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By Joyce Mukucha
According to a number of studies, the timely and enduring access to antiretroviral therapy (ART) by HIV-infected individuals has been shown to substantially reduce the HIV transmission risk, HIV-related morbidity, and mortality.
However, there is evidence that in addition to the limited supply of antiretrovirals (ARVs) and linkage to Anti-retroviral treatment (ART) in many low-income countries, HIV+ persons often encounter barriers in accessing ART-related services even in contexts where these services are freely available and Zimbabwe is not excluded.
People Living with HIV(PLHIV) are not the only ones failing to access critical health services but also other Key Populations (KPs) are experiencing the same dilemma which as a result affect their health.
In his presentation during a National AIDS Council (NAC) media workshop which was held last week in Chinhoyi, Ricardo Bako from NAC highlighted that KPs including PLHIV are at heightened risks and cannot access services because of stigma and discrimination, state and non-state violence, and harassment restrictive laws and policies, criminalization of behaviors or practices.
Bako pointed out that KPs were encountering challenges related to a national lockdown which include interruptions in access to services including ART, Pre-Exposure Prophylaxis (PrEP), condoms, lubricants, and other modern contraception methods.
“Other challenges include economic shocks resulting in loss of income, housing, food, and health security. Disruption in the continuity of KP programs as health facilities are re-purposed to respond to COVID-19 acute cases and temporary closure of safe spaces, resulting in KPs becoming more difficult to reach and them experiencing challenges in accessing services,” he said.
The Zimbabwe National HIV/AIDS Strategic Plan IV 2021-2025, defines the following key populations’ groups: Gay men and bisexual men and other men who have sex with men (MSM) sex workers (SW) and their clients, transgender people, people who inject drugs (PWID) and people in closed institutions including prisoners.
Spiked Online Media spoke to various KPs particularly HIV-positive persons who are on ART to have a better understanding of the access-related barriers they face whenever they want to access treatment.
In an interview, a Warren Park 3 woman, Stella(not real name) said sometimes the ART drugs will be scarce at clinics which then forces them to keep going back for resupply on a monthly basis incurring transport costs.
“There are times when we go to the clinic and we are given medicine for three months and even for six months. Unfortunately, sometimes, we are being told that there is a shortage of drugs and they give us only one container which lasts for one-month meaning we are forced to go back again the following month. As for me, I don’t take my drugs locally because I don’t want people to stigmatize me so I travel out of Harare whenever I want my medication. So imagine I’m given medicine for one month, I need transport every month for my drug pick, it costs me a lot,” Stella said.
Another Warren Park 1 woman who have sex with other women and refused to divulge her name for confidential reasons said because of her sexual orientation healthcare workers developed an attitude when assisting her as they draw a conclusion that she is lesbian and sometimes she even fail to access her ART drugs.
“This is who I’m and I can’t change it, I have sex with other women and I’m HIV positive but that shouldn’t hinder me from accessing my drugs. There was a time when I visited a local health facility in Harare and I wasn’t given treatment as the nurse told me this”….munotadza neiko kutora chirwere imi muchiita nevamwe vakadzi?Manje mushonga wapera tongokupai wevhiki motozodzoka next week mainini.”(how can you not contract the virus whilst you indulge in sexual activities with other women? We ran out of medicine, you better come back next week).
“My heart was broken because I didn’t have enough drugs for that week and it affected me. At home, I have no one to share my problems with because already they discriminate against me because of my health status. There is a need for measures to be put in place to ensure that our life is not put at risk as well as making sure that we are not discriminated against when we want to access our medication,” she said.
A Glen Norah A based man who identified himself as Papa Lodza said during lockdown access to services during lockdown decreased which at some point led him to default his ART medication.
“During this Covid-19 period, we are encountering a lot of challenges in as much as accessing our drugs is concerned. In the meantime, the situation seems to be better because the movement restrictions have been relaxed. During the lockdown, I suffered a lot because I had to travel to my rural home in Wedza to collect my pills. I avoid taking them to a local clinic because I fear that relatives, neighbours, and the surrounding members of the community will discriminate against me.
“When I was traveling during the lockdown, the police at roadblocks were not understanding and they harassed me to an extent that I was forced to show them my clinical card divulging my status unwillingly. There was a time when I quit taking my medication because I didn’t want to be questioned at roadblocks and my wife is the one who kept convincing me that I shouldn’t stop taking the drugs. I would like to let the government and policymakers that during pandemics, key populations face many challenges which need to be addressed,” said Papa Lodza.
In an effort to address this, Bako pointed out that the Government of Zimbabwe, through the Ministry of Health and Child Care (MoHCC) and NAC, was implementing a comprehensive package of prevention, treatment, and support services for KPs in collaboration with KP led and KP serving Community-Based Organizations, and funding partners.
He said the efforts were in line with the UNAIDS 2021-2025 strategy which emphasise the need to make concerted efforts in leaving no one behind when it comes to the provision and delivery of health services without hindrances.
“Globally, Key Populations and their sexual partners contribute 62% of new adult HIV infections (UNAIDS, 2019). The UNAIDS 2021-2025 strategy calls for bold action to “put people at the centre to prevail against pandemics” and ensure a human rights-based approach to development- leaving no one behind.
“It emphasizes the removal of structural barriers to access to HIV services to key populations and other vulnerable groups creating an enabling legal and policy environment to catalyse an effective AIDS response and, addressing violence and gender inequality,” he said.
The presentation also indicated that Zimbabwe remains one of the top countries heavily burdened by the HIV and AIDS and TB epidemic with 1. 4 million PLHIV (2019 estimates) 1.3 million adults and 84 000 children.
The HIV Prevalence, he said, stands at 11.8% (15-49 age group) with 14.8 percent female and 8.6 percent male.
Bako also emphasised that the KP community was in need of proper visibility, so as to promote respect and understanding of diversity in terms of sexual behaviours, gender identity and sex characteristics highlighting that it is the role of the media to promote awareness and to help in shunning discrimination.
“A common and widespread phenomenon of discriminatory behaviours targeting the KP community is the media (re)production of negative stereotypes and perceptions about KPs and the misrepresentation of their behaviours and life.
“The media can be used in a positive, educational and awareness raising, way to change public opinions, promote equality of human rights and promote KP sensitive HIV/SRH services.”
