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1 million on HIV treatment

In Zimbabwe, antiretroviral therapy is saving lives and securing futures

Story by United Nations Development Programme November 30th, 2017

With one in seven adults living with HIV, Zimbabwe has one of the highest prevalence rates in the world, a situation aggravated by a major shortage of public health workers and serious economic challenges. Yet despite the difficulties, 1 million Zimbabweans living with HIV are now receiving antiretroviral treatment.

To mark World AIDS Day 2017, meet the individuals behind this milestone as they explain how access to HIV treatment has transformed their lives and secured their futures.

The sun rises over Zimbabwe’s capital city, Harare.

Sarah, From devastation to hope

In 1993, Sarah collapsed at her home. She was taken to hospital where her twin baby boys were stillborn. Heartbroken and in shock, Sarah then had to face more devastating news. Doctors had carried out a routine HIV test. The result was positive. Distraught and unable to come to terms with her status, she later tried to take her own life.

“When I found I was HIV positive, I went into denial. I took rat poison and was rushed to hospital.”
Sarah (49) at her home in Old Mabvuku, Harare, Zimbabwe.

Living a full life seemed an impossibility to Sarah until her brother, an HIV activist who was also positive, took her to support groups for people living with HIV.

Accessing treatment and meeting so many other people who were living with HIV opened Sarah's eyes to a future she hadn’t thought possible. Her brother eventually passed away and today she credits him for helping her live her life and accept her HIV positive status.

Sarah sits for a portrait in her room in Old Mabvuku, in Harare, Zimbabwe. Sarah has been on ART since 2001.
Dr Robert Scott is Sarah's first doctor, and the first African American to become licensed to practice in Zimbabwe. He specialized in HIV.
“I started to realize there are a lot of people who are HIV positive – some who are more educated than me, some who have better lives than me and some who don’t - but they are still surviving so I know I can also survive.”

In the 1990s, HIV devastated communities across Sub-Saharan Africa, increasing the numbers of orphans and eroding family structures. In 1998 alone, 2 million people in Africa died of AIDS - 5500 funerals a day – according to UNAIDS.

Sarah’s medication sits next to a portrait of her late brother Peter, who helped her accept her HIV status.

Theresa, Educating the next generation

Theresa found out she was HIV positive in 1999 when her husband left her and the family. “I was hurt because I had only had sexual relations with my husband. I kept my status to myself and only revealed it to my family two years later” .

“If I couldn’t take antiretroviral therapy I would have been dead by now.”
Theresa, grandmother of 15, has been on ART since 2008.

Theresa has also experienced stigma and discrimination and feels this is due to a lack of information and knowledge.

“People still have the old way of thinking that if someone is HIV positive they shouldn’t touch their plate, or touch or wear clothes or anything. I actually heard some people saying that before I hire a maid I insist on her getting tested first because I don’t want an HIV positive person to work for me.”

Theresa works in her community as a behaviour change volunteer with Family AIDS Caring Trust (FACT).

To challenge this, Theresa wants to ensure her grandchildren grow up to see a positive representation of people living with HIV.

“They even remind me to take my pills, which makes me happy to know that they are growing up knowing that being HIV positive is not a bad thing.”
UNDP_ZW_HIV_11.jpg

Since 2006, 393,000 deaths have been averted due to access to antiretroviral therapy in Zimbabwe, with more than 49,000 deaths averted in 2016 alone. New HIV infections have also fallen by two thirds in the last 15 years.

A pharmacist at St. Albert’s Mission, one of the first sites to offer HIV testing and treatment services in the country
Stores line the street in front of St Albert’s Mission Hospital in Bindura.
A patient receives instructions from a clinician at the OI clinic at St. Albert’s Mission Hospital.

Lloyd, A way of life

Lloyd has been on antiretroviral therapy for nearly as long as he can remember. On treatment at 7 years old, he originally struggled to understand what it meant.

“I just thought it was a little sickness.”
Lloyd (18) visits an adolescent support centre at Wilkins Hospital in Harare, Zimbabwe.

Being introduced to an adolescent HIV support group helped Lloyd come to terms with his status, and he now serves as a community adolescent treatment supporter: “The support group helped me to be where I am today, because 80 percent of my friends now are people who I met there.”

For a period when he was younger, and feared people in his school class would learn about his status, Lloyd stopped taking his medication. But now he believes his treatment is key to helping him fulfill his dream of becoming a successful musician.

“I realized, if I keep taking my medication, I will have a future.”
On ART since the age of 7, Lloyd understands the treatment is critical to living a full life.

Melisa, A positive outlook

With no-one to take care of her or her 4-year-old daughter, Melisa turned to sex work as a way to support her family.

In 2015, Melisa fell ill and started to lose weight. She eventually went to the hospital where she was diagnosed with Tuberculosis, and encouraged to get tested for HIV: “The nurses would say to me, look at so-and-so, they are positive but look how healthy they are.”

Since then Melisa has started on antiretroviral therapy and has come to terms with being HIV positive.

This led her to disclose her status to her loved ones and, importantly, to be open about being HIV positive in her work.

“With clients who want to have unprotected sex, I tell them that I am on ART and that if they have a family, I don’t want to endanger them.”
Melisa (30) is a commercial sex worker who has been on ART since she found out about her status in 2015.
No condom, no sex” is written on a hat belonging to Memory, a sex worker in Chipadze, Bindura, Zimbabwe.
Memory in her room in Chipadze, Bindura, Zimbabwe

Melisa feels it is important for her to continue treatment because she would like to see her daughter grow up and also has hopes of building a new life.

“I hope to find a man who is HIV positive who also understands that I am HIV positive and build a life together knowing our statuses.”
Melisa: “I am now used to sex work, but I am slowly shying away from it because my daughter is grown."

Protecting the future

In partnership with the government of Zimbabwe and the Global Fund to fight AIDS, Tuberculosis and Malaria (the Global Fund), UNDP plays a vital role in supporting the country to increase the number of people on antiretroviral therapy and to strengthen public health systems.

While HIV remains a major health challenge in Zimbabwe, with 1.3 million people living with HIV at the end of 2016, the decline of life expectancy, which had reached 41 years in 2003, has been reversed, reaching 61 years in 2015.

The increase in people on HIV treatment also means that 1 million people living with HIV are now able to live longer, healthier and more productive lives. Research shows that HIV patients on effective antiretroviral treatment are more likely to be engaged in the labour force, and family members are also more likely to be working or in school.

A lab worker prepares blood samples for infectious disease screening at the National Blood Service in Harare.

To protect development gains, and in the face of an evolving and uncertain political environment, additional funding of US$426 million has been announced. The agreement between UNDP and the Global Fund will support programmes for the next three years, ensuring universal access to HIV prevention, treatment, care and support services.

This vital work will also mean that more people like Sarah, Theresa, Lloyd and Melisa are able to live longer, healthier and more productive lives.

A patient waits for a prescription at St. Albert’s Mission Hospital.
Footnote: Story by Rebecca Webb/UNDP; photos by Cynthia R. Matonhodze/UNDP Zimbabwe
Zimbabwe