Midway through a deaf peer educators training workshop, held recently in Harare, one of the participants, George, raised his hand and Paida, the facilitator, gave him a chance to speak.
"You have just said that using condoms will prevent HIV transmission, but I am failing to understand how I will be protected since the condom does not cover the whole body?" George asked in sign language.
Another deaf participant, Peter immediately chips in: "But even if I go for counselling and testing, how would I be assisted by the officers who cannot converse in sign language? Even the nurses and doctors cannot explain to me what HIV does to my immune system."
Before Paida had even attempted to respond, Kudakwashe threw in yet another poser: "When I got tested the counsellor signed that I am negative, but I was so worried because in the sign language diction 'negative' implies a situation which is not good."
Such are the complex situations that are experienced by Zimbabwe's community with hearing impairments, otherwise normally referred to as the deaf community.
Zimbabwe is globally renowned for implementing the best HIV and Aids intervention programmes, one of the reasons organisers of the International Conference on Aids and STI's in Africa (ICASA), held in Harare last year, considered in allowing the country to host the prestigious event.
However, a few people in the country are aware of the crude reality facing some 200 000 people living with hearing impairments in Zimbabwe. This community still views HIV as a complicated topic, which is only relevant to the hearing community.
In highlighting the challenges that affect deaf people on HIV and Aids issues the world over, United States Disability Studies Quarterly asserts that the deaf risk becoming characterised by a set of assumed statuses, social positions and needs for intervention that are thought to be homogenous and inherent to the group.
In turn, stereotyping spurs public definitions of the HIV pandemic as a problem that concerns one group and not another. This paradigm, which attributes HIV and Aids to the social other, may lead to the further marginalisation of infected individuals. It may also contribute "to the complacency and denial of the reality of risk of infection", the quarterly says.
The report further notes that in addition to this apparent lack of accurate knowledge of sexuality, studies show that youth with hearing impairments are frequently unaware of or misinformed about HIV and Aids and how it is transmitted and prevented. At college these youths are found to be significantly less informed about HIV and Aids than their hearing counterparts.
Furthermore, studies on adolescents' knowledge of HIV and Aids reveal that high school students who are deaf have extremely limited core knowledge of Aids, tend to be unaware of which behaviours place them at risk of infection, and have limited knowledge on transmission prevention.
Within the deaf community, there are numerous social and environmental factors that may influence lack of knowledge regarding sexuality and HIV and Aids. Many youth who are deaf find few opportunities to acquire information, and encounter inadequate school-based instruction, misinformation from family members and peers, and parental reluctance to provide sexual education.
People with hearing impairment may also have limited access to mainstream mass-information systems. Mainstays of the public health approach, such as television, radio, newspapers, magazines, the internet, as well as commercials and advertisements may not fully reach the deaf community because information via these systems is targeted at the general population who can hear and read a spoken language.
In assessing the challenges bedevilling people with hearing impairments, Barbara Nyangairi of the Deaf Zimbabwe Trust, said: "The fact that the country has no facilities to offer sign language in the education sector implies that the majority of the deaf people cannot read and write. This makes it difficult for the deaf to read any materials that convey HIV and Aids information.
"Lack of sign language interpretation or captions on adverts that raise awareness on HIV issues further complicates the situation.
"In health institutions, deaf people still lie confused and scared in hospital beds not knowing what is about to be done to them because there are no people who are able to effectively communicate with deaf patients in health institutions.
"Yet the Constitution of Zimbabwe guarantees access to basic health services to all citizens.
"Lack of sign language proficiency by medical personnel is a serious obstacle hampering access to health services by the deaf in Zimbabwe.
"As a consequence many deaf people are reluctant to go to hospitals thus exposing themselves to risks of poor health and low life expectancy."
However, National Aids Council of Zimbabwe (NACZ) communications officer, Tadiwa Pfupa, perceives the situation differently.
"The deaf are treated as people because they are people. Prevalence is not taken by geographical area, age or gender of people."
"However, that does not mean that we do not have special programmes tailor-made for the deaf. The major challenge is that sign language is not standard. What one sign means in one community is different from the other. NAC is not an implementer, but a coordinator and a number of our implementing partners are good in sign language."
Disability HIV and Aids Trust's advocacy and knowledge management advisor, Farai Mukuta, proffered another view.
"Be that as it may, there is a serious challenge due to communication barriers. The country boasts of tremendous strides in its interventions, but, unfortunately, whatever has been said in terms of prevalence reduction refers to the able-bodied. The deaf are the forgotten tribe in terms of HIV knowledge.
"There should be extensive sign language training for personnel in Aids service organisations; NACZ should have a disability desk where concerns and challenges faced by the deaf are addressed. The NACZ board should have a seat for people with disabilities occupied by a person with a disability.
"The Global Fund should meaningfully fund deaf-run organisations and their affiliates to address the concerns of this forgotten tribe, the deaf. And most importantly, health personnel and voluntary counselling and testing workers should be trained in basic sign language and ensure that sign language interpreters are available," said Mukuta.
Rosemary Mundhluli, a deaf rights activist, suggested: "Educational tools and techniques must be tailor-made in Zimbabwe sign language (ZSL) and should be accompanied by visual tools such as pictures, videos, role playing conducted by deaf peer educators. All education materials should be developed in partnership with individuals who are deaf and these should include, pamphlets written along with visual images and ZSL structured phrases.
"ZSL HIV video tapes with actors speaking in sign language, as well as captioned posters that include people speaking in sign language on issues specifically related to HIV and Aids and deafness, must be considered as some of the interventions."
Former Miss Deaf Zimbabwe, Kudakwashe Mapeture, believes that a holistic approach in dealing with this issue has to be adopted through grassroots mechanisms.
"Sexuality and HIV and Aids education programmes should be introduced in all school-based instruction for the deaf, be it in mainstream or residential schools. This education should be designed to provide youth who are deaf with accurate knowledge about safe sex practices and HIV and Aids prevention. In addition, such education should be designed with the goal of reducing sexual abuse of children who are deaf.
"The deaf cultural grapevine needs to be utilised as a means of disseminating accurate information on HIV and Aids and prevention, as well as on available resources and potential advocacy channels. The public health system and political processes need to become more accessible and welcoming of people who are deaf.
"Health care providers and community health clinics need to increase their knowledge base and resources to do HIV prevention with persons who are deaf and hard of hearing."
Former United States president Bill Clinton once noted: "We live in a completely interdependent world, which simply means we cannot escape each other.
"How we respond to Aids depends, in part, on whether we understand this interdependence.
"It is not someone else's problem. This is everybody's problem."