FEATURE: Zimbabwe turns tide on HIV – although some people still refuse treatment

By Jeffrey Moyo for Health Policy Watch

HARARE: Michelle and Michael Mutsvaki were infected with HIV from their mother at birth, but while their parents have shunned antiretroviral (ARV) medicine to treat their HIV, the siblings have opted for treatment.

The siblings, aged 22 and 24, learnt about their HIV status from their mother, but she assured them that their faith would protect them from succumbing to the disease.

But faith did not save their father. Instead, they watched him die of HIV complications a decade ago despite the intervention of faith healers.

Meanwhile, their mother, a follower of the African indigenous Johane Masowe Church, still clings to her religious beliefs and concoctions instead of taking ARVs.

But after Michelle and Michael learnt about the importance of taking antiretroviral treatment from HIV/AIDS activists who visited their school in 2017, they made one of the most important decisions of their lives: opting to take ARV treatment despite their parents’ advice. Seven years on, they are doing well.

The siblings were both born at home without the assistance of nurses because their parents avoided clinics and hospitals due to their religious beliefs.

Labour and birth is a risky time for newborn babies born to mothers with HIV because of there is a lot of exposure to body fluids which is how HIV is transmitted.

Mother-to-child HIV transmission is rare nowadays as pregnant women with HIV are encouraged to take ARVs to ensure that their viral load is undetectable before giving birth, and newborns are also given ARVs at birth to prevent infection.

Unfortunately, without medical help, Michelle and Michael were unable to avoid contracting HIV at birth.

Citizens embrace ARVs

Zimbabwe’s adult population has come to embrace HIV treatment. The Zimbabwe Population-based HIV Impact Assessment Survey conducted in 2020 revealed 86.8% of adults living with HIV knew their status, and of those who were aware that they were living with HIV, 97% were receiving antiretroviral treatment.

About 1.4 million people in Zimbabwe are living with HIV, and the health ministry says that some 1.2 million Zimbabweans are on ARVs.

The huge uptake of ARVs has been the main reason for a 50% decline in the national HIV incidence over the past 10 years, according to a report from UN Development Programme (UNDP), which works with the health ministry and the Global Fund to prevent HIV.

HIV prevalence in adults (15-49 years) has fallen from its peak of 26.5% in 1997 to 11% in 2021. In 2022, the incidence rate of new infections was at 0.17%, and there was a decline in new HIV infections for all age groups.

Meanwhile, AIDS deaths have also plummeted over the past 20 years. In 2002, an estimated 130,000 people died of HIV-related complications whereas by 2021, the death toll was around 20,200, according to a UNICEF report.

Treatment holdouts

Yet as the southern African nation registers success in combatting HIV/AIDS, other people living with the disease have remained adamant they will not take treatment.

Susan Mutsvaki, Michelle and Michael’s mother, has openly expressed contempt for ARV drugs, citing her faith as a barrier to taking modern medicines for any form of illness

Mutsvaki, aged 47, says she has lived with HIV for the past two decades without taking any treatment or ARVs. Instead, she firmly believes that a concoction of water and pebbles that she was instructed to drink by her bishop at her church a decade ag, has helped keep her safe while living with HIV.

Mutsvaki is a member of the Johane Masowe Church, which traditionally worships at open-air gatherings with all congregants donning white garments.

Mutsvaki operates a market stall at the Rezende Bus terminus in central Harare, where she  sells fruit, vegetables, popcorn and cigarettes.

She keeps a white bag with her that contains a 750 ml bottle of water mixed with pebbles, which she sips from, as told by her religious leader whom she refers to as a “prophet”.

“I have not been sick at all from HIV. This bottle and the stones in it are my prayers from our prophet and I believe these are making wonders for me as you see how fit I look,” Mutsvaki said.

While Zimbabwe prides itself of achieving success in preventing HIV/AIDS, there are a few holdouts who have pulled in the opposite direction.

Hector Chinopa is one of these. When he contracted COVID-19 in 2020, he asked staff at the Wilkins Hospital in Harare for an HIV test, which came out positive.

But barely four years after surviving the coronavirus, 36-year-old Chinopa has been dodging antiretroviral drugs.

Like Mutsvaki, he reasons that he has not been ill since contracting COVID so he hasn’t felt a strong need to seek treatment.

“I’m not sick. Do I look sick when you look at me? No, I’m not sick,” Chinopa told Health Policy Watch.

Teen sons may have died of HIV

Linet Gavi, 41, who tested HIV positive two years ago, also has not taken any treatment. But she is uncertain about whether her two teenage sons, who passed away in 2019, were living with HIV.

The boys, aged 15 and 18 at their deaths, suffered from severe headaches and coughing, and had bouts of diarrhea, according to their mother. They vomited often and they both lost their hair and weight during the time of their illness.

At that stage, Gavi was in the dark about her HIV status. Since she was diagnosed, she wonders whether she might have passed the virus to them at birth.

But Gavi is resistant to taking ARVs because she claims she has witnessed friends and family becoming seriously ill after beginning ARV treatment.

“I don’t want to die by taking ARVs. I had relatives and friends who took ARVs after suffering from HIV, but they are no more today. I’m fine without treatment and I have not been sick. I just eat some crushed garlic to boost my immune system,” Gavi claimed.

Chinopa, Gavi and Mutsvaki all said they have not dared seeking treatment from government clinics after testing positive for HIV although the Zimbabwean government has been making urgent calls for all HIV patients to be placed on treatment.

Zimbabwe’s prevention of mother-to-child HIV transmission program has been operational since 2002, transitioning from a pilot program in 1999 to a national initiative. Children born since then, such as Michelle and Michael, could have been spared HIV infection if their mothers consulted clinics and gave birth in health facilities.

International help

Between 2003 and 2022, the Global Fund has invested $1.8 billion in Zimbabwe’s HIV programme and recently approved a three-year HIV grant of  (2024-2026) $437 million.

Despite a few people refusing ARVs to this day, Zimbabwe has made significant strides in prevention and treatment.

An official from Zimbabwe’s Health Ministry, who declined to be named, told Health Policy Watch, that ARVs were available for everyone who tested HIV-positive and were willing to take the treatment.

“Those people you say are refusing treatment are making their own decisions not to have the ARVs, but I can tell you the treatment is available for all who test positive for HIV,” said the government official, who was not authorised to speak to the press.

Although some Zimbabweans are resisting HIV treatment, late last year authorities announced that 95% of its HIV-positive population reached undetectable levels of the virus. 

In November 2022, the Ministry of Health’s Dr Chiedza Mupanguri told a media briefing that 95% of Zimbabweans living with HIV had reached undetectable viral loads, meaning that the level of virus in their bodies is so small it cannot be transmitted to others.

This year, Zimbabwe became the first country in Africa, and the third in the world behind Australia and the US, to approve CAB-LA, a long-acting injectable medication that prevents HIV.

CAB-LA acts as a pre-exposure prophylaxis (PrEP) and is recommended by the World Health Organization (WHO) for those at high risk of contracting HIV.

While the country has pledged to target the entire population in its battle against HIV, individuals like Chinopa, Gavi, and Mutsvaki remain steadfast in their refusal to participate.

HIV/AIDS activists attribute the current deaths to those living with the disease for rejecting treatment due to myths suggesting that the drugs intended to help them actually hasten their demise.

“Many getting killed by AIDS these days are either defaulting on treatment or not on treatment at all,” Moris Mukundu, an AIDS activist in Harare, told Heath Policy Watch.