US embassy cable - 04HARARE1688

UNCLAS SECTION 01 OF 04 HARARE 001688 
 
SIPDIS 
 
STATE/GAC, TOBIAS,O'NEIL JENNINGS, 
STATE/AF, NEULING 
NSC, TEITELBAUM 
USAID/AFR,SUKIN,COPSON 
USAID/GH, CORINO, ROGERS, STANTON, PRESSMAN, 
HHS/THOMPSON, STEIGER, HHS/CDC, GERBERDING 
 
 
E.O. 12958: N/A 
TAGS: AMED, EAID, PREL, US, ZI, HIV/AIDS 
SUBJECT:  ZIMBABWE'S APPLICATION OF GUIDANCE FOR 
IMPLEMENTING PRESIDENT'S EMERGENCY PLAN FOR AIDS 
RELIEF 
 
REF: (a) State 168905   (b) 001563 
 
1.Summary: Posts were requested to report to S/GAC 
on their application of the guidelines for 
implementing the President's Emergency Plan and the 
situation of HIV and AIDS in their country (reftel 
a). Under the leadership of the U.S. Embassy, the USG 
departments and agencies working in Zimbabwe (STATE, 
USAID, DHHS CDC, DHHS NIH, DHHS HRSA, DOD, and PAS) 
are implementing a coordinated strategy to address 
Zimbabwe's HIV and AIDS crisis.  The strategy 
tegy 
maximizes the comparative advantages of each agency in 
working toward the single goal of mitigating the 
national HIV and AIDS crisis.  The President's 
Emergency Plan principles, including balanced 
messages, collaboration with faith and community-based 
organizations, fostering leadership, expanding 
networks, and effective monitoring and evaluation, 
have been integrated into all aspects of the strategy. 
 As discussed in a recent briefing for S/GAC Tobias by 
staff from the US Mission in Harare, despite the 
challenging political and economic environment, the 
coordinated strategy is achieving results and helping 
to strengthen a comprehensive national response to the 
epidemic. During this period of difficult political 
relationships, support for HIV and AIDS activities is 
one of the key ways in which the USG is able to 
provide assistance to the people of Zimbabwe.  End 
summary. 
 
2. Epidemiology:  Zimbabwe is one of the countries 
most affected by the HIV and AIDS epidemic.  With an 
estimated HIV prevalence of 24.6%, no family or 
institution in Zimbabwe is untouched.  There are an 
estimated 3,290 deaths each week due to AIDS and 
some 800,000 children aged 0 to 14 currently living 
in Zimbabwe have been orphaned by the disease.  Life 
expectancy has fallen from 61 years in the mid-1980s 
to only 34 years today. 
 
3.Government of Zimbabwe (GOZ) Response:  The 
GOZ's response to the epidemic is guided by the 
National Policy on HIV/AIDS for Zimbabwe and the 
Strategic Framework for a National Response to 
HIV/AIDS.  The National AIDS Council (NAC) is 
responsible for coordinating the GOZ's response to 
the epidemic and for dispensing funds raised through 
the AIDS levy, a 3% payroll tax for HIV levied on 
all employees.  The NAC has been subject to some 
criticism domestically that it has been slow to 
disburse funds from the AIDS levy and has not 
adequately coordinated GOZ or other donor HIV 
programs.  It has also suffered, like many 
institutions in Zimbabwe, from high staff turnover. 
USG agencies and UNAIDS are committed to working 
with NAC to try and address these weaknesses. 
Nonetheless, the AIDS levy is an innovative approach 
to mobilizing national resources, demonstrating 
government and citizen commitment to combating the 
epidemic.  The NAC has also been proposed as the 
principle recipient for some funds to be received by 
Zimbabwe under the Global Fund to Fight AIDS, 
Tuberculosis and Malaria. 
 
