Raymond Yekeye
Programmes Director
National AIDS Council

• 15% of adults are HIV-positive ZDHS 2010/11 compared to
18% in 2005-06
– Currently, 18% of women and 12% of men are infected
• Prevalence is highest among the widowed and the divorced/separated
• Prevalence increases with number of lifetime partners
• 12% of couples are discordant
• 6% of young people age 15-24 are HIV-positive
Source ZDHS 2010-2011

Percent HIV positive, women and men age 15-49 years
2005-06 ZDHS 2010-11 ZDHS
21
18 18
15 15
12
Total Women Men

12
10
8
2
0
6
4
Percent HIV positive, women and men age 15-24 years
7,8
5,5
11
7,3
ZDHS 2005/06 ZDHS 2010/11
4,2
3,6
Total Women Men

Draft Zimbabwe Combination HIV Prevention Framework
SBCC
• Sexual behaviors and related norms
• Stigma
• Gender relations
• Demand creation for services through community,
IPC, mass media, advocacy, leadership
Core programme areas
Medical male circumcision
Condom Promotion
ART/Positive Prevention
PMTCT
Key affected populations
Complementary health interventions
• HIV treatment and care, OI/STI treatment, blood safety
• Sexual and reproductive health
• Nutrition
• Clinical GBV management
Critical enablers / structural interventions
• Strengthened health systems
• Policies
• Social protection (school attendance, cash transfers)
• Access by all populations concerned (youth, women, men)

Basis and Rationale of HIV Prevention Approach
• Given the primary transmission mode, significant emphasis on prevention of sexual transmission
• Primary orientation of behavior change communication is to increase acceptance of biomedical prevention services within target populations
• Applying the latest prevention technologies and “stateof-the-art” practices
• Utilizing evidence-based monitoring and evaluation methods to maximize public health impact
• Fully integrated within nationally “owned” prevention programs

Behavioural Strategies
• Improving utilization of HIV prevention services, particularly:
– Couples where risk perception is low
– Reduction of number of sexual partners
– Youth: address bottlenecks to condoms and increase post-HTC support
– Special services for MARPS e.g
sex workers, mobile populations
Biomedical Strategies
• STI prevention and control
• eMTCT
• Male circumcision
• Treatment adherence & counselling
• Universal access to female and male condoms
UNIVERSAL HIV TESTING AND COUNSELLING (integrated with other health services)

• Documented progress:
- Adult participation in testing more than doubling in the past 5 years
• Post HTC Services still limited
- Follow up of HIV negative and
HIV positive clients with on-going counseling and support

Prevention of Mother to Child Transmission
• Challenges within the PMTCT program
– Not all women are attending ANC
– Women still delivering outside the formal health care system
– Data from private medical facilities not included in national data bases
– Pediatric HIV care services in MOHCW are weak: linkages to care for HIV positive infants difficult to initiate and maintain
– Nurse led initiation of ART still not formalized
70%
60%
50%
40%
30%
20%
10%
0%
Trends in % of pregnant women with HIV receiving ARV for PMTCT, 2006-09
15%
2006
28%
2007
46%
2008
59%
2009

VMMC is offered as integrated HIV prevention package
 T&C
 STI treatment
 Condom promotion
 Counseling on safer sexual practices
Positive program experience:
 Adverse events: < 1.5%
 Uptake HIV testing: 100%
 HIV (+) circumcised: < 1%
• Currently dependent on physicians for service-provision; would like to expand to nurses & midwives
• Low funding levels limits service expansion; Country Team has submitted a 3-year , $82.8 million proposal to scale-up services

• Primary target populations:
– sexually active adults, couples in long-term sexual relationships,
MARPs
• Behavior Change Communications:
– Promotes self efficacy to negotiate and correctly use condoms
• Public sector distribution:
– 95% coverage of public sector health facilities and achieving stock out rates below 5% for male condoms
– approximately 30 million male & 2.3 million female condoms distributed through 1,200 health facilities and 400 community based distributors nationwide

• Communications oriented to the promotion and adoption of prevention services:
– Testing & counseling
– PMTCT
– Condom use
– VMMC
• Monitoring and evaluating communications interventions for impact on acceptance of prevention services:
– Intervention-specific progress indicator measurement
– Quantification of persons reached with key prevention services, to help estimate public health impact
– Annual population based surveys

• Target populations:
– Persons living with HIV
– Higher-risk populations:
• Sex workers & their clients
• Migrant workers ( miners, truck drivers)
• Prisoners
• Farm workers
• Internally displaced population groups
• Returned migrants
• Alcohol users
• Youths (15-29 yrs.)

• ART coverage December 2011 – 436,000 adults
• ART target 2012 - 451,944 adults (82% of need,
40% of all PLWH)
• ART as prevention would require scale up in HTC, access to ARVs, adherence and retention
• 436,000436,000 adults
• 36,000 adults

• Legal & policy framework – mostly supportive
• Education – increased access to basic education
• Poverty – increased social cash transfers & livelihood support to households
• Social norms – high GBV despite punitive laws
& victim friendly systems

Generalized Epidemic
Source: Schwartlander, B
For Whom?: explicitly identify and prioritize on populations, geography, Age, Sex…
Outcomes
CORE INTERVENTIONS
CRITICAL ENABLERS
Political commitment /Advocacy
Management, M&E, Procurement
Research and innovation
Community mobilisation
Testing , counselling and referral
Stigma reduction
Gender violence/ local response impacting exposure
Laws, legal policies and practices
Incentives
75%
20%
MAJOR
SYNERGIES
5%
Social Protection, Education, Health Systems , STI treatment, Blood safety, Gender, Legal reform, Poverty reduction, Employer practices