US embassy cable - 03HARARE757

UNCLAS SECTION 01 OF 03 HARARE 000757 
 
SIPDIS 
 
STATE FOR OES DAS CHOW, AF/FO AND AF/S 
NSC FOR DWORKIN, JFRAZER 
USAID/W FOR G/PHN A/A PETERSEN 
AFR A/A NEWMAN, DCHA A/A WINTER 
HHS FOR STEIGER 
HHS/CDC JGERBERDING AND EMCCRAY 
PRETORIA FOR CROWLEY 
ROME PLEASE PASS TO FODAG 
 
 
E.O. 12958: N/A 
TAGS: KHIV, TSPL, OSCI, TBIO, KSCA, US, ZI, HIV/AIDS 
SUBJECT:  USG Response to Zimbabwe HIV/AIDS Crisis 
 
1:   Summary:  The USG in Zimbabwe is implementing a 
comprehensive response to the HIV/AIDS pandemic, 
characterized by close coordination between USAID and 
CDC programs.   These joint efforts have established a 
strong foundation aimed at HIV/AIDS prevention, 
care/treatment and mitigation.  The USG is now poised to 
build on and expand these programs to achieve 
significantly greater impact and, thereby, save 
additional lives if we have sufficient resources. 
Specifically, the USG in Zimbabwe is well placed to make 
progress in high-priority areas, such as expansion and 
integration of VCT and PMTCT programs, and pragmatic 
models of ARV treatment.  Some remarkable success 
stories are emerging in Zimbabwe of what can be 
achieved, even in the absence of strong political 
leadership and in the midst of crippling socioeconomic 
and political crises.  USG progress on HIV/AIDS in 
Zimbabwe, due to close teamwork among agencies at post 
and partnerships with a range of public and private 
actors, demonstrates that effective response to the 
pandemic need not remain paralyzed while awaiting 
political leadership.  End Summary. 
 
2.   HIV/AIDS Epidemic in Zimbabwe: Over the past 
several years, Zimbabwe has been wracked by a series of 
profound and interlocking crises with humanitarian, 
economic, social and political dimensions.  The 
generalized HIV/AIDS epidemic in particular has helped 
propel the country towards a humanitarian crisis at both 
household and national levels.  An estimated 2,000 
deaths per week are attributed to the epidemic.  Many 
deaths are due to curable conditions like tuberculosis. 
Stigma remains a major obstacle to progress.  It is 
estimated that only 10% of HIV-infected Zimbabweans know 
their HIV status.  The once-strong national health 
system, now crippled due to economic constraints and 
massive out-migration of critical staff, is unable to 
cope with the demands for care and treatment associated 
with the epidemic.  An estimated 2,300,000 adults and 
children in Zimbabwe were living with HIV/AIDS in 2001, 
including an estimated 34% of all adults aged 15-49 
years (UNAIDS 2002). Given the high prevalence of 
infection, mortality rates will escalate for many years 
to come. 
 
3.   Synergistic Coordination: In the face of these deep- 
rooted problems, the national response to HIV/AIDS moves 
forward.  Some remarkable success stories are emerging 
in Zimbabwe of what can be achieved in progress against 
HIV/AIDS, even in the absence of strong political 
leadership and in the midst of crippling socioeconomic 
and political crises.  To a substantial degree, this 
progress can be attributed to an unusually synergistic, 
highly coordinated set of USG activities in Zimbabwe, 
being implemented by USAID, HHS/CDC, the National 
Institutes of Health (NIH), the Health Resources and 
Services Administration (HRSA), private US companies and 
NGOs.  USG efforts have established a strong foundation 
of programs aimed at HIV/AIDS prevention, care/treatment 
and mitigation.  We are now poised to build-on and 
expand these programs to achieve significantly greater 
impact and, thereby, save additional lives if sufficient 
resources are available. In addition, both USAID and CDC 
actively interact with GOZ and domestic and 
international stakeholders on the programming, 
monitoring and evaluation of funds pledged to Zimbabwe 
by the Global Fund for AIDS, TB and Malaria (GFATM). 
 
