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Accessing hard to reach populations key in responding to HIV and AIDS

By Byron Mutingwende

THE lofty goal of achieving zero new infections of HIV and AIDS both at community and national levels requires that strategies be formulated to access traditionally hard to reach groups. These groups include gay men and other men who have sex with men (MSM), those people who inject drugs, transgender persons, sex workers, cross border traders, among others, who though marginalised, are susceptible to contracting HIV.
According to the United States Agency for International Development (USAID), the above key groups are disproportionately infected with HIV compared to the general population.
“There is no way toward an AIDS-free future without targeting approaches toward these highly marginalized and often hard to reach populations,” USAID said in a statement recently.

According to USAID, the overall HIV prevalence among female sex workers in sub-Saharan Africa is about 14 times the overall HIV prevalence among the general population of women ages 15 to 49; while the relative global burden among MSM compared to men in the general population shows a 19-fold difference.
“Rates among transgender persons and injecting drug users also are disproportionately high. Coverage rates of effective interventions among these key populations are extremely low, while stigma and discrimination – including gender-based violence – is high. Key populations, their partners and clients of sex workers face alarmingly low access to services as persistent societal barriers stand in the way. The implementation and scale-up of comprehensive prevention and treatment interventions are needed to address the burden of HIV faced by key populations. Without this, we cannot effectively turn the tide on HIV,” USAID said.

The National AIDS Council (NAC) concurs, saying there is need to intensify community level prevention interventions at local level to ensure better and people-centered programmes that encompass the needs of key populations.
“This new shift is also expected to be more effective in better targeting for specific populations within districts that drive the epidemic as well as address unique needs of each district. The response is now therefore need-specific and not generalized. It is important to note that centralized disbursement of funds meant more work at central and provincial levels. This shift in resources management will allow staff at these offices to focus on other issues in the response in addition to ensuring compliance with policies and guidelines related to programmes implementation.” NAC said in a statement.
In 2015, NAC set aside $5 million to support various HIV-prevention interventions with each of the country’s ten provinces receiving $500 000 which was distributed to districts according to their specific needs and key drivers of the epidemic based on district driven planning.
In Zimbabwe, NAC manages the country’s multi-sectoral resonse to HIV and AIDS. The Zimbabwe National HIV and AIDS Strategic Plan (2011-2015) says global rates of new HIV infections have steadily declined over the past years, with the annual rate falling by nearly 25% between 2001 and 2009.
It went on to say that Southern Africa remains the epicentre of the global HIV epidemic but the fact that Zimbabwe is among the first countries in the region to have recorded HIV prevalence declining from 20.1% in 2005 to 14.26% in 2009 was heartening.
“The annual HIV incidence has also declined from a peak of 1.14% in 2006 to 0.85 in 2009. My government, through the National AIDS Council (NAC) in collaboration with local and international partners is providing effective leadership for the national multi-sectoral HIV and AIDS response despite significant funding, human resource, and material challenges. Through the decentralized NAC structures, we are able to ensure that services reach all people. Our vigorous national behaviour change campaign and the employment of several prevention strategies must be hailed. However, let me hasten to say that if we have to achieve an AIDS free generation, we should aim to reduce the annual HIV incidence by more than fifty per cent by 2015,” President Mugabe said on the strategy.
However, the 50 percent target seems far from being a reality since a number of key populations including persons with disabilities feel there is need for more response strategies to address challenges affecting them regarding HIV and AIDS.
In addition, homosexuals are considered as taboo in Zimbabwe and anyone who comes out in the open to be engaging in same sex relationships and marriages will be arrested according to law. President Mugabe is on record saying homosexuals are “worse than pigs and dogs” and deserve no place in society.

A member of the Gays and Lesbians of Zimbabwe who requested anonymity said it was difficult for gay couples to seek HIV treatment together because of fear of arrest and or stigma and discrimination by members of the community.
Senator Annah Shiri who represents persons with disabilities in the Upper House said there is need to tailor-make programmes that address specific needs of key populations in order to adequately contain the spread of HIV.
Small and Medium Enterprises and Cooperative Development Deputy Minister Noveti Muponora has pledged his ministry’s support for the work being done by the Leonard Cheshire Disability Zimbabwe Trust to help people with disabilities achieve sustainable livelihoods saying this would go a long way in reducing the spread of HIV among them.
Officially opening the Second Leonard Cheshire Disability Access to Livelihoods Workshop at the trust’s headquarters in Harare’s Westwood suburb, the Deputy Minister said his ministry was working with various other organisations in implementing sustainable livelihood projects for small and medium-sized businesses and cooperatives.
He said this model, which entailed training potential beneficiaries, making start-up kits and capital available and following up to guide beneficiaries in implementing their projects, had proved effective in empowering disadvantaged groups, such as widows, orphans and drought-stricken and disaster victims.
“We are, therefore, grateful that Leonard Cheshire Disability Trust has adopted the same model in their plans to empower people with disability to be self-reliant,” he said
He said his ministry had taken a keen interest in what the trust was doing through its livelihoods programme. The ministry was, he said, looking at ways in which it could nurture this initiative.

A study paper by the University of California also revealed that prisoners are at exceptional risk for infection with HIV because of the association of injecting drug use with incarceration. It went on to say that women prisoners who have practiced prostitution, which frequently is associated with injecting drug use and contacting with HIV-infected sex partners, are at additional risk for HIV infection.
Zimbabwe Prison and Correctional Services spokesperson Elizabeth Banda said homosexual activities that were rife in prisons also exposed prisoners to high incidences of contracting HIV and called on the need to scale up guidance and counseling services to inmates on protection against contracting the scourge.


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