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Cablegate: Zimbabwe's Application of Guidance For

This record is a partial extract of the original cable. The full text of the original cable is not available.

UNCLAS SECTION 01 OF 04 HARARE 001688

SIPDIS

STATE/GAC, TOBIAS,O'NEIL JENNINGS,
STATE/AF, NEULING
NSC, TEITELBAUM
USAID/AFR,SUKIN,COPSON
USAID/GH, CORINO, ROGERS, STANTON, PRESSMAN,
HHS/THOMPSON, STEIGER, HHS/CDC, GERBERDING


E.O. 12958: N/A
TAGS: AMED EAID PREL US ZI HIV AIDS
SUBJECT: ZIMBABWE'S APPLICATION OF GUIDANCE FOR
IMPLEMENTING PRESIDENT'S EMERGENCY PLAN FOR AIDS
RELIEF

REF: (a) State 168905 (b) 001563

1.Summary: Posts were requested to report to S/GAC
on their application of the guidelines for
implementing the President's Emergency Plan and the
situation of HIV and AIDS in their country (reftel
a). Under the leadership of the U.S. Embassy, the USG
departments and agencies working in Zimbabwe (STATE,
USAID, DHHS CDC, DHHS NIH, DHHS HRSA, DOD, and PAS)
are implementing a coordinated strategy to address
Zimbabwe's HIV and AIDS crisis. The strategy
tegy
maximizes the comparative advantages of each agency in
working toward the single goal of mitigating the
national HIV and AIDS crisis. The President's
Emergency Plan principles, including balanced
messages, collaboration with faith and community-based
organizations, fostering leadership, expanding
networks, and effective monitoring and evaluation,
have been integrated into all aspects of the strategy.
As discussed in a recent briefing for S/GAC Tobias by
staff from the US Mission in Harare, despite the
challenging political and economic environment, the
coordinated strategy is achieving results and helping
to strengthen a comprehensive national response to the
epidemic. During this period of difficult political
relationships, support for HIV and AIDS activities is
one of the key ways in which the USG is able to
provide assistance to the people of Zimbabwe. End
summary.

2. Epidemiology: Zimbabwe is one of the countries
most affected by the HIV and AIDS epidemic. With an
estimated HIV prevalence of 24.6%, no family or
institution in Zimbabwe is untouched. There are an
estimated 3,290 deaths each week due to AIDS and
some 800,000 children aged 0 to 14 currently living
in Zimbabwe have been orphaned by the disease. Life
expectancy has fallen from 61 years in the mid-1980s
to only 34 years today.

3.Government of Zimbabwe (GOZ) Response: The
GOZ's response to the epidemic is guided by the
National Policy on HIV/AIDS for Zimbabwe and the
Strategic Framework for a National Response to
HIV/AIDS. The National AIDS Council (NAC) is
responsible for coordinating the GOZ's response to
the epidemic and for dispensing funds raised through
the AIDS levy, a 3% payroll tax for HIV levied on
all employees. The NAC has been subject to some
criticism domestically that it has been slow to
disburse funds from the AIDS levy and has not
adequately coordinated GOZ or other donor HIV
programs. It has also suffered, like many
institutions in Zimbabwe, from high staff turnover.
USG agencies and UNAIDS are committed to working
with NAC to try and address these weaknesses.
Nonetheless, the AIDS levy is an innovative approach
to mobilizing national resources, demonstrating
government and citizen commitment to combating the
epidemic. The NAC has also been proposed as the
principle recipient for some funds to be received by
Zimbabwe under the Global Fund to Fight AIDS,
Tuberculosis and Malaria.