4.NGO/FBO Response:  Zimbabwe's non-government 
organizations (NGOs) and faith-based organizations 
(FBOs) play a vital role in responding to the HIV 
and AIDS epidemic.  Both provide home-based care 
services, support children affected by AIDS, provide 
information and counseling services, offer pastoral 
care, and support other community-based services. 
Most rely heavily on volunteers for services.  The 
USG currently supports the Zimbabwe AIDS Network, a 
member organization of over 400 HIV-related NGOs. 
In addition, Mission hospitals provide 75% of the 
medical care in rural areas and have been some of 
the leading hospitals in implementing innovative 
programs for HIV and AIDS.  The ability of NGOs to 
implement programs, however, could be adversely 
affected by the GOZ's pending NGO bill (reftel b) 
that, if enacted in its present form, would provide 
for an extreme level of government control over the 
operations of NGOs.  The precise impact on those 
NGOs working in HIV and AIDS is unclear at this 
point, but post will continue to monitor the 
situation closely. 
5.  USG Coordinated Response:  The USG has been a 
leading provider of bilateral HIV and AIDS 
assistance to Zimbabwe since the early days of the 
epidemic, with HIV and AIDS currently included as 
one of the top priorities in the Mission Performance 
Plan.  Under the coordination of the U.S. Embassy, 
USAID, DHHS CDC, DHHS NIH, DHHS HRSA, DOD, and PAS 
support an integrated $20 million per year 
assistance program with a single goal:  Mitigation 
of the national HIV and AIDS crisis in Zimbabwe by 
instituting proven prevention strategies, while 
developing and implementing new interventions to 
assist HIV-infected persons, orphans, and others 
affected by HIV and AIDS.  To achieve this goal, the 
USG implements a three-pronged strategy that 
addresses prevention, care and support, and 
infrastructure and capacity building.  Each agency 
concentrates on areas of comparative advantage. 
 
6.Prevention:  The focus of the USG program is to 
move Zimbabweans beyond HIV awareness to individual, 
community, and policy-level behavior change. 
Activities include (a) a coordinated mass media 
program based on the ABC model that targets youth 
and young adults; (b) programs involving government, 
businesses, and labor to improve policy frameworks, 
leadership, and advocacy strategies; (c) training in 
prevention strategies for NGOs, FBOs, and the 
uniformed services; (d) inclusion of HIV and AIDS as 
part of the annual International Visitors Program; 
and (e) programs involving FBOs, CBOs, NGOs, and 
community planning boards in developing and 
disseminating coordinated messages that promote 
behavior change.  As part of the mass media program, 
we recently launched an innovative national "Trusted 
Partner" campaign which helps define the elements of 
trust, and encourages faithfulness through slogans 
such as "one partner, one life."  In April, the 
leadership and advocacy program helped sponsor 
public HIV testing for Members of Parliament-the 
first time high-ranking Zimbabwean politicians had 
publicly undergone voluntary HIV testing, helping to 
break the entrenched cycle of stigma. 
 
7.  Care and Support:  The USG program focuses on 
the introduction of clinical interventions to 
prevent transmission of the HIV virus and to improve 
access to clinical care for HIV and AIDS as well as 
HIV-related conditions.  As the entry point to care 
and support, wider HIV testing is encouraged through 
a series of VCT centers, mobile outreach to rural 
areas, counseling and testing in antenatal clinics 
and other clinical venues, and the promotion of 
referral networks.  In 2003, over 170,000 
Zimbabweans were tested in USG-supported sites, an 
estimated 90% of all Zimbabweans tested that year, 
and the number continues to grow.  With the arrival 
of USG-purchased antiretroviral drugs in August 
2004, USG support for the expansion of Zimbabwe's 
national treatment program was officially launched. 
This program provides an excellent example of USAID 
and DHHS CDC coordination, with USAID providing 
expertise in ARV procurement, logistics management, 
and site readiness, and DHHS/CDC providing technical 
support for laboratories, informatics, and training 
in clinical management of ARVs.  By the end of the 
year, some 300 Zimbabweans with AIDS are expected to 
be on USG-procured ARVs, with more added in 2005. 
 
8.Infrastructure and Capacity Building:  USG 
support is aimed at strengthening the organizational 
and absorptive capacity of both public and private 
health systems and services as the foundation for 
expanding and improving the quality of HIV and AIDS 
programs and interventions.  USG agencies provide 
financial and technical assistance to improve 
surveillance and modeling of the HIV and AIDS 
epidemic and related disease reporting systems.  In 
addition, the USG supports improvements in supply 
chain and logistics management for drugs, condoms, 
contraceptives, and other HIV-related supplies. 
Furthermore, the USG assists and participates in 
national oversight bodies and donor coordination 
committees responsible for the monitoring and 
evaluation of Zimbabwe's national response to HIV 
and AIDS.  The Monitoring and Evaluation Task Force 
is currently developing a national M&E plan that 
responds to the mandate of "the Three Ones" and 
demands accountability for results. 
 
