic and Health Survey in 2015, between respondents aged 15-49 who were familiar with the concept of HIV or AIDS, slightly less than a quarter of men and women surveyed had a prejudiced and discriminatory viewpoint towards those living with the virus.

Prevalence

Prevalence of HIV/AIDS in Africa, total (% of population ages 15–49), in 2011 (World Bank)

over 15%   5-15%   2-5%   1-2%   0.5-1%   0.1-0.5%   not available

Transmission Statistics

Despite the severity of the epidemic, prevalence rates in Zimbabwe have begun to show signs of decline. Dr. Peter Piot, head of UNAIDS, said that in Zimbabwe, "The declines in HIV rates have been due to changes in behaviour, including increased use of condoms, people delaying the first time they have sexual intercourse, and people having fewer sexual partners." While reports from organizations such as UNAIDS and the WHO demonstrate a continued decline of HIV/AIDS prevalence in Zimbabwe, many demographics are still at risk of transmitting the virus. According to a study conducted across Sub-Saharan Africa involving 68 epidemiological studies, the most high-risk factors for contracting HIV/AIDS that carry the strongest association with the virus are multiple sexual partners, high numbers of paid sex activity, and the presence of co-infections such as the HSV-2 infection and other sexually transmitted infections. In addition to this, a 2016 study found that an individual having more than three sexual partners, as well as less organized education are risk factors for HIV/AIDS and a non-viral coinfection. Furthermore, a key study published in 2017 conducting HIV/AIDS research in Zimbabwe, Malawi, and Nigeria reports that "almost 80% of all infant infections [were] attributed to roughly 20% HIV-positive pregnant and breastfeeding women not retained on antiretroviral therapy." Moreover, it is estimated that the largest transmitter of HIV/AIDS within the population in Zimbabwe continues to be unprotected heterosexual sex.

Mortality Rates

Mortality rates in Zimbabwe attributed to the HIV/AIDS epidemic continue to decline along with diagnosed infections. As of 2018, UN AIDS reported that there had been a 60% decrease in AIDS-related deaths since 2010, along with a 24,000 person decrease in new HIV infections. In this same year, data from the Centers for Disease Control and Prevention reports that there was an estimated 19,000 deaths from the virus.

Control and Prevention

Treatment

More women are affected by HIV/AIDS than men as an overall percentage of the population. However, women are treated at higher rates than men, with 93% of women living with HIV treated, as compared to 83% of men.

National Policy

In the past century, the national government in Zimbabwe has made efforts to address the epidemic by providing medical assistance to citizens living with HIV/AIDS, in addition to being counted as the first country in Africa to agree to the adherence of the World Health Organization's recommended steps for Antiretroviral Therapy, (ART). However, as of 2016, the WHO had only given a partial implementation rating to the government for its adaptation to WHO Key Population Guidelines as well as implementation on Viral Load Monitoring. Additionally, the national government has passed several laws and policy initiatives with the intent of protecting those living with the virus from discrimination, and to provide them with the necessary medical treatments. Some of these include guaranteed anonymous HIV testing, laws prohibiting the discrimination against those living with HIV/AIDS, as well as government efforts such as the Zimbabwe National Behaviour Change Programme. Nevertheless, those living with HIV/AIDS continue to face social stigma and discrimination in various employment sectors.

Impact on Vulnerable Populations

Women and Children

Women living with HIV/AIDS undergo a significant amount of obstacles due to socio-cultural constraints, and oftentimes gender norms prevent women from accessing healthcare services. The number of children aged 0-14 living with the virus is estimated to be at 84,000 which is notably lower than men aged 15 and over living with HIV/AIDS (490,000) or women (730,000). However, recent studies show that there are a variety of exceptions to these trends associated with socioeconomic status, as children in rural Zimbabwe that are "HIV-exposed and uninfected" have a 40% higher chance of death than those who are not exposed to the virus. Infants are at risk of contracting the virus through mother-to-child transmission when HIV-positive mothers breastfeed without undergoing antiretroviral therapy. Progress has been made as in the 2015 year, World Health Organization studies found that 93% of pregnant women had received antiretroviral treatment for the prevention of mother-to-child transmission, (also known as PMTCT).

Sex Workers

Sex workers in Zimbabwe face disproportionate levels of discrimination that impede their abilities to access treatment options. Furthermore, the majority of sex workers diagnosed with HIV/AIDS do not follow through with treatment options such as antiretroviral therapy upon diagnosis. Of those that utilize referrals, attrition rates are notoriously high and only a small number of individuals attend more than one appointment.

LGBTQ+ Community

Sexual relations between men are illegal in Zimbabwe.

*COPIED AND PASTED FROM ORIGINAL ARTICLE TO INCORPORATE LATER*

The 2012 Zimbabwe Demographic And Health Survey (ZDHS) estimated national HIV prevalence rates at 15%, meaning that they estimated 12% infection rate for men, and 18% for women. However, these numbers are based on data from pregnant women at antenatal clinics, which are notoriously unreliable in estimating national HIV prevalence rates, because the subset of the population used, pregnant women, are not statistically representative of the general population. No follow up testing is done if more than 10% of samples show a positive result after the initial test. As a result, false positives are not eliminated from the survey results.^{[citation needed]}

Response rates and methodology: HIV prevalence data were obtained from testing dried blood spot (DBS) samples voluntarily provided by women age 15–49 and men age 15–54 who were interviewed in the 2010- 11 ZDHS. The DBS were collected using the finger stick method. Of the 18,554 eligible respondents, 75% were both interviewed and provided DBS specimens. Coverage rates were higher in rural areas (83%) than in urban areas (63%)

High risk groups, including migrant laborers, people in prostitution, girls involved in intergenerational sexual relationships, discordant couples, and members of the uniformed services warrant special attention in the fight against HIV/AIDS. Young adults and women are hardest hit by the epidemic. In 2005, approximately 930,000 women over the age of 14 were estimated to be living with HIV/AIDS in Zimbabwe.

Zimbabwe continues to suffer a severe socioeconomic and political crisis, including unprecedented rates of inflation and a severe 'brain drain' of Zimbabwe's health care professionals. Elements of a previously well-maintained health care infrastructure are crumbling. Zimbabwe's HIV crisis is exacerbated by chronic food insecurity. Sub-optimal nutrition increases the vulnerability of individuals with compromised immune systems to life-threatening opportunistic infections, such as tuberculosis. Gender inequality and widespread practices of multiple and concurrent sexual relationships, and cross-generational sex fuel Zimbabwe's epidemic, particularly among youth. Social norms, including stigma associated with HIV/AIDS, excessive alcohol consumption, and a reluctance to talk about HIV status or sexual relations also create barriers to behavior change.

However, the tide in the epidemic is now being reversed as more and more people are now accessing ARVs.