Turning the tide on HIV in Zimbabwe, one AIDS denialist at a time
BETA is reporting from the 2017 Conference on Retroviruses and Opportunistic Infections (CROI) this week in Seattle—bringing you the latest news, updates, and research on HIV treatment and prevention.
How does a country—with a history of AIDS-denialism in government, and a financial crisis spanning 10 years—turn the tide on AIDS?
Look to Zimbabwe, a sub-Saharan African country at the heart of our world’s HIV epidemic.
Dr. James Hakim, a researcher at the University of Zimbabwe, delivered a moving plenary lecture about his country’s, and his own, history with HIV at CROI last evening. In addition, he discussed how the country is overcoming extraordinary challenges, with rates of overall HIV viral suppression this year that surpass those in the U.S.
The early years of HIV
Zimbabwe’s first AIDS case was in 1985. Instead of sounding the alarm, the government responded with denial.
“People were worried about the impact of AIDS on tourism and commerce. In general, there was a negative perception of AIDS sufferers,” said Hakim.
Hakim remembers a colleague in his research group being prevented from publishing data on AIDS-related Kaposi’s Sarcoma in 1991, out of fear that it would alarm the heads of state and government.
Hakim, at the time a resident in Nairobi, recalled seeing his first AIDS patient in 1984. “I was entrusted to look after a patient, who appeared to have a new disease. Needless to say, the young lady died after two weeks of agonizing illness.”
His second HIV/AIDS patient was two years later, in Saudi Arabia. The woman was admitted to the hospital in severe respiratory distress, and required breathing support. “When the HIV test came back positive,” said Hakim, “we were instructed, from above, to extubate the patient.” She died, after breathing support was removed, after six hours.
“These two cases left me with a sense of hopelessness and anxiety,” said Hakim. “I moved to Zimbabwe in the early 1990s where I saw hundreds of similar cases, and worse.”
This was when Hakim realized, that even though he trained as a cardiologist, in order to truly serve his community in Zimbabwe, he needed to learn how to treat people living with HIV and AIDS. “There was no question,” he said.
Realization that HIV is here to stay
The Zimbabwean government eventually realized that they needed to mobilize a coordinated front against HIV and AIDS. It started with the universal screening of blood for transfusion in 1985, and a short-term emergency plan for HIV in 1987. By 1994, the National HIV response began to take shape, said Hakim. And in 1999, the tide really began to turn.
The country instituted a National AIDS Policy and strategic framework, started to locally manufacture its own generic antiretrovirals, and established the National AIDS Trust Fund. Also known as the “AIDS Levy,” the Trust Fund is a national 3% tax on all personal or corporate income, earmarked to support AIDS prevention and education activities. In 2009, the AIDS Levy generated $5.7 million dollars; in 2014, it generated $38.6 million.
Antiretroviral therapy clinics rolled out across the country, and more and more people received ARVs.
The country has made impressive gains on getting people living with HIV access to ARVs. Currently, a country with about 1.2 million people living with HIV has about 65% of its HIV-positive population virally suppressed. (By comparison, the U.S. also has about 1.2 million people living with HIV—with only 30% who are virally suppressed.)
Successful collaborations—at home and abroad
Collaborations with other research organizations have allowed Zimbabwe to participate in important HIV prevention and treatment studies—including HPTN 052, DART, PEARLS, the STRIDE study, and more. To build a workforce of medical providers, PEPFAR and NIH have provided $130 million to fund medical schools across sub-Sahara Africa.
“Progress towards achieving the 90-90-90 targets in Zimbabwe is a testament to the robust global coalition to fight AIDS and the resilience of the Zimbabwean people in making these efforts work,” said Hakim. “The research community in Zimbabwe has defied odds and made remarkable contributions towards AIDS prevention, treatment and care.”