4.   HIV/AIDS Prevention: A major aspect of USG 
assistance is focused on prevention of HIV/AIDS among 
youth and young adults.  USAID (television) and CDC 
(radio) have supported the production and broadcast of 
long-running soap operas/serial dramas that model target 
behaviors through the use of inspiring stories and 
character role modeling.  USG-sponsored behavior change 
programming seeks to stimulate demand for key services 
such as VCT and PMTCT, and takes direct aim at reduction 
of stigma and support of people living positively. 
USAID's television drama is now the highest-rated show 
on TV in Zimbabwe, and is providing "product placement" 
opportunities to the CDC-supported radio drama to 
stimulate listening in the first few weeks of the 
latter. 
 
5.   Voluntary Counseling and Testing (VCT): With a 
nationwide network of 14 USAID-supported VCT centers in 
place, large increases in demand for these services are 
now being experienced, with some clinics seeing over a 
hundred clients per day and 65,000 per year.  Recently 
piloted mobile VCT services, to reach additional 
underserved areas of the country, have also resulted in 
overwhelming demand.  These achievements are 
complemented by strong USAID-supported social marketing 
campaigns through TV, radio and other media.  As a 
result, USAID is well positioned to expand support for 
these services, in collaboration with faith and 
community-based organizations, to keep up with this ever- 
increasing demand.  Knowledge of HIV status is the 
cornerstone of prevention and behavior change as well as 
the entry point for expanded HIV/AIDS care and treatment 
programs.  As such, the expansion of VCT services, in 
traditional and new settings, is critical to realizing 
an impact on the epidemic. 
 
6.   Prevention of Mother to Child Transmission (PMTCT): 
CDC and the Elizabeth Glazer Pediatric AIDS Foundation 
(EGPAF), a private U.S. NGO, have been two principal 
drivers working to jump-start the national PMTCT 
program.  This has resulted in an energized national 
PMTCT partnership of key stakeholders who now support 
this critical intervention in approximately 80 clinics 
and hospitals.  Almost 10% of pregnant women nationwide 
are now reached by PMTCT, up from fewer than 1% just 2 
years ago, with dramatic expansion of coverage possible 
in the near future.  The result is that more and more 
new mothers are tested, preventative interventions are 
undertaken, and risk of HIV transmission to newborns is 
significantly reduced.  In order to meet the growing 
demand and opportunities for PMTCT services, additional 
resources will be required. 
 
7.   VCT and PMTCT Integration:   Building on these two 
programmatic pillars, USAID and CDC are collaborating 
closely on integrating VCT and PMTCT programs.  Our 
objectives are to increase the cost-effectiveness of 
each program, to use limited human resources 
efficiently, and to satisfy the rapidly increasing 
demand for expanded HIV counseling and testing services 
among pregnant women, their partners and families. 
Because the national PMTCT program is principally run 
through the public health system, integrating VCT and 
PMTCT programs would require USAID to join with CDC in 
working with public health authorities.  Integrating 
these programs, and constructing a robust nationwide 
counseling and testing service that functions in a 
variety of settings, will provide a firmer foundation on 
which to construct the delivery of broader care and 
treatment programs, including ARVs, to pregnant women, 
their partners and families. 
 
Opportunities:   For an additional $2 million/yr, USG 
efforts could scale up substantially, possibly reaching 
25% of 15-49 yr olds with knowledge of HIV serostatus 
(through combined PMTCT and VCT) by the end of 2004, 
rather than the projected increase to 15%. 
 
