KNOW YOUR EPIDEMIC: THE ZIMBABWEAN HIV AND AIDS CONTEXT

ZIMBABWE AND HIV/AIDS
HIV and AIDS was first reported in Zimbabwe in 1985. In the early 1990's about 10% of the adult population were estimated to be living with HIV and AIDS It rose dramatically to about 29% by 1997. But since then the prevalence has declined to the current estimate of 13,7% according to Ministry of Health (2009). Zimbabwe has a population of 12 million people and the number of people living with HIV and AIDS is estimated to be 1 300 000. The HIV pandemic has disproportionately affected women with 680 000 of them living with it and the children with HIV and AIDS are 120 000. The age group with most People living with HIV and AIDS is between 15-45 years.

The decline in the HIV prevalence rate has been to some positive changes in sexual behavior due to increased awareness of HIV and AIDS. The Zimbabwe Demographic and Health Survey showed that around 76% of women and 81% of men know that condoms can reduce the risk of HIV infection. Also there is an increase in the number of young people delaying the debut sex encounters. Also there is reduced sex partners amongst both the married and those still single.

THE GOVERNMENT AND CIVIL SOCIETY RESPONSE
The Zimbabwean government was slow to acknowledge the problem and take appropriate action when HIV and AIDS first emerged in Zimbabwe. National Aids Co-ordination Programme (NACP) was set up in 1987 and several short and medium term AIDS plans were carried out in the preceding years but the country's first HIV and AIDS policy was announced. NACP was replaced by National AIDS Council (NAC) in 1999 and in the same year the government introduced AIDS levy on all taxpayers to fund the work of the NAC.

These measures have had a positive impact, the political will towards fighting HIV and AIDS is there in Zimbabwe but other issue have led to a situation where the government is unable to adequately address the crisis. The government response to HIV and AIDS have been compromised by other political and social crisis that have dominated political attention and negatively affected the implementation of the National AIDS policy. National AIDS Council is also poorly organize and lack the resources to effectively respond to HIV and AIDS in the country.

Some political tension between Zimbabwe and some western countries has decreased aid or at other times halted altogether thereby negatively affecting the responses to HIV and AIDS by both the government and Civil Society Organizations. Although, Zimbabwe is still receiving a substantial amount on HIV and AIDS, these donations are not as much as other Sub-Saharan African countries are receiving. For example Zambia, a neighboring nation with a similar HIV prevalence rate, was reported in 2008 to be receiving $187 per HIV positive person annually from foreign donors and in Zimbabwe the figure was estimated to be just $4 per person

THE EFFECTS OF HIV AMONGST WOMEN AND CHILDREN
It is estimated that 680 000 women and 120 000 children are living with HIV and AIDS in Zimbabwe. There are large social and economic gaps between women and men in Zimbabwe, and these inequalities have played a central role in the spread of HIV. Constrictive attitudes towards female sexuality contrast with lenient ones towards the sexual activity of men, resulting in a situation where men often have multiple sexual partners and women have little authority to instigate condom use. W omen's roles and their biological vulnerability to HIV infection have been a major driver of HIV infection amongst women in Zimbabwe. According to UNAIDS estimates, almost 60% of Zimbabwean adults living with HIV at the end of 2006 were female. This gender gap is even wider amongst young people – women make up around 77% of people between the ages of 15 and 24 living with HIV.

As the rural Zimbabwe remains a fertile ground for the spread of HIV and AIDS, women in this area face a multiple HIV induced problems. Most of them they lack access to facilities such as post-exposure prophylaxis and adequate maternal health attention because they have limited access to information on these. However, because of limited human resources and poor infrastructures, many women are still not receiving these drugs others have to walk for distances of more than 20km to reach the next clinic or hospital. This has increased mother to child-transmission although most of the hospitals in the country have drugs to prevent such incidences.The provision of drugs to prevent mother to child rose from 4% in 2006 to about 35% in 2009. Although this is an encouraging scale-up, access to nevirapine remains low especially in rural areas.

Prevention campaigns that emphasise safe sex and abstinence often fail to take into account these realities, and are more applicable to the lives of men than those of women. Women are likely to be poorer and less educated than men, exposing them to HIV infection and making it harder for them to access treatment, care and information.

On palliative care, current statistics indicate that more than two third of all Home Based Care giving for People Living with HIV and AIDS are women. These women often struggle to bring in income whilst providing care therefore many families affected by AIDS suffer from increasing poverty. Also young girls are greatly affected where both parents are ill from HIV and AIDS as they become the main carers at other times even foregoing their school education. When both parents die she becomes the head of the family; this scenario also applies to young boys who found themselves in the same predicament.

YOUTH AND HIV/AIDS
Young people in Zimbabwe are much more vulnerable to HIV/AIDS than older people are. Because their social, emotional and psychological development is incomplete, they tend to experiment with risky behavior, often with little awareness of the danger. In fact, risky sexual behavior often is part of a larger pattern of adolescent behavior in the country, including alcohol and drug use, delinquency, and challenging authority

Nevertheless, most young people have only limited knowledge about HIV/AIDS—largely because the society make it difficult for them to obtain information especially in the rural areas. . Because adolescents are in a period of transition, in which they are no longer children but not yet adults, public health responses to their needs are often conflicting and confused. At the same time, social norms and expectations, along with peer opinion, affects young people's thereby exposing them to risk behavior.

AIDS deaths have forced many adolescents to take on adult roles in Zimbabwe, the transition from childhood to adulthood is disappearing. Often, children must leave school to care for a dying parent or relative. Because AIDS consumes family budgets, fewer funds remain available for children's education, health care, and other needs. Moreover, children who care for relatives with AIDS but who remain in school are often older than their classmates and thus more likely to drop out of school early Some strategies being proposed to alleviate the impact of HIV/AIDS on children include subsidizing school expenses such as school uniforms and school fees.

Also young girls are greatly affected where both parents are ill from HIV and AIDS as they become the main carers at other times even foregoing their school education. When both parents die she becomes the head of the family; this scenario also applies to young boys who found themselves in the same predicament.

With the Anti-retro-viral drugs prolonging the life of people living with HIV and AIDS, young children are graduating into adolescence but there is lack of knowledge and guidance on these children on how to deal with their developing sexual life, there is no sexual and reproductive education amongst the youth.

CONCLUSION

The Zimbabwean government and Civil Society organization response to the AIDS crisis has been commendable given the limited resources under which they are operating. Prevention and treatment initiatives have been scaled up and the national HIV prevalence seems to have declined.

Despite this, HIV prevalence is still one of the highest in the world and the majority of those in need of antiretroviral treatment are not receiving it. A prevalence rate of 13,7 remains high therefore its not a time to relax; there is need to reinvigorate and scale up prevention and awareness programming on HIV/AIDS in Zimbabwe.