9.  Strengthening FBOs and CBOs:  Given that 90% of 
Zimbabweans are Christian, with most of those 
belonging to a church and actively religious, 
working with church organizations offers a real 
opportunity to reach a large segment of the 
population with HIV and AIDS interventions and to 
combat stigma.  The USG strategy recognizes this 
opportunity and works closely with a wide variety of 
FBOs, particularly in the areas of orphan care, 
home-based care, leadership and advocacy, and 
prevention and counseling.  Zimbabwe's network of 
Mission hospitals offers another target of 
opportunity and serves as an important partner in 
prevention of parent to child transmission (PPTCT) 
programs, the antiretroviral program--with Howard 
Mission Hospital being one of the initial 5 sites in 
the National Antiretroviral Treatment Program 
supported by the USG -- and the expansion of 
referral networks.  The USG supported the creation 
and ongoing function of the Care for HIV Prevention 
and Postive-living (CHAPPL) Network of 10 leading 
mission hospitals, brought together to identify and 
share best practices for HIV care and support. 
Currently, 4 out of 10 of these hospitals provide 
some level of antiretroviral treatment. Community- 
based organizations (CBOs), similarly, are key USG 
partners in responding to the HIV and AIDS crisis. 
USG support for strengthening the capacity of 
communities and their formal and informal 
organizational structures is instrumental in helping 
communities meet the needs of orphans and others 
affected by AIDS, mobilize for VCT and PPTCT, and 
disseminate HIV prevention messages. 
 
10.Challenges:  The USG's HIV and AIDS program in 
Zimbabwe faces a series of challenges to achieving 
its goal.  In addition to the HIV and AIDS crisis, 
Zimbabwe is currently facing enormous political and 
economic difficulties.  Due in large part to these 
difficulties, as well as to the impact of HIV and 
AIDS and high levels of emigration, Zimbabwe's 
strong public health system has started to 
deteriorate over the last several years.  At the 
same time, soaring inflation has reduced the 
purchasing power of the USG's already limited HIV 
budget.  In fact, expansion of several successful 
USG-supported programs in HIV testing and treatment 
is limited primarily by the lack of adequate 
financial resources.  In addition, stigma continues 
to be a significant barrier to the development of 
strong public leadership, candid discussion, and the 
open promotion of HIV products, services, and 
information. 
 
11.Opportunities:  While relations between the GOZ 
and USG are strained in general, cooperation with 
the Ministry of Health and Child Welfare remains 
strong.  The health care infrastructure, although 
much weaker than a few years ago, is still stronger 
than in many African countries.  The USG also has 
excellent working relationships with civil society 
and plays a lead role in the health donor community. 
In spite of the many challenges, the USG has been 
able to coordinate efforts and build on comparative 
advantages to put in place a comprehensive program 
positioned to both scale up and scale out.  With 
additional funding, the program could quickly expand 
its initiatives in counseling and testing, 
antiretroviral therapy, and orphan support to reach 
greater numbers of Zimbabweans and more rapidly help 
to mitigate Zimbabwe's HIV and AIDS crisis. We have 
also initiated food support for chronically ill 
individuals who are home bound and food supplements 
for chronically ill out-patients undergoing TB 
treatment or with substantial weight loss. 
 
12.Conclusion:  Although not a President's 
Emergency Plan focus country, the USG HIV and AIDS 
program in Zimbabwe is already successfully 
implementing the principles and guidelines outlined 
in Reftel (a).  With its coordinated approach and 
emphasis on maximizing each USG agency's comparative 
advantage, the program is making a significant 
difference in the lives of millions of Zimbabweans. 
In spite of the difficulty of implementing 
activities in Zimbabwe's current environment of 
political and economic upheaval, program results 
demonstrate that success can still be achieved 
through this coordinated approach.  The program is 
now positioned to expand to reach larger numbers of 
Zimbabweans should additional resources become 
available.   DELL