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.