BULAWAYO, ZIMBABWE – In Zimbabwe, where one in 10 people are HIV-positive, the response to the AIDS crisis has been described as slow, weak and selective.
Here, hundreds of people living with AIDS who should be receiving free treatment die for lack of medication and nutrition, thanks to a healthcare infrastructure that is marred by bribery and corruption.
A new report produced by the Zimbabwe Lawyers for Human Rights revealed that 73 percent of HIV-positive respondents had been asked to pay bribes to health workers in order to be included on the list of people receiving government-subsidized antiretroviral medication, ARVs, and other services. Those unwilling or unable to pay reported being turned away or given inadequate services.
Nationwide, the report implicates nurses at government hospitals and clinics in the bribery scheme. Nurse aides, administrative personnel and other support staff were also implicated, but doctors were typically not named by respondents as among those requesting or accepting bribes.
Of the 747 respondents who were asked for bribes by health care workers, 57 percent were trying to access ARVs; 24 percent needed diagnostic services; and 19 percent were seeking enrollment in other HIV support programs. The authors of the report noted that the long waiting lists at many hospitals drove desperate patients to pay bribes as high as $100. The average wage here is just $500 per year.
Benjamin Caetano Sande, 46, the coordinator for Positive Living Association of Zimbabwe, an organization that strives to improve services for people living with AIDS, says resources are not being effectively used. Sande says there is a severe shortage of ARVs in Zimbabwe and says many people die while on the long lists waiting for services.
In 1999, Zimbabwe introduced the National AIDS Trust Fund, commonly referred to as the AIDS Levy. The Levy is fueled by a 3-percent tax on all taxable income. The purpose of the fund is to support HIV-prevention efforts and care for those with AIDS.
But Sande says the funds are not well-used, as the majority of the AIDS Levy is used for education rather than treatment.
“The 3-percent AIDS Levy is being used on workshops and other peripheral activities instead of procuring adequate drugs for us," Sande says. "The majority of Zimbabweans are now well-aware of HIV, but still resources are being used for awareness programs. That is not fair at all.”
The National AIDS Council, which was created through an Act of Parliament in 1999 and started operating in 2000, manages the fund. Dr. Tapiwa Magure, NAC chief executive officer, says there are currently 315,617 people receiving ARVs in Zimbabwe, the most in history. But data from nongovernmental organizations indicates that there are an additional 600,000 people still on the waiting list for the drugs, many of whom say they were asked to pay bribes in order to receive drugs and services.
In one Bulawayo clinic, HIV-positive patients were routinely asked to pay for services that are supposed to be free. Other patients say they were told certain drugs were not available or diagnostic equipment was broken until they paid a bribe. After, the drugs became available and the equipment was declared functional again.
AIDS activist Lisa Moyo, 35, says that the government does not closely monitor the health delivery system in Zimbabwe, and, as a result, corruption has become rampant. Moyo says the ZLHR report accurately conveys her experiences helping people living with HIV/AIDS to attempt to access health services here.
“They are at the mercy of health professionals because of lack of efficient oversight and accountability mechanisms,” Moyo says of the people who are often most vulnerable and require immediate treatment.
Advocates such as Sande and Moyo say that services for HIV-positive people in Zimbabwe have declined significantly in recent years while many countries in Africa have elevated their standards of care.
Rejoice Ncube, 33, a peer counselor at the United Bulawayo Hospitals, who is HIV-positive, says that while many die waiting for access to ARVs, many more die because of poor nutrition.
“People on treatment used to get food packs on the same day they collected their monthly allocation of drugs,” Ncube says. “The food packs were provided by nongovernmental organizations while the government provided the drugs. This process stopped, and we do not know the reasons for the stoppage.”
Ncube says she too has seen the general health standards of people living with AIDS deteriorate in recent years. She said there is a need to introduce nutritional supplements to patients so that their immune systems are not compromised by malnutrition, but she acknowledges that in the current corrupt environment any additions to holistic care are unlikely.
The findings of the ZLHR report were based on interviews with 1,024 people living with HIV in the provinces of Masvingo, Harare, Bulawayo and Manicaland.
The report concluded that corruption in the healthcare system discourages treatment, testing and other health-seeking behaviors. The researchers noted that they found a significant shift in people living with HIV who said they have given up on accessing essential medicines and diagnostic services.
Nurses in public clinics refused to go on record for this article.
