US embassy cable - 05HARARE1611

UNCLAS SECTION 01 OF 02 HARARE 001611 
 
SIPDIS 
 
STATE FOR OES DAS, AF/FO AF/S 
USAID/W FOR KENT HILL, GH/AA; ROXANA ROGERS, GH/OA; HOPE 
SUKIN, AFR/SD; CARL HAWKINS, GH/PRH/CLM; CONSTANCE CARRINO, 
GH/HIV-AIDS; RANDALL TOBIAS, S/GAC; MARJORIE COPSON, AFR/SA 
HHS FOR STEIGER 
HHS/CDC FOR JGERBERDING, SBLOUNT,EMCCRAY, KFENTON, DBRIX, 
RSIMONDS 
 
E.O. 12958: N/A 
TAGS: KHIV, TSPL, OSCI, TBIO, KSCA, US, ZI, HIV/AIDS 
SUBJECT: Fall in Zimbabwe's National HIV/AIDs Prevalence 
Estimate 
 
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Summary 
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1.  The "Zimbabwe National HIV/AIDS Estimates 2005" will be 
officially released November 30 2005.  The study's key 
finding is that the estimate of HIV/AIDS prevalence in 
adults (aged 15 to 49 years) was 20.1% in 2005, 
substantially lower than the 2003 estimate of 24.6%.  The 
new figure represents a true decline in Zimbabwe's HIV 
prevalence rate, the first such national decline in a Sub- 
Saharan African country since Uganda in the mid-1990s. 
Review of other data suggest that behavioral changes appear 
to be at least part of the answer.  While the estimated 
adult prevalence of HIV/AIDS is decreasing, it still remains 
alarmingly high and intensive external support from the U.S. 
and other donors will continue to be needed.  End Summary. 
 
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National Estimates Show Fall in Prevalence Rate 
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2.  Zimbabwe National HIV/AIDS Estimates 2005 will be 
officially released by the Ministry of Health and Child 
Welfare (MOHCW) November 30 2005.  A preliminary report will 
also be distributed, with dissemination of the full report 
expected by late February/early March 2005.  The study 
provides estimates of the prevalence rate, the number of 
persons living with HIV/AIDS, the number of HIV/AIDS 
orphans, the number of new cases of HIV and AIDS, and the 
number of AIDS-related deaths. 
 
3.  The study's key finding is that the estimated HIV/AIDS 
prevalence in adults (age 15 to 49 years) in Zimbabwe was 
20.1% in 2005, with a range from 17.0 to 23.5%.  The 2003 
study reported an estimated adult HIV/AIDS prevalence in 
Zimbabwe of 24.6%.  This reflects a true decline in the 
proportion of Zimbabweans with HIV/AIDS and is supported by 
data from the 2000-2004 Antenatal Clinic Surveys and the 
ZVITAMBO clinical trial.  This represents the first such 
decline in the prevalence rate of a sub-Saharan African 
country since Uganda in the mid-1990s. 
 
4.  Other estimates included in the report were as follows: 
an estimated 1,391,397 Zimbabweans age 15-49 years were 
living with HIV/AIDS in 2005, of whom 780,000 were women; an 
estimated 1,050,000 HIV/AIDS orphans (age 0 to 14 years) 
were living in Zimbabwe at the end of 2005; an estimated 
131,370 new HIV infections and 134,990 new AIDS cases 
occurred among adults age 15 to 49 years in 2005; an 
estimated 26,610 new HIV infections and 29,4670 new AIDS 
cases occurred among children age 0 to 14 years in 2005. 
Finally, the number of AIDS-related deaths during 2005 was 
estimated to be 139,950 among adults and 29,150 among 
children. 
 
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Background on the Study and U.S. Role 
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5.  "Zimbabwe National HIV/AIDS Estimates 2005" was locally- 
produced in Zimbabwe, by a working group including MOHCW, 
Centers for Disease Control and Prevention (CDC)-Zimbabwe, 
the University of Zimbabwe, the Biomedical Research and 
Training Institute/Imperial College of London, the World 
Health Organization (WHO) and UNAIDS.  Data from HIV 
surveillance at sentinel antenatal clinics was used to 
produce HIV prevalence curves using the Estimates and 
Projection Package (EPP) software.  The HIV/AIDS estimates 
were generated using the software package Spectrum. 
Zimbabwe will continue to conduct antenatal clinic 
surveillance at the same antenatal clinic sites as in 
previous years in an effort to obtain the most accurate 
trends and estimates possible, and will continue to examine 
the antenatal clinic data and other data sources such as the 
nation-wide population-based Zimbabwe Young Adult Survey and 
the Zimbabwe Demographic Health Survey Plus to validate and 
interpret the estimates. 
 
6.  CDC-Zimbabwe has provided intensive technical assistance 
to MOHCW in conducting HIV surveillance at sentinel 
antenatal clinics since 2000, in analyzing this data to form 
the basis for the new estimates, and in coordinating working 
group efforts to generate the estimates and produce the 
final estimates report.  CDC-Zimbabwe and CDC-Atlanta also 
provided technical expertise in methodology and training in 
analytic software packages.  CDC-Zimbabwe financial and 
technical investments in developing the MOHCW informatics 
infrastructure and the University of Zimbabwe Informatics 
Training Unit contributed greatly to this process, and 
additional financial support was provided for supplemental 
trainings and printing/publication of the report for 
widespread dissemination. 
 
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Behavioral Changes Appear Key 
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7.  The estimates reflect the trends in HIV prevalence, but 
not the reasons the trends are occurring.  Testing of stored 
samples from 2000-2004 antenatal surveys and 2001 and 2005 
population-based surveys for HIV incidence (new infections) 
later this year will provide further insights into the 
pattern of recent declines.  Review of other existing 
epidemiological data by MOHCW, the Imperial College of 
London, UNAIDS, and CDC-Zimbabwe suggests that mortality 
from HIV/AIDS has stabilized and that behavior change 
(increased condom use, delay in first sex by young women) 
starting in the late 1990s is at least partially responsible 
for the decline.  The results of the second population-based 
survey including behavioral indicators and HIV biomarkers 
are expected in 2006, which will allow comparisons of 
behaviors in 2001 and 2006 and hopefully confirm the key 
role of behavior change in the declining prevalence rate. 
 
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Need For Continued Assistance 
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8.  The 2005 estimates will be used to monitor Zimbabwe's 
progress towards the United Nations General Assembly Special 
Session on HIV/AIDS (UNGASS) and the Millennium Development 
goals.  They were shared with UNAIDS and WHO for inclusion 
in the "Report on the Global HIV/AIDS Epidemic 2005," which 
was released on November 21 2005.  The data in the report 
will also be used nationally and locally to assist in 
planning for prevention and treatment services and to raise 
awareness of the differences in HIV/AIDS prevalence, new HIV 
infections, new AIDS cases, and AIDS deaths by gender and in 
HIV/AIDS prevalence by area of residence.  The MOHCW plans 
to use the Zimbabwe Demographic Health Survey Plus data to 
confirm the prevalence rate. 
 
9.  Despite the good news contained in Zimbabwe's second 
nationally produced study of HIV/AIDS estimates, the scale 
of the pandemic in Zimbabwe is still enormous.  Over 1.6 
million people and 20.1% of the adult population are living 
with HIV/AIDS in Zimbabwe, alarmingly high figures. 
Additional interventions for HIV/AIDS prevention and 
treatment are greatly needed to minimize the devastating 
impact of this disease on Zimbabweans.  We are optimistic 
that continued USG assistance to HIV/AID programming in 
Zimbabwe can help ensure that this declining trend is 
maintained. 
 
Schultz