Zimbabwe; The Masculinity HIV Epidemic

Case 2: Zimbabwe; The Masculinity Epidemic

Politics: The Economic, legal, cultural and social context 

For Zimbabwe, 86%-90% funds still come from international donors. The National HIV and AIDS strategy is driven by three tiers: organized White community with connections to the Western world through kinship relations; the Central government; and private citizens. The central government promoted adoption of a Combination Prevention Strategy policy, which focused on a number of areas to prevent new infections. This approach includes prevention of mother-to-child transmission, voluntary medical male circumcision, behaviour change communication, condom programming and STI management. Homosexual acts are illegal in Zimbabwe for men who have sex with men (sometimes referred to as MSM), but legal for women who have sex with women. As a consequence of this punitive law, national statistics are rarely available. Zimbabwe, joined South Africa and Kenya to increase HIV prevention services and investment. 

The Zimbabwean government collects an AIDS levy, which is made up of 3% payee and corporate tax which contributes considerably to the domestic share of funding for the national HIV response. Although this is still low compared to the prevention and care needs. The White community and private citizens many of whom are staying outside of Zimbabwe remit money to help families in what is known as the extended family care system.

People: Knowing how many are involved in order to engage

In Zimbabwe, among young women, HIV prevalence increases with age, with 2.7% of women aged 15-17 living with HIV, increasing to 13.9% of women age 23-24. Among young men, HIV prevalence holds steady at around 2.5% until the age of 23-24 when it increases to 6%.

However, as only 64% of young women (15-24) and 47.5% of young men have ever tested for HIV, prevalence among this group could be significantly higher.

Zimbabwe is one of those countries in Africa dealing with a higher child-related TB. This demography competes with many other population demographies for attention and resources. 

The White Zimbabweans and the other Zimbabwe nationals staying outside are two groups who are a second engine driving prevention and care continuum in Zimbabwe.

Polygamous relationships and Gender Based Violence in domestic settings, are commonplace in Zimbabwe. These contribute to inability of women and girls in homes to engage in quality sexual reproductive and healthy living practices.

Prevention: Making prevention a best-practice

In Zimbabwe, masculinity norms inhibit men from getting tested and engaging in treatment. In 2016, 75% of people living with HIV knew their status. A large discrepancy between men and women exists, with 76% of women and girls living with HIV aware of their status, compared to 68% of positive men and boys. 

Planet: The idea of universalizing and synchronizing best practices

An understanding of frameworks promotes internationally acceptable standards of care and reduces on complexities. One such standard in the HIV care world is the use of fixed dose combination of Stavudine (d4T), Lamivudine (3TC) and Nevirapine and Efavirenz-containing combinations that include AZT/3TC or d4T/3TC as a fixed dose tablet (Keith et Al, 2004). International HIV organizations play a key role in advocating for strong targets and indicators by which to measure progress. For example, those focussing on equal access to HIV services for all, call for global indicators to properly include key affected populations. UNAIDS’ Fast Track targets for 2020 include:

90% of people living with HIV know their status; of whom 90% are on treatment; of whom 90% are virally suppressed (90-90-90)

Fewer than 500,000 new HIV infections annually (a 75% reduction since 2010).

Those working in the field of HIV, including policy makers, programmers, governments and community-based organizations operate within the framework of global HIV targets.

Current targets are geared toward ending AIDS as a public health threat by 2030.

The men in Zimbabwe are pivotal in rolling back HIV. The disadvantages of a masculinity epidemic can be turned around into a mobilisation advantage to fight HIV.  Zimbabwe has a high literacy rate and this could act to their advantage. Very good record keeping makes it a possibility to make reports cascading into the UNAIDS and a political dispensation which in turn ensures rights for all people needing services are upheld, a zero-tolerance to discrimination, it must be evidence based and commit to enabling institutionalized outreach services to all beneficiaries. This will entrench a possibility for grassroots to build the necessary critical mass for prevention and care tailored to unique needs but addressing the internationally agreed upon objectives. It should be noted here that by grassroots in Zimbabwe is meant all those structures consisting of all Black and White Zimbabweans and private citizens who together are resources of different kind. This will ensure the prevention and care continuum system exist including meeting objectives such as: encouraging taking medication and going to clinics for monitoring by those living with HIV. For more see: HIV and AIDS in Zimbabwe. 

A Golf Course. Source: Google