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GlobalPost's John Donnelly and a team of reporters investigate what experts are calling a 'turning point' in the global fight to reduce HIV infection rates. Successes in southern African countries have produced valuable lessons on effective approaches to fight AIDS, lessons that need to be learned in US cities where infection rates remain persistently high — particularly among African-Americans. Meanwhile a political confrontation looms in Washington over critical funding which could threaten gains already made.

Zimbabwe: A country left behind on AIDS surges ahead

Despite being largely left behind by PEPFAR, Zimbabwe has still managed to reduce its HIV prevalence rate.

Dire situation in hospitals

At Chitungwiza Hospital, located in a city of more than 4 million about 20 miles south of Harare, skeleton staff serve more than 800 patients a day. Several staff members said they were struggling to cope. Still, said hospital chief executive Obadiah Moyo, the situation was worse before the Global Fund intervened.

According to the Global Fund, 450,000 people need AIDS drugs but just over 210,000 are receiving them. 

The situation, according to Zimbabwe officials, could turn worse quickly without outside assistance. Christopher Tapfumaneyi, the health ministry’s permanent secretary, told a special parliamentary committee earlier this year that 66,000 people living with HIV could be cut off the drug because of “donor fatigue.”

“Our international partners are on their way out and we now have to rely on the Ministry of Finance. We have submitted bids but we didn’t get the funding. The whole of this year we never got any funding,” Dr. Tapfumaneyi told the parliamentary committee.

The situation worries organizations such as Médecins Sans Frontières (MSF). 

“MSF urges donors to make sufficient funding available for free and effective HIV treatment to all who need it. Domestic resources must be augmented with consistent and continued international involvement. Only then can we curb the HIV epidemic in Zimbabwe and similar high-burden, low-income contexts,” MSF’s head of mission for Zimbabwe, Fasil Tezera, wrote in a recent column published on the group’s web site. 

In the meantime, the country’s health workers, often for little or no pay, continue to help those who are HIV positive.

One woman’s motivation

Tendekai Sibanda at a meeting with community care workers

(Farai Mutsaka/GlobalPost)

For Tendekai Sibanda, 38, there is a personal motivation to continue to help. Her aunt, she said, died in her arms in 2000. Her aunt kept her condition secret for fear of what others would think of her, or whether they would shun her.

“I only knew it was HIV after a while because she would keep it from me,” Sibanda said. “I would accompany her to hospital but I never got inside to hear what the nurses told her. It was only after I heard some friends discussing the symptoms of HIV that I took a closer look at my aunt. I also realized that people were afraid to get close to her.

“Later I got the guts to tell that I had figured out her condition and she opened up,” said Sibanda.

After her aunt’s death, she became determined to work with people living with HIV.

“The problem was that the community was not organized. It was a burden at times I had to carry alone,” she said.

Sibanda began forming discussions on HIV with close friends and relatives, unsure how to open up to a community still treating HIV positive people as outcasts.

‘Courage and patience’

“When ministry of health and Global Fund officials came to our area talking about community initiatives, it was like manna from heaven,” Sibanda said. “I knew what I wanted to do but had no idea of exactly how to go about it without support.” 

With 13 colleagues — one of whom is HIV positive — they have turned the HIV prevention message into a gospel here. They do all they can for those infected.

“We clean, wash clothes, cook and collect drugs for them,” Sibanda said. “We visit the bed ridden more often and teach their family members on how to treat them and care for them. This kind of work requires courage and patience.”

GlobalPost/Kaiser Family Foundation global health fellow Emily Judem contributed to this article.

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