US embassy cable - 03HARARE758

UNCLAS SECTION 01 OF 02 HARARE 000758 
 
SIPDIS 
 
FROM AMBASSADOR SULLIVAN FOR: 
STATE, FOR AF A/S KANSTEINER AND OES DAS CHOW, 
USAID/W FOR ANNE PETERSON AND AFR A/A NEWMAN, 
HHS FOR SECRETARY THOMPSON AND WILLIAM STEIGER, 
WHITE HOUSE FOR DR. J. O'NEILL, 
NSC FOR AFRICA SR DIR JFRAZER AND JDWORKIN, 
ROME FOR AMB HALL, 
PRETORIA FOR CROWLEY 
ALSO PASS TO CDC/JGERBERDING 
 
E.O. 12958: N/A 
TAGS: KHIV, TSPL, OSCI, KSCA, ZI, US, HIV/AIDS 
SUBJECT: USG HIV/AIDS PROGRAMS IN ZIMBABWE: POISED FOR 
FURTHER PROGRESS 
 
REF: HARARE 757 
 
1. I call your attention to reftel which outlines the 
progress the US has made in HIV/AIDS prevention, 
care/treatment and mitigation in Zimbabwe, perhaps the second 
most affected country in the world. I believe it critical 
that the USG continue to give priority attention to 
Zimbabwe's enormous public health crisis now, building on the 
success of our current efforts and taking advantage of 
opportunities for more progress. As noted in the Mission 
Program Plan(MPP), we need to work where we can be most 
effective in saving lives -- in Mission and Church Hospitals 
in many cases, in the public health system, and with 
faith-based and other NGO's.  We also need to take advantage 
of opportunities that we have helped put in place to save 
lives now, since delay will only assure that the HIV crisis 
and Zimbabwe's other related crises worsen for years to come, 
making the task of Zimbabwe's eventual recovery under future 
governments that much more difficult.  This telegram and  the 
referenced telegram point out several opportunities to build 
on our success.  I appeal to addressees and to the 
interagency group that reviews the MPP to assure that US 
HIV-AIDS programs for Zimbabwe receive the resources 
necessary to continue their progress.  (In this context, I am 
not concerned about whether Zimbabwe makes up part of any 
priority list, but that the USG dedicate the resources 
necessary to build on our current progress and take advantage 
of real opportunities to save more lives now.) 
 
2. Background: Zimbabwe has been wracked by a series of 
profound and interlocking crises with humanitarian, economic, 
social and political dimensions.  The once strong national 
health system is now crippled due to economic constraints and 
emigration of staff and the effects of the epidemic which 
affects an estimated 2,300,000 of the twelve million 
Zimbabweans. Notwithstanding the difficulties, US agencies, 
including USAID, HHS/CDC, NIH, and HRSA, together with 
private US companies and NGO's have collaborated closely for 
maximum effect to establish a strong foundation for programs 
aimed at prevention, treatment and mitigation. 
 
3.. Examples of Integrated Programming and Additional 
Opportunities 
 
USAID has supported an increasingly successful Voluntary 
Counseling and Testing(VCT) network of 14 centers, while CDC 
together with the Elizabeth Glazer Foundation have 
jump-started a national Prevention of Mother to Child 
Transmission(PMTCT) program at some 80 clinics and hospitals, 
which already reaches 10 per cent of pregnant mothers.  USAID 
and CDC are now collaborating closely on integrating the VCT 
and PMTCT programs to satisfy the rapidly increasing demand 
for expanded HIV counseling and testing services among 
pregnant women, their partners and families. Because the 
PMTCT program is principally run through the public health 
system, integrating VCT and PMTCT programs will require USAID 
to join CDC in working with public health authorities. 
Integrating these two programs will also 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. 
 
Opportunity: Resources will determine our reach. Current USG 
resources will enable us to reach 15 percent of seropositive 
mothers, while an additional two million per year would 
enable us to reach about 25 per cent of seropositive mothers. 
 
4. ARVs: CDC has worked with the GOZ to develop guidelines 
and protocols for ARV treatment and to prepare for the 
laboratory-associated treatment requirements, while USAID has 
performed a comprehensive assessment of logistical factors 
for ARV delivery on a large scale.  CDC has also brokered 
arrangements between Pfizer and the GOZ for the initiation 
and expansion of the Pfizer Diflucan Donation Program for 
treatment of two significant opportunistic infections.  Both 
CDC and USAID actively interact with the GOZ and domestic and 
international stakeholders on the programming, monitoring and 
evaluation of funds pledged to Zimbabwe by the Global Fund. 
 
Opportunity: For approximately three million dollars per 
year, the USG could support a pragmatic, well-designed, 
intensively evaluated highly active anti-retroviral 
therapy(HAART) program sustaining between 3,000 and 5,000 
persons with advanced HIV infection. 
 
5. Bottom line: We are making real progress in Zimbabwe in 
laying the foundation for a broad and effective HIV-AIDS 
intervention.  Our programs are totally consistent with our 
policy of support for the Zimbabwean people, even as we 
differ with the GOZ. Notwithstanding Zimbabwe's current 
crises, the population, health sector and civil society, 
including faith-based organizations, possess the fundamental 
conditions for major progress in prevention, treatment and 
mitigation.  The HIV-AIDS crisis in Zimbabwe is so severe 
that waiting is not an option.  I urge that the USG commit to 
providing all possible assistance to attacking the disease 
now. 
SULLIVAN