4.NGO/FBO Response: Zimbabwe's non-government
organizations (NGOs) and faith-based organizations
(FBOs) play a vital role in responding to the HIV
and AIDS epidemic. Both provide home-based care
services, support children affected by AIDS, provide
information and counseling services, offer pastoral
care, and support other community-based services.
Most rely heavily on volunteers for services. The
USG currently supports the Zimbabwe AIDS Network, a
member organization of over 400 HIV-related NGOs.
In addition, Mission hospitals provide 75% of the
medical care in rural areas and have been some of
the leading hospitals in implementing innovative
programs for HIV and AIDS. The ability of NGOs to
implement programs, however, could be adversely
affected by the GOZ's pending NGO bill (reftel b)
that, if enacted in its present form, would provide
for an extreme level of government control over the
operations of NGOs. The precise impact on those
NGOs working in HIV and AIDS is unclear at this
point, but post will continue to monitor the
situation closely.
5. USG Coordinated Response: The USG has been a
leading provider of bilateral HIV and AIDS
assistance to Zimbabwe since the early days of the
epidemic, with HIV and AIDS currently included as
one of the top priorities in the Mission Performance
Plan. Under the coordination of the U.S. Embassy,
USAID, DHHS CDC, DHHS NIH, DHHS HRSA, DOD, and PAS
support an integrated $20 million per year
assistance program with a single goal: Mitigation
of the national HIV and AIDS crisis in Zimbabwe by
instituting proven prevention strategies, while
developing and implementing new interventions to
assist HIV-infected persons, orphans, and others
affected by HIV and AIDS. To achieve this goal, the
USG implements a three-pronged strategy that
addresses prevention, care and support, and
infrastructure and capacity building. Each agency
concentrates on areas of comparative advantage.

6.Prevention: The focus of the USG program is to
move Zimbabweans beyond HIV awareness to individual,
community, and policy-level behavior change.
Activities include (a) a coordinated mass media
program based on the ABC model that targets youth
and young adults; (b) programs involving government,
businesses, and labor to improve policy frameworks,
leadership, and advocacy strategies; (c) training in
prevention strategies for NGOs, FBOs, and the
uniformed services; (d) inclusion of HIV and AIDS as
part of the annual International Visitors Program;
and (e) programs involving FBOs, CBOs, NGOs, and
community planning boards in developing and
disseminating coordinated messages that promote
behavior change. As part of the mass media program,
we recently launched an innovative national "Trusted
Partner" campaign which helps define the elements of
trust, and encourages faithfulness through slogans
such as "one partner, one life." In April, the
leadership and advocacy program helped sponsor
public HIV testing for Members of Parliament-the
first time high-ranking Zimbabwean politicians had
publicly undergone voluntary HIV testing, helping to
break the entrenched cycle of stigma.

7. Care and Support: The USG program focuses on
the introduction of clinical interventions to
prevent transmission of the HIV virus and to improve
access to clinical care for HIV and AIDS as well as
HIV-related conditions. As the entry point to care
and support, wider HIV testing is encouraged through
a series of VCT centers, mobile outreach to rural
areas, counseling and testing in antenatal clinics
and other clinical venues, and the promotion of
referral networks. In 2003, over 170,000
Zimbabweans were tested in USG-supported sites, an
estimated 90% of all Zimbabweans tested that year,
and the number continues to grow. With the arrival
of USG-purchased antiretroviral drugs in August
2004, USG support for the expansion of Zimbabwe's
national treatment program was officially launched.
This program provides an excellent example of USAID
and DHHS CDC coordination, with USAID providing
expertise in ARV procurement, logistics management,
and site readiness, and DHHS/CDC providing technical
support for laboratories, informatics, and training
in clinical management of ARVs. By the end of the
year, some 300 Zimbabweans with AIDS are expected to
be on USG-procured ARVs, with more added in 2005.

8.Infrastructure and Capacity Building: USG
support is aimed at strengthening the organizational
and absorptive capacity of both public and private
health systems and services as the foundation for
expanding and improving the quality of HIV and AIDS
programs and interventions. USG agencies provide
financial and technical assistance to improve
surveillance and modeling of the HIV and AIDS
epidemic and related disease reporting systems. In
addition, the USG supports improvements in supply
chain and logistics management for drugs, condoms,
contraceptives, and other HIV-related supplies.
Furthermore, the USG assists and participates in
national oversight bodies and donor coordination
committees responsible for the monitoring and
evaluation of Zimbabwe's national response to HIV
and AIDS. The Monitoring and Evaluation Task Force
is currently developing a national M&E plan that
responds to the mandate of "the Three Ones" and
demands accountability for results.

