An ambitious state plan that will almost double the number of people on antiretroviral (ARV) treatment by the end of 2010 has drawn mixed reactions from AIDS activists, but increased donor funding has made the government quietly confident.
The Minister of Health and Child Welfare, Dr Henry Madzorera, recently announced plans to increase the number of people on ARVs from the current 180,000 to 300,000 by the end of the year, but the gap is still huge: an estimated 500,000 adults living with HIV need the life-prolonging medication, according to the National AIDS Council.
Madzorera told IRIN/PlusNews that with the external sources of funding the country was already receiving, and still expected to get, his recent announcement that treatment would be scaled up was "not a shot in the dark".
The money includes Zimbabwe's recently signed grant in Round 8 of the Global Fund mechanism and its extended Round 5 grant, the United States President's Emergency Plan for AIDS Relief (PEPFAR), and a basket funding mechanism to which donors contribute for various HIV/AIDS interventions, known as the Expanded Support Programme on HIV/AIDS (ESP).
"Scaling up treatment is part our strategic plan this year. This is not a political statement, as some may want to believe, because we are standing on solid ground and we have the financial support to meet this projection," said Madzorera.
Zimbabwe is expected to receive about US$169 million from the Global Fund, one of the few international donors that has stood by the country in spite of its many problems. "With Round 8, the Global Fund will help us strengthen our health delivery system through the training of health professionals in HIV/AIDS management," he said.
PEPFAR, the leading provider of bilateral HIV and AIDS assistance to Zimbabwe, supports ARV drugs for at least 40,000 of the 180,000 people per year receiving the medication. Madzorera said government would also be counting on the ESP, which supports the national ARV programme in 16 districts.
The ESP campaign kicked off in April 2007 and is expected to end in March 2010. It had aimed to place 58,000 HIV-positive people on treatment by the end of 2009 but at the end of September 2009 around 48,000 people were on ARVs, according to the NAC.
ESP funding partners include the UK Department for International Development, Irish Aid, Norway, the Canadian International Development Agency, and the Swedish International Development Agency.
"With all these major donors assisting us I cannot see why the 300,000 target we set is unachievable. In addition to funding from these major donors we have smaller organisations that are also coming in with their own support," Madzorera said. The health ministry received the biggest allocation in the national budget - about US$285 million.
Is it feasible?
Yet HIV/AIDS activist Chitiga Mbanje told IRIN/PlusNews said the target of 300,000 people on treatment was too ambitious in light of the numerous problems in the health sector.
"We may have the resources from all those donors but I don't think we quite have the capacity to scale up treatment. Many people are receiving their treatment from government-run institutions that are seriously understaffed, as most medical staff have left the public sector for greener pastures," said Mbanje.
"Most people living with HIV on the state ARV programmes ... have to wait for months to get the result of a CD4 count [indicating the strength of the immune system] or just a blood test to monitor how well they are responding to treatment ... if we are failing to support 180,000 on treatment, what will happen when the system now has to cope with 300 000? The rollout must be cautiously done."
Tinashe Mundawarara, HIV/AIDS and human rights programme manager at Zimbabwe Lawyers for Human Rights, warned that the government could not afford to rest on its laurels once it reached 300,000 people in need of treatment.
"Focus must be on mobilising more resources because by the end of the year, the number of people needing urgent treatment will have increased. We know that 500,000 people are in urgent need of treatment, but that number will not remain static," said Mundawarara.
Zimbabwe's HIV prevalence rate is now 13.7 percent, down from 14.1 percent in 2008, according to new estimates released by government in late 2009.
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The Minister of Health and Child Welfare, Dr Henry Madzorera, recently announced plans to increase the number of people on ARVs from the current 180,000 to 300,000 by the end of the year, but the gap is still huge: an estimated 500,000 adults living with HIV need the life-prolonging medication, according to the National AIDS Council.
Madzorera told IRIN/PlusNews that with the external sources of funding the country was already receiving, and still expected to get, his recent announcement that treatment would be scaled up was "not a shot in the dark".
The money includes Zimbabwe's recently signed grant in Round 8 of the Global Fund mechanism and its extended Round 5 grant, the United States President's Emergency Plan for AIDS Relief (PEPFAR), and a basket funding mechanism to which donors contribute for various HIV/AIDS interventions, known as the Expanded Support Programme on HIV/AIDS (ESP).
"Scaling up treatment is part our strategic plan this year. This is not a political statement, as some may want to believe, because we are standing on solid ground and we have the financial support to meet this projection," said Madzorera.
Zimbabwe is expected to receive about US$169 million from the Global Fund, one of the few international donors that has stood by the country in spite of its many problems. "With Round 8, the Global Fund will help us strengthen our health delivery system through the training of health professionals in HIV/AIDS management," he said.
PEPFAR, the leading provider of bilateral HIV and AIDS assistance to Zimbabwe, supports ARV drugs for at least 40,000 of the 180,000 people per year receiving the medication. Madzorera said government would also be counting on the ESP, which supports the national ARV programme in 16 districts.
The ESP campaign kicked off in April 2007 and is expected to end in March 2010. It had aimed to place 58,000 HIV-positive people on treatment by the end of 2009 but at the end of September 2009 around 48,000 people were on ARVs, according to the NAC.
ESP funding partners include the UK Department for International Development, Irish Aid, Norway, the Canadian International Development Agency, and the Swedish International Development Agency.
 If we are failing to support 180,000 on treatment, what will happen when the system now has to cope with 300,000 |
Is it feasible?
Yet HIV/AIDS activist Chitiga Mbanje told IRIN/PlusNews said the target of 300,000 people on treatment was too ambitious in light of the numerous problems in the health sector.
"We may have the resources from all those donors but I don't think we quite have the capacity to scale up treatment. Many people are receiving their treatment from government-run institutions that are seriously understaffed, as most medical staff have left the public sector for greener pastures," said Mbanje.
"Most people living with HIV on the state ARV programmes ... have to wait for months to get the result of a CD4 count [indicating the strength of the immune system] or just a blood test to monitor how well they are responding to treatment ... if we are failing to support 180,000 on treatment, what will happen when the system now has to cope with 300 000? The rollout must be cautiously done."
Tinashe Mundawarara, HIV/AIDS and human rights programme manager at Zimbabwe Lawyers for Human Rights, warned that the government could not afford to rest on its laurels once it reached 300,000 people in need of treatment.
"Focus must be on mobilising more resources because by the end of the year, the number of people needing urgent treatment will have increased. We know that 500,000 people are in urgent need of treatment, but that number will not remain static," said Mundawarara.
Zimbabwe's HIV prevalence rate is now 13.7 percent, down from 14.1 percent in 2008, according to new estimates released by government in late 2009.
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