Financial Gazette (Harare)
David Masunda Deputy Editor-in-Chief
30 May 2002
CONFUSION greeted the abrupt announcement by Zimbabwe this week declaring a six-month state of emergency to tackle the killer disease AIDS.
Experts questioned the government's timing while others wondered whether the new directive would have any impact given its short life-span.
AIDS experts and organisations representing HIV-positive Zimbabweans questioned the government's wisdom to declare the emergency when the country is in the grip of a severe foreign currency squeeze, a devastating drought and mounting poverty, is politically rudderless and its entire health delivery system is crumbling.
Others however saw the government's move, meant to prepare conditions for the importation of cheaper or generic antiretrovirals (ARVs) contrary to the widespread belief that it is a new onslaught against AIDS, as a step in the right direction.
Antiretroviral drugs can prolong the lives of people infected with HIV but there is no cure for the disease.
Although available locally, most of the ARVs which usually have to be taken in combinations of two or three therapies cost more than four times the monthly salary of an ordinary Zimbabwean worker.
The government declaration of the emergency on Monday will allow Zimbabwe health authorities and companies to import or make cheaper ARVs or their generic versions.
Deputy Health Minister David Parirenyatwa said the move was in line with conditions laid down by the World Trade Organisation (WTO) in its Trade Related Intellectual Property Rights regulations to buy or manufacture generic versions of patented drugs.
Evaristo Marowa, a medical doctor who is the executive director of the state's National AIDS Council (NAC), said the emergency was a positive step because Zimbabwe would now be able under the WTO regulations to import or allow the manufacture of cheaper ARVs or their generic versions.
"We will now be able to source antiretroviral drugs from companies with competitive prices but of course not compromising the quality of the products," said Marowa, whose NAC this year gave the Ministry of Health about $966 million to buy AIDS and anti-HIV drugs.
"Right now one wants to be more positive and pro-active and look at how we can take advantage of this policy and this declaration to take it forward."
Jefter Mxotshwa, the acting director of the Zimbabwe National Network of People Living with HIV/AIDS (ZNNP+), a lobby group of HIV-positive people, said it was questionable that the six-month emergency would result in the wider availability of the ARVs or the reduction of their cost locally.
Mxotshwa said given the state of the country's health system where qualified personnel were deserting the public health system in droves for overseas jobs, it was better if Zimbabwe had addressed the question of health delivery first before tackling the importation of AIDS drugs such as ARVs.
He said it would be almost impossible to order, receive and distribute sizeable quantities of ARVs from overseas suppliers to needy patients all over Zimbabwe within six months.
"We don't even have the foreign currency and we have not placed any foreign order yet. I doubt if the government can distribute even one imported drug to areas as far as Muzarabani sufficiently in six months," Mxotshwa noted.
Norman Nyazema, a leading clinical pharmacologist and researcher on HIV/AIDS, said the emergency was useless unless the key factors associated with HIV/AIDS infection in Zimbabwe such as poverty were addressed.
"Poverty is feeding on HIV and HIV is feeding on poverty. A lot of Zimbabweans who are dying unnecessarily because of HIV are malnourished and they are not eating. Why are they not eating? It is because they are unemployed," Nyazema, a lecturer at the University of Zimbabwe's medical school, said.
"Is declaring a state of emergency going to provide infant formula for babies who are being born to HIV-positive mothers?"
He said the emergency would have been unnecessary had Zimbabwe stuck to its national AIDS policy signed by President Robert Mugabe in December 1999, a view also shared by Mxotshwa.
The declaration of the emergency could be a "political gimmick" to attract Western aid for AIDS and then divert that money and funds that are compulsorily collected by the government through the AIDS levy to other causes, said Nyazema.
Mxotshwa said ZNNP+ wanted the government to release more money for the importation of drugs to treat opportunistic infections killing many local AIDS patients than to buy the ARVs or their generics.
Zimbabwe has one of the highest HIV infection rates in the world, with at least one in five people suspected of carrying the virus that causes AIDS.
Health officials say more than 600 000 Zimbabweans have died from AIDS in the last five years and two million others are HIV-positive.
Many Zimbabweans who die from AIDS succumb to opportunistic infections such as pneumonia and tuberculosis (TB) which thrive when their immune systems break down.
Nyazema said while diseases such as TB were easily curable, many patients were succumbing to drug-resistant TB after treatment because they almost always returned to the same environment they originally caught the disease from.
Recent statistics show that the AIDS epidemic is spreading rapidly in Zimbabwe, with as many as 350 people, mainly youths aged between 15 to 24 years, being infected by HIV every day.
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