US embassy cable - 05HARARE1440

UNCLAS SECTION 01 OF 02 HARARE 001440 
 
SIPDIS 
 
AID/W FOR AFR/SD/HRD, G/PHN/DAA 
G/PHN/POP, G/PHN/HN, G/PHN/HN/HIV 
G/PHN/HN/HPSR, G/PHN/HN/EH 
G/PHN/HN/CS 
AFR/SA, MARJORIE COPSON 
 
E.O. 12958: N/A 
TAGS: AMED, EAID, PREL, US, ZI, HIV/AIDS 
SUBJECT: ZIMBABWE ARV CRISIS LOOMING 
 
1)   Summary:  A crisis is looming for Zimbabweans 
living with AIDS on anti-retroviral (ARV) 
regimens.  There are currently very low stock- 
levels of all ARV drugs in both the public and 
private sectors.  Due to foreign exchange 
shortages and controls, the GOZ is either 
unwilling or unable to provide adequate resources 
to procure ARVS.  UNICEF is trying to work out a 
solution to the immediate problem by negotiating a 
currency swap with the Ministry of Health (MOH). 
If longer-term solutions are not rapidly found, 
there is a significant risk of drug resistance or 
death for those that will no longer have access to 
these life prolonging drugs. End Summary. 
 
2)   Background:  Zimbabwe is at the epicenter of 
the HIV/AIDS pandemic and is experiencing a 
generalized epidemic that has propelled the 
country towards a crisis affecting every family in 
the nation.  The following statistics depict the 
gravity of the situation:  20% of sexually active 
adults (15-49 years) are HIV-infected; life 
expectancy has fallen from 61 years to 34; there 
are an estimated 3,290 deaths due to AIDS each 
week and an estimated 1,000,000 children have been 
orphaned due to AIDS.  Of the 1.8 million that are 
HIV positive, approximately 342,000 are in need of 
(ARVs) drugs.  It is estimated that only 20,000 
Zimbabweans presently have access to ARVs. Half 
are estimated to be receiving the ARVs from the 
public sector, with the other half purchasing from 
private pharmacies. 
 
3)   Candid Admission by GOZ:  At a recent HIV 
Care and Treatment Forum, GOZ officials were 
uncharacteristically forthright on ARV stock 
levels, stating that public sector stock levels 
were below 3 months of supply. (Note: Minimum 
standard stock levels for the ARVs should be 6 
months. End note.) Stock levels in private local 
pharmacies are extremely low or unavailable. 
 
4)   Broken Promises:  In 2004 the Ministry of 
Finance stated that it would supply the Ministry 
of Health with US$2 million per month in foreign 
currency to purchase ARVs. In December 2004, the 
Ministry of Finance finally made US$2 million 
available and the MOH used the funds to procure 
generic drugs through a local manufacturer. 
Despite the Ministry of Finance's commitment, no 
further foreign currency has been made available 
to the MOH for ARV procurement. 
 
5)   AIDS Activists:  Both international and local 
media have started to publicize the impending ARV 
stock out crisis and the lack of foreign currency 
for drug procurement generally.  While AIDS 
activists in Zimbabwe are rarely vocal, they have 
recently banded together to petition the Governor 
of Zimbabwe's Reserve Bank to make foreign 
currency available for ARVs. 
 
6)   Price Increases:  The price of ARVs for 
patients receiving care in public sector health 
facilities has remained stable for over a year at 
a subsidized rate of less than US$2 for a month's 
supply.  The cost is rapidly escalating, however, 
at private sector pharmacies due to high inflation 
(359%) and the rising cost of foreign currency. 
In July alone, the cost of a month's supply of 
generic fixed-dose combination ARVs increased from 
US$7 to US$17; the same supply now costs US$46. 
Like most commodities in Zimbabwe, the price of 
ARVs increases weekly, if not daily.  With an 
estimated 75% unemployment rate in the formal 
sector, and 80% of the population living below the 
poverty line, the reality is that the vast 
majority of Zimbabweans can ill afford the price 
of ARVs even at a subsidized rate.  In addition, 
there are significant other costs to accessing 
ARVs, such as laboratory tests or even transport 
to a health facility. 
 
7)   Drug Resistance:  Increased ARV prices and 
shortages will inevitably have dramatic 
repercussions for patients on treatment.  ARVS 
need to be taken consistently, on a daily basis, 
as interruptions can cause resistance to the 
drugs.  As costs rise and supplies are inadequate, 
doctors fear that patients may cope by reducing 
the quantity they take on any given day or by not 
being able to take the drugs at all. 
 
8)   Foreign Currency:  The cause of the low 
stocks of ARV drugs is the acute shortage of 
foreign currency to purchase the drugs 
internationally. While Zimbabwe has some local 
production of generic ARVs, the sole local 
manufacturer (Varichem Pharmaceuticals Private 
Limited) is also facing problems due to shortages 
of foreign currency needed for importation of raw 
materials to produce the drugs. 
 
9)   Global Fund: Zimbabwe has received limited 
amounts of Round 1 Global Fund monies devoted to 
ART, insufficient to cover the current national 
requirements. In October, Zimbabwe was awarded 
Round 5 monies. However, it is unlikely these 
monies will flow quickly enough to mitigate the 
national shortages. Moreover, the Global Fund 
proposal specified intensive coverage of only a 
limited number of districts, not to the overall 
national supply.  Thus Zimbabwe may, in fact, be 
put into a contradictory predicament to 'scale up' 
ART in certain districts per the Global Fund 
proposal, while running out of supplies in many 
other districts. 
 
10)  Local Currency Swap:  UNICEF is actively 
trying to put together a solution to the immediate 
drug shortage by negotiating a currency swap with 
the MOH.  Under this plan, the GOZ would provide 
local currency to UNICEF/Zimbabwe which, in turn, 
would use its foreign currency and its procurement 
channels to procure ARVs for the GOZ public health 
system.  UNICEF/Zimbabwe would use the local 
currency supplied by the GOZ for its own in- 
country operating costs.  Last week, the MOH 
hosted a meeting in which it proposed that donors 
and international NGOs also participate in the 
swap mechanism and that UNICEF manage the funds 
and procure the ARVs. 
 
11)  Comment:  A number of questions remain 
regarding whether the GOZ will be able to solve 
the ARV shortage.  Even with UNICEF's assistance, 
it is unclear at this point if the Ministry of 
Finance will approve the proposed swap process 
and, if it does, whether it will provide 
sufficient local currency for it to work.  Even if 
all goes well with the proposed swap, the 
underlying problem is Zimbabwe's fast contracting 
economy which is simply not generating the foreign 
exchange necessary to pay for the country's import 
needs: food, fuel, electricity, drugs, etc. 
Zimbabweans currently taking ARVs and the hundreds 
of thousands still in need of these drugs are 
increasingly taking note of the GOZ's expenditures 
on foreign travel, imported vehicles and large 
arrearage payments to the IMF.  They are starting 
to openly question the GOZ's priorities for 
foreign currency and whether these include their 
needs for life saving drugs. 
DELL