9. Strengthening FBOs and CBOs: Given that 90% of
Zimbabweans are Christian, with most of those
belonging to a church and actively religious,
working with church organizations offers a real
opportunity to reach a large segment of the
population with HIV and AIDS interventions and to
combat stigma. The USG strategy recognizes this
opportunity and works closely with a wide variety of
FBOs, particularly in the areas of orphan care,
home-based care, leadership and advocacy, and
prevention and counseling. Zimbabwe's network of
Mission hospitals offers another target of
opportunity and serves as an important partner in
prevention of parent to child transmission (PPTCT)
programs, the antiretroviral program--with Howard
Mission Hospital being one of the initial 5 sites in
the National Antiretroviral Treatment Program
supported by the USG -- and the expansion of
referral networks. The USG supported the creation
and ongoing function of the Care for HIV Prevention
and Postive-living (CHAPPL) Network of 10 leading
mission hospitals, brought together to identify and
share best practices for HIV care and support.
Currently, 4 out of 10 of these hospitals provide
some level of antiretroviral treatment. Community-
based organizations (CBOs), similarly, are key USG
partners in responding to the HIV and AIDS crisis.
USG support for strengthening the capacity of
communities and their formal and informal
organizational structures is instrumental in helping
communities meet the needs of orphans and others
affected by AIDS, mobilize for VCT and PPTCT, and
disseminate HIV prevention messages.

10.Challenges: The USG's HIV and AIDS program in
Zimbabwe faces a series of challenges to achieving
its goal. In addition to the HIV and AIDS crisis,
Zimbabwe is currently facing enormous political and
economic difficulties. Due in large part to these
difficulties, as well as to the impact of HIV and
AIDS and high levels of emigration, Zimbabwe's
strong public health system has started to
deteriorate over the last several years. At the
same time, soaring inflation has reduced the
purchasing power of the USG's already limited HIV
budget. In fact, expansion of several successful
USG-supported programs in HIV testing and treatment
is limited primarily by the lack of adequate
financial resources. In addition, stigma continues
to be a significant barrier to the development of
strong public leadership, candid discussion, and the
open promotion of HIV products, services, and
information.

11.Opportunities: While relations between the GOZ
and USG are strained in general, cooperation with
the Ministry of Health and Child Welfare remains
strong. The health care infrastructure, although
much weaker than a few years ago, is still stronger
than in many African countries. The USG also has
excellent working relationships with civil society
and plays a lead role in the health donor community.
In spite of the many challenges, the USG has been
able to coordinate efforts and build on comparative
advantages to put in place a comprehensive program
positioned to both scale up and scale out. With
additional funding, the program could quickly expand
its initiatives in counseling and testing,
antiretroviral therapy, and orphan support to reach
greater numbers of Zimbabweans and more rapidly help
to mitigate Zimbabwe's HIV and AIDS crisis. We have
also initiated food support for chronically ill
individuals who are home bound and food supplements
for chronically ill out-patients undergoing TB
treatment or with substantial weight loss.

12.Conclusion: Although not a President's
Emergency Plan focus country, the USG HIV and AIDS
program in Zimbabwe is already successfully
implementing the principles and guidelines outlined
in Reftel (a). With its coordinated approach and
emphasis on maximizing each USG agency's comparative
advantage, the program is making a significant
difference in the lives of millions of Zimbabweans.
In spite of the difficulty of implementing
activities in Zimbabwe's current environment of
political and economic upheaval, program results
demonstrate that success can still be achieved
through this coordinated approach. The program is
now positioned to expand to reach larger numbers of
Zimbabweans should additional resources become
available. DELL

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