Article: The Face of HIV/AIDS in Zimbabwe

22 October 2001

Article: The Face of HIV/AIDS in Zimbabwe

Up to 30 percent of population infected

By David Pitts
Washington File Staff Correspondent

Harare, Zimbabwe - Ohias Mashinda is 36 years old. He is one of more than three million Zimbabweans believed to be infected with HIV/AIDS. Despite his frailty, he has somehow made his way from the bush to a public hospital in Chitungwiza, a sprawling township (called a high density area in this country) about 20 miles outside the capital city. If he is lucky, he will be one of the few to receive hospice care. There are no drugs to treat AIDS itself and Ohias has little money for drugs to relieve his symptoms. He doesn't even have money for transportation to get back home.

"About 70 percent of the people who come to the hospital have HIV/AIDS," says Brenda Poulton, a 68-year old nurse from Ireland who came to what was then Southern Rhodesia in 1955. She works closely -- and with the kind of easy humor that comes from mutual respect -- with Simplisius Ngwerume, a native Zimbabwean and social worker. He is coordinator of care in Chitungwiza for the Island Hospice Service, the first hospice in all of Africa. It opened in 1979 - serving mostly cancer patients then. Now, it cares overwhelmingly for people who will die from AIDS. Most days, the two old friends do what Poulton calls a "ward round to pick up patients who have come to the hospital to die whose last days might be made more comfortable by hospice care."

In her small, cramped office at the hospital, Poulton and Ngwerume interview a succession of very sick people who have come here for help -- any kind of help. All who come on this day have never been tested for HIV and, although knowledgeable about the disease, will not admit they have it. Andrew is a 35-year old teacher, who is so sick he has not taught school in months. "This is the future of Zimbabwe -- dying before your eyes -- a young professional, the kind of person we cannot afford to lose," says Ngwerume. "Families already destitute are losing breadwinners every day. Most of the people we see are between 21 and 48 years old," he adds. Poulton and Ngwerume estimate that here in Chitungwiza it takes about two years for HIV infection to progress to full-blown AIDS and soon thereafter, death.

According to official figures, about 8,000 people are dying from AIDS each month. The population of the country is 12 million. Andrew says he has trouble breathing and his joints are very painful "He likely has TB," says Poulton, "one of the most serious opportunistic infections we see." According to U.S. sources, Zimbabwe has the highest estimated tuberculosis rate in the world -- annually more than 500 cases per 100,000 persons. It is one of the most serious of the opportunistic infections that affects people who are immunosuppressed because of HIV. It also makes many family members afraid to help their loved ones who are sick because they fear being infected with TB.

Later in the day, Poulton and Ngwerume climb into a vehicle to visit hospice patients in and around Chitungwiza. Island Hospice offers care where people live, partly because it doesn't have the funds for a central facility. The first stop is the home -- really the room -- of Matthias, whose wife is so sick she can barely move. She lies on a piece of cloth in a tiny room that has no bed and just one chair. The home has no facilities, not even running water, although there is a tap outside not far away. Matthias says there is no one to care for his wife while he is at work. He earns about 2,000 Zimbabwean dollars a month working fulltime -- the equivalent of about two U.S. dollars a week. That would buy two boxes of cereal at a store, for example.

"We have drugs to treat the pain," says Poulton, "but we don't always know whether the pain is from the disease or from hunger." In the center of the room where Matthias' wife lies too weak to move is a small bucket containing a towel, rubber gloves, a bar of Lifebuoy soap and other needed items. On the side of the bucket is a label -- "from the U.S. Agency for International Development (USAID)" -- evidence that this help at least from the people of the United States has filtered down directly to Zimbabweans who desperately need it. Poulton has a number of these buckets in her office back at the hospital -- ready to give to whoever needs them. It is a measure of the shortage of even basic essentials in Chitungwiza that she asks families to return the buckets with whatever is left in them when they are no longer needed -- in effect, when the patient dies.

The USAID office in Harare says that the international assistance being offered can scarcely keep up with the scale of the epidemic even though much of it is targeted at fighting HIV/AIDS. Two-thirds of all U.S. assistance to this country is directed at combating the disease. But the statistics continue to paint a grim picture of a nation facing a dire threat. According to USAID figures, the crude death rate in Zimbabwe will be more than 200 percent higher in 2005 than it was in 1990. Zimbabwean life expectancy is expected to decline to 35 years by 2010, compared with 66 years in 1997. By 2005, there will be a predicted one million AIDS orphans, one twelfth of the population. By 2015, there will be 20 percent fewer people alive in Zimbabwe than there are today. Statistics like these, say USAID officials on the ground here, indicate that HIV/AIDS is not just a health story. It is a threat to the country's existence as a functioning society.

In the last few years, USAID has refocused its effort in fighting AIDS in Zimbabwe. As a result of the various education campaigns, there is now "near universal awareness," of HIV/AIDS and what causes it, the agency says. But that has not translated into behavior change. So the emphasis now is on behavior modification, particularly expanding the number of voluntary HIV counseling and testing centers and broadening the availability of condoms. "But without the drugs to treat AIDS," says Ngwerume, "many people don't see the reason for getting tested. They are afraid. Getting men to use condoms also is difficult. This is a male dominated culture," he adds.

"The HIV epidemic is intimately connected to the poverty of the country as well," says Dr. Michael St. Louis, director of the Harare office of the Centers for Disease Control (CDC), a U.S. federal agency based in Atlanta, Georgia. "There is a lack of infrastructure and basic equipment," he says. "The health system's capacity to respond is very limited. We are mainly providing technical assistance to help improve the services that are available." CDC, which has a large program here, works closely with the Zimbabwean Ministry of Health and Child Welfare as well as USAID and other donor agencies. A major focus is on reducing mother-to-child transmission of HIV.

In general, CDC's effort is focused in three major areas: prevention; care and treatment; and infrastructure development. "For example, as far as TB is concerned, there is often a failure to diagnose because of the inadequacy of the equipment," St. Louis says. "We are trying to remedy that as well as strengthen laboratory procedures in general. Also, there is a lack of good information, which we are trying to rectify. We also want to make the HIV rapid test more widely available because the older tests take too long and that's a problem in a country like Zimbabwe," he adds.

At the Island Hospice, Poulton and Ngwerume and others working directly with people living and dying with AIDS stress the need for basic supplies and drugs. "Even a bar of soap to keep clean can make a difference," they say. Karla Lamadora, an American and director of the Island Hospice program, says, "We don't charge for our services because our patients are very poor. We rely on charitable donations. There is a huge tragedy going on here. People can't talk about the loss. So many families are affected and there are so many funerals."

Some help is coming from sister hospices in New York State and also from the U.S.-based Foundation for Hospice in SubSaharan Africa, Lamadora says. "They have sent us large packages of vitamins," for example. "In a country, where lack of nutrition is everywhere, even basic vitamins are making a difference. What we are trying to do is alleviate the suffering and make our patients as comfortable as possible. With the resources we have, this is all we can do."