Consideration
as we call for Zeros
1 February 2012
By Darlington Muyambwa
Another year and yet again
another World AIDS Day came and went. As we continue to remember those whose
lives were cut short by AIDS, let’s take stock of our collective achievements towards
universal access to treatment and urge rights holders to put their money where
their words are-on the zeroes.
More than three decades into the
epidemic, 2011 held so much promise and for the first time, an AIDS free
generation seems realistic come 2012 and beyond.
While the target of Zero HIV
infections, Zero AIDS related deaths and Zero Discrimination epitomizes the
dream of an AIDS free generation, the effort required has to transcend
rhetoric.
The three zero vision is more
significant for resource constrained but high burden countries like Zimbabwe. Such
countries need to consider the fact that as the epidemic is evolving, responses
have to do the same and they need not to take the business as usual approach.
While announcing multiple
response positives, UNAIDS also offered a warning that funding for the response
is dwindling. In the context of reduced
resources, there is evident contestation for space and relevance amongst
organisation whilst at population level sexual risk taking remains prevalent- a
recipe that contradicts the Zero vision.
The most distinct aspect of the
three Zero vision is the collectivity it conjures. However, Zimbabwe’s response
faces a potentially divisive moral dilemma which took root in policy and
programming debates throughout 2011.
The debate around the
feasibility of providing condom education, demonstration and distribution has
divided opinion and generated debate only rivaled by political discourse. At
its core is a moral argument versus the practical need to provide access to
prevention information and commodities.
Although the debate has receded,
it is by no means a sign that consensus was reached. Without taking a position,
it is critical to outline that the debate has taken an overly moralistic tone
to an extent of becoming almost political.
In a country where an estimated
93 percent of new infections arise out of unprotected sexual contact, is it not
imperative to ensure access to prevention? Although prevention is wider than
just condoms, condoms remain one of the practical commodities we need
considering the sexual debut of the young people in today’s world.
From a prevention viewpoint, our
concern should not be so much about who is having sex and at what age and
whether they are in school or not. Our critical concern should be are they having
safer sex and do we have programs, information, services and commodities that
ensure their competency in practicing safer sex? If the above becomes the key
consideration then our preoccupation should be on inculcating a culture of safer
sex regardless of age gender or other determinants.
The debate has raised key
questions around parenting, parent-child relations and multi influenced
socialisation. However, not all of the multiple socializing factors provide
accurate information and not all families have open relationships for young
people to seek clarification. While experience used to be the best teacher, in
the context of HIV it becomes the worst teacher with potential to destroy its
students.
Although there can be no
straight forward answer about how and when education of sexual and reproductive
health should start, it is straightforward that families should redefine
relations and take more responsibility for providing accurate information and
guidance.
The other issue that has attained
even more political significance is that of sexual minorities. Like the issue
of condoms and youths, this has taken a moralistic and political turn to the
extent of losing its significance.
Despite our moral inhibitions, sexual
minorities exist and cannot be wished away by political statements.
Just as how we used to see HIV
as something the “other” person had to worry about we still find ourselves not
moved by men who have sex with men, sex workers or people with disabilities
when it comes to designing effective prevention programs.
Even though we differ on
principles and morals around certain practices and orientations it is now our
obligation to be as inclusive as possible so that we strive for Zero. To get to
Zero we cannot afford to exclude any section of our society simply because of
our moral differences.
To get to Zero we need to do
more on services and commodities to ensure that there is provision of services
for the whole continuum of sexual and reproductive health and rights.
Although we have significantly
done well in our PMTCT interventions there still remain structural challenges
at service delivery point that makes it difficult for one to access a service
as simple as testing and counseling-Experts might deny this but the general population
may agree.
We need to be more vigilant and
open minded in our approach to the epidemic. Realities have transformed, unlike
what we used to be told as children that “AIDS Kills” it is not killing anymore
but rather it can be prevented, treated and managed. Decades into the epidemic we
have seen that fear does not work but instead we need to think of better ways
of transforming behaviors.
To
get to Zero as a country we need to first thrive for a single digit, we
urgently need to improve our services and ensure that we become more receptive,
we need to be more resourceful and accountable, we need (more than ever) to use
all resources we have differently and more effectively.