8.   Care/Treatment and Mitigation: The landscape of 
HIV/AIDS care, treatment and crisis mitigation programs 
in Africa is rapidly changing, and Zimbabwe is no 
exception.  Hundreds of organizations are at work 
providing palliative, curative and/or psychosocial care 
to those infected, affected and/or orphaned by this 
epidemic.  CDC and USAID are collaborating on efforts to 
improve the design, implementation and coordination of 
care and mitigation programs so that successful models 
can be replicated on a broad scale.  This includes major 
efforts to expand successful models for HIV/AIDS care 
developed by Mission and Church hospitals through CDC's 
innovative Network for HIV/AIDS Care, Prevention, and 
Positive Living (CHAPPL) among church-related hospitals. 
Mission and Church hospitals provide in excess of 50% of 
all health care services to rural Zimbabweans, as purely 
government facilities face continued shortages of staff, 
medicines and other supplies.  As for mitigation, USAID 
has set in place a robust 4.5 million grant program 
designed to strengthen the capacity of communities and 
NGOs to better support the needs of orphans and children 
affected by HIV/AIDS. 
 
9.   ARVs: Access to anti-retroviral (ARV) drugs is an 
evolving issue, on which USG agencies have collaborated 
extensively and developed a broad set of public-private 
partnerships. There are existing institutions that are 
already providing ARVs on a small scale, and still 
others that have the capacity but only lack access to 
the drugs.  CDC has worked with the GOZ and leading care 
specialists to develop guidelines and protocols for ARV 
treatment as well as to prepare for the laboratory 
associated treatment requirements.   USAID has performed 
a key comprehensive assessment to examine logistical 
constraints and required approaches to ARV delivery on a 
broad scale.  CDC has successfully brokered arrangements 
between Pfizer and the GOZ for the initiation and rapid 
expansion of the Pfizer Diflucan Donation Program for 
the life-saving treatment of two significant 
Opportunistic Infections (OIs) within public and mission 
hospitals.  CDC has brought in expertise from HRSA to 
assist with training needs for HIV care and ARVs, and is 
working with NIH-funded grantees from the University of 
California at San Francisco to share technical expertise 
in such areas as lab quality assurance for CD4+ and 
viral load testing, and training for ARV treatment. 
 
Opportunity:  For $3 million/yr, the USG could support 
pragmatic, well-designed, intensively evaluated highly 
active anti-retroviral therapy (HAART) programs 
sustaining perhaps between 3,000 and 5,000 persons with 
advanced HIV infection. 
 
10.   Surveillance/Information/Advocacy/Research: CDC 
has supported 3 consecutive years of increasingly high- 
quality HIV surveillance, plus Africa's first combined 
behavioral and biologic national household survey of 
young adults.  CDC's work has improved understanding of 
the epidemic, and established baselines on which to 
measure, monitor and evaluate progress of the national 
response.  USAID and CDC have worked successfully to 
stimulate improved communication, information 
dissemination and advocacy efforts among key Zimbabwean 
organizations, including the initiation of programs to 
boost the capacity of NGOs to formulate and advocate for 
improved HIV policies and programs.  NIH funded research 
activities focus primarily on testing and evaluation of 
behavioral and clinical interventions.  However, USAID 
and CDC work closely with NIH researchers on the ground 
to incorporate synergies between research and program 
activities, where and when possible. 
 
11.   Human Capacity Development and Retention:  For an 
annual expenditure of less than $1 million, CDC has 
supported the strengthening and expansion of the Masters 
of Public Health and the Masters of Clinical 
Epidemiology programs at the University of Zimbabwe.  In 
2002-3, more than 40 masters-level students in Zimbabwe 
are being supported by these programs.  Additionally, 
support to the faculty for teaching, research, and 
HIV/AIDS services has had a profound and positive effect 
on retention of national leaders in their faculty posts. 
 
Opportunity:  For an additional $1 million a year, the 
field training facilities and related distance learning 
infrastructure could be strengthened, additional 
partnerships and exchange programs with US universities 
and other institutions could be facilitated, and the 
program could be expanded regionally within southern 
Africa.  SULLIVAN