HIV/AIDS Program Summary

Zimbabwe is fighting one of the most severe HIV and AIDS epidemics in the world. As part of its humanitarian program, and recognizing the regional impact of HIV/AIDS, USAID supports a comprehensive HIV prevention, care, and treatment program with $26.9 million in FY 2007, including $11 million in commodities provided by Washington. USAID has invested nearly $150 million in the fight against HIV/AIDS in Zimbabwe since 2000.

Studies confirm that 98 percent of Zimbabweans are aware of the cause, method of transmission, and ways to prevent HIV/AIDS. However, a key challenge is helping people use the information they have about HIV/AIDS to change behaviors and prevent new infections. Evidence shows that progress is being made, as the HIV prevalence (the number of infected persons in a population at a given point in time) has declined from 24 percent in 2001 to 15.6 percent in 2007.

USAID efforts confront not only a huge disease burden, but also a badly deteriorated public health system. Once among the best in sub-Saharan Africa, today, Zimbabwe's health care system is characterized by inadequate staffing, reduced accessibility by the general population, shortages of essential drugs and medical supplies, and outdated and poorly functioning equipment. The most recent Demographic and Health Survey (DHS) in 2005/2006 reported that many health indicators had worsened, including nutritional status, the proportion of children who are orphaned or considered vulnerable, poverty measures, number of births attended by a health professional, and availability of most essential drugs. Additionally, though maternal and child mortality has declined, the levels are still of severe proportion. USAID programs are designed with intentional spill-over effects to strengthen systems within the public health sector to address some of these issues.

The U.S. Government PEPFAR (President's Emergency Fund for AIDS Relief) team in Zimbabwe (USAID, U.S. Centers for Disease Control and Prevention, the Department of Defense, and the U.S. Embassy Public Affairs Section) is implementing a strategy for 2006-2010 which compliments Zimbabwe's own National Plan. It aims to strengthen the will and capacity of all Zimbabweans to demonstrate leadership and take effective action to address HIV. It encourages Zimbabweans at all levels of society to take ownership of both the epidemic and the response, using a three-pronged approach:

• Intensive transformative systems strengthening for delivery of prevention, care, and treatment services. USG support takes place entirely within the national HIV/AIDS program, building national leadership and capacity at the central, district, and facility levels to scale up and implement quality programs.
• Development of innovative, evidence-based program models and tools that will be expanded to national scale with leveraged resources. USG efforts have strategically supported pilot projects and targeted evaluations, ensuring that the latest research and lessons learned are brought to Zimbabwe, tested, adapted, and adopted nationally.
• Technical and organizational capacity development of indigenous organizations to scale up and sustain these systems and programs. At the technical level, USAID plays a leading role in updating curricula and training modules, training service providers, building supervision capacity, and developing guidelines and tools for service providers.

Prevention of Mother to Child Transmission (PMTCT): USAID supports the Ministry of Health and Child Welfare (MOHCW) in increasing access to and improving the quality of PMTCT services in the public health care system, including the integration of family planning services into PMTCT; policy and guideline development; training of health care providers; technical assistance; supervision; and operations research. Prime Implementing Partner(s): Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) and Abt Associates

Behavior Change Promotion: USAID supports the development and implementation of the National Behavior Change Strategy, including developing and disseminating mass media messages on issues such as abstinence, be faithful, correct and consistent condom use, stigma, male responsibility, cross-generational sex; complementing mass media efforts with interpersonal communications programs that train parents, pastors, and other key leaders to reach youth with messages and support systems; promoting health seeking behaviors with information on PMTCT, testing and counseling, and treatment services; and social marketing of condoms. Prime Implementing Partner(s): Abt Associates

Anti-retroviral Therapy (ART) Services: USAID supports ART services in the public sector through technical assistance, training, and development of policies and guidelines. Prime Implementing Partner(s): Partnership for Supply Chain Management

Commodity Logistics and Drug Procurement: USAID works with the MOHCW and the Zimbabwe National Family Planning Council to ensure the delivery of critical HIV-related commodities to public health facilities; supports the design and implementation of a more unified logistics system for HIV-related commodities; and procures anti-retroviral drugs for 40,000 patients each year. Prime Implementing Partner(s): Partnership for Supply Chain Management and JSI-Deliver II

Testing and Counseling: USAID supports the MOHCW in rolling out provider-initiated testing and counseling (PITC) in the public health system through development of policies and systems to support PITC, training, technical assistance, and strengthening referral linkages; and maintains a core set of New Start voluntary counseling and testing services in urban areas, with increased mobile outreach to rural populations. Prime Implementing Partner(s): Abt Associates

Palliative Care: USAID supports a network of New Life centers that offer post-test services and referrals to HIV positive individuals. Prime Implementing Partner(s): Abt Associates

Orphans and Other Vulnerable Children (OVC): USAID provides sub-grants to local non-government organizations to work at the community level to support orphans and other vulnerable children with education, psycho-social, and other critical services; and supports national level advocacy, communications, and monitoring and evaluation for OVC. Prime Implementing Partner(s): Catholic Relief Services

Donor coordination is key to maximize the reach and impact of our programs. By leveraging funds and co-financing the USG is able to remain responsive to changing program needs, which are driven in large part by the fluidity of the situation in Zimbabwe, while also working with all partners to build the foundation for a sustainable national response.

The USG, in cooperation with the GOZ, non-governmental organizations, community and faith-based organizations, the private sector, and other bilateral and multilateral partners, including the Global Fund, USG agencies has achieved significant accomplishments and continues to seek innovative ways to address the impact of HIV/AIDS. In June 2007, the U.S. announced the provision of antiretroviral (ARV) drugs for 40,000 Zimbabweans living with HIV/AIDS, as well as HIV rapid test kits, for the next three years. This new support is worth $18 million. In September, a new agreement was signed to continue support for programs on pediatric aids and PMTCT. A new program to help Zimbabweans address the plight of orphans and vulnerable children will be launched in early 2008.