Speech by Executive Director, MR Itai Rusike on behalf of African Civil Society Platform at the CONTINENTAL WORLD AIDS DAY COMMEMORATION on 1 DEC 2014 -VICTORIA FALLS, ZIMBABWE
“Getting to Zero in Africa – Africa’s Responsibility, Everyone’s Responsibility”
Distinguished guests, Ladies and Gentlemen all protocols observed
It gives me great pleasure to stand in front of you on this momentous occasion, when we take a moment to reflect on the pandemic that has raged on since the mid-1980s.
This is a scourge that has challenged our social, economic, and health systems; and forced us to revisit our cultural fabric, religious, moral and behavioural sub-systems. Saying this, I am reminding all of us that HIV is not strictly a health issue, perhaps AIDS is? Coming from a civic society background, particularly one that advocates strongly for primary health care. This means that communities’ actions, beliefs, behaviours including where they sleep and with whom, when they get pregnant etc has a bearing on whether they will contract HIV, while access and utilization of health with respect to the health system strength factors determine whether they will get AIDS and/or die from it. , This therefore means that the 1948 definition of health by the World Health Organization; i.e. “health is not merely the absence of disease or infirmity, but the complete physical, social and psychological wellbeing”, primary health care as defined at Alma Ata in 1978, the Abuja Declaration of 2000, the Abuja call to action in 2005, the WHO per capita spending on health, the Millennium Development Goals of 2005, and the new thrust towards universal health coverage; must all come together to make for the correct policy directives, socio-economic environment that ensures minimal to zero new HIV infections, early diagnostics and correct and consistent management of infected children and adults in well functioning and managed health systems. Today we must scrutinize the full determinants of the HIV and AIDS pandemic, and in moving forward, agree on a new set of targets to ensure we take up our individual and shared “responsibility to get to zero in Africa”.
The Community Working Group on Health (CWGH) applauds Zimbabwe for making provisions for improved health and quality of life in the new constitution by acknowledging that health is a fundamental human right, and that access to quality health care should be universal to all citizens. We further appreciate the opportunity given to the CWGH, other members of the civic community, individuals and institutions to have their voices heard in the constitution making process, and we now demand to see the provisions of this new constitution implemented.
The first case of HIV in Zimbabwe was recorded 30 years ago, yet the effects of the disease continue to undermine our efforts to develop the country in general and the health sector in particular. The country has battled the HIV and AIDS pandemic and registered successes of reduction in both incidence and prevalence. However it is important to note that it has not yet stopped new infections nor stopped AIDS deaths. ART coverage is high, but not universal and TB prevalence mirrors that of HIV; meanwhile the supply of basic drugs and health services remains erratic such that some patients still complicate and/or die from preventable diseases.
Remarkable achievements in scaling up the implementation of effective treatment programmes and prevention strategies have led to a reduction in the number of new HIV infections as evidenced by a peak of 27% national prevalence in 1997 and current estimate of 14%. As a direct result of these strategies, there has been a gradual improvement in the quality of life of those living with HIV infection. Today, as we commemorate World AIDS Day together, as the continent of Africa, we celebrate these gains, with a firm hope of reaching zero.
At the same time, we highlight the urgent need to invest in evidence-based practice to get us to zero in Africa – zero new infections – zero deaths – zero discrimination. We need prevention methods that are controlled by women, and a way to prevent new infections in our youth and young adolescents. In Zimbabwe, we have a long history of conducting research, producing data to shape national and global responses to the HIV pandemic. Zimbabwean researchers have completed groundbreaking research in many areas, working on their own and in collaboration with regional and international colleagues. Policy was informed by such local research findings to lower the threshold for ART initiation, to treat sero-discordant couples and to start ART earlier in TB co-infected patients. Community HIV testing strategies were piloted here and novel methods for prevention of mother-to-child transmission were evaluated some years back; in fact, the data that showed extended prophylaxis with nevirapine was safe in breastfeeding babies came from Zimbabwean research participants. We should today celebrate all these achievements and be spurred to do even more and get to zero.
I would like to commend the National Aids Council (NAC) for a sterling job for making sure that HIV infection and prevalence rates significantly go down in the country. It is through a vibrant multi-sectoral approach coordinated by NAC that the country managed to reduce prevalence rate from 21,5% in 2001 to the current 14%.
Without the AIDS Levy – which is a home-grown solution – and the support of other partners such as the Global Fund, PEPFAR, EU, DFID and others NAC would not have been able to accomplish this huge achievement. However, more still needs to be done to further reduce HIV and AIDS prevalence in the country considering that Africa’s HIV prevalence stands at 4.8% while the average prevalence for the world is a mere 0.8%. It is also critical at this point in time to explore how the AIDS Levy can also benefit care and prevention of other non-communicable diseases closely associated with HIV and AIDS. It is increasingly being observed that as more people survive longer on ART other non-communicable diseases like some certain types of cancers are becoming common including complications of the ART therapy itself. Instead of sitting on our laurels we need to be proactive
We definitely need to explore more home grown solutions as a country to grow the AIDS Levy to fully capacitate NAC to enable to carry its mandate effectively and efficiently. Ladies and gentlemen, we should find ways of taking everyone on board including those in the informal sector that are not currently contributing to the AIDS Levy because without this inclusive approach, we will not get to zero. Getting to zero in Africa will entail a coordinated effort to accelerate the implementation of proven effective interventions and a push to discover new modalities for prevention across the continent. Male circumcision, microbicides, pre-exposure prophylaxis; all these will need to be rolled-out while we search for a safe and effective vaccine that prevents HIV infection and tip the balance towards sustained disease control. A candidate HIV vaccine is being tested in Southern Africa – and, yes, we look forward to Zimbabwe’s participation in this grand endeavour.
To defeat HIV/TB and other diseases we need global solidarity by the contributing donor countries to the Global Fund and increase domestic finance by the implementing countries. I would also want to acknowledge the contribution to the Global Fund of US$1 Million by the Government of Zimbabwe in 2014 this really shows the serious commitment to the epidemic by our government.
It is also my honest belief that if we work together and mobilise resources we could increase our Anti-Retroviral Therapy (ART) coverage which currently stands at 86.1%. It is very worrying to note that a lot of people are dying because they are failing to access drugs; meanwhile we talk of universal access to health services and the right to health in the nation’s constitution!
Locally we need to ensure community accountability mechanisms through the strengthening of the NAC governance structures at all levels by putting in place community involvement mechanisms at all levels of NAC, capacitating and monitoring them to perform.
Ladies and gentlemen, the fight for better health is everyone’s responsibility. May I point out that we in the civil society are very prepared to work with NAC, the Ministry of Health and Child Care, and other progressive stakeholders towards universal health coverage and get to zero new HIV infections.
I wish Africa as a whole much strength to continue the struggle in the fight against HIV and AIDS to ensure that the continent gets to ZERO new infections as this year’s theme says, ”Getting to Zero in Africa – Africa’s Responsibility, Everyone’s Responsibilty.”
Getting to zero in Africa can be achieved in our lifetime. Let us work together across our continent towards an AIDS-free generation.
Thank You, Tatenda, Siyabonga
Itai Rusike (Mr)