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close this bookAIDS in Africa; Country by country (ADF Profile Book). (UNAIDS, 2000, 243 p.)
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Zimbabwe

HIV/AIDS epidemiological summary

Information on HIV prevalence among antenatal clinic attendees has been available from Zimbabwe since 1989. In the major urban areas, Harare, Bulawayo, and Chitungwiza, HIV prevalence among antenatal clinic attendees tested increased from 10% in 1989 to 36% in 1994. In 1997, 30% of antenatal clinic attendees tested HIV-positive. Age detail is available from Harare in 1995 only. Twenty-six per cent of antenatal clinic attendees less than 20 years of age (which included 28% of women 15-17 years of age) tested positive for HIV.

Outside Harare, sentinel surveillance information among antenatal clinic attendees has been available since 1990. Since then, HIV prevalence among tested antenatal clinic attendees increased from 12% in 1990 to 37% in 1995. In 1997, a median of 30% of antenatal clinic women tested in 31 sites were HIV-positive. In Masvingo, in 1995, where 42% of antenatal clinic attendees tested were HIV-positive, 34% of women less than 20 years of age were HIV-positive. Peak infection occurred among women 20-24 years of age: 49% tested positive for HIV.

There is only one study available with information on HIV prevalence among sex workers in Zimbabwe. In 1994 - 95, 86% of sex workers tested in Harare were HIV-positive.

In Harare, HIV prevalence among STI clinic patients tested increased from 52% in 1990 to 71% in 1995. Outside Harare, HIV prevalence among STI clinic patients increased from 6% in 1987 to 72% in 1996.

Estimated number of people living with HIV/AIDS, end 1999

Adults and children

Adults
(15-49)

Adult rate
(%)

Women
(15-49)

Children
(0-14)

Source: UNAIDS/WHO, June 2000

1 500 000

1 400 000

25.06

800 000

56 000

Demographic impact of HIV/AIDS


Year

Estimate

Source

Children who lost their mother or both parents due to HIV/AIDS at age 14 or younger since the beginning of the epidemic


1999

900 000

UNAIDS/WHO, June 2000

Estimated AIDS deaths


1999

160 000

UNAIDS/WHO, June 2000

Behavioural indicators


Year

Age group

Male

Female

Reported condom use during most recent Intercourse with a non-regular partner (%)


-

-

-

-

Reported non-regular sexual partnership over a 12-month period (%)


-

-

-

-

Measured HIV prevalence


Year

Median

Min.

Max.

Women in antenatal care clinics - major urban areas (%)


1997

29.7

24

33.3


Figure

Economic Impact of HIV/AIDS

Summary of the economic impact of HIV/AIDS

Data on the economic impact on Zimbabwe are relatively extensive as compared with many other countries in sub-Saharan Africa. The macroeconomic impact of AIDS has been estimated using a recent model, and preliminary results show a considerable impact on the economy as a whole. Of the sectors explored here, a survey in 2000, exploring the impact of AIDS-related female mortality, reveals its devastating impact on the household and consequent reduction in school enrolment rates. Studies in the area of agriculture show a reduction in production, while studies in the business sector show rising production costs due to AIDS-related morbidity and mortality. In the area of education, a UNAIDS/UNICEF model shows that increasing mortality rates have led to discontinuity, with many pupils losing or having a change in their teachers. In health, a study in costing AIDS-related hospitalizations shows bed occupancies of 50% due to AIDS and increased lengths of stay. No studies have explored the issue of supply in health care or the impact of rising mortality rates in health care workers. Finally, a model of resource requirements for AIDS in health demonstrates that there is a large gap in funding required to meet the full needs of a scaled-up care and prevention programme, equivalent to US$ 4.5 - 7 per capita and 1.4% of GDP.

Macroeconomic impact

Preliminary results of a model developed in 2000 estimate the annual loss in GDP growth per capita as a result of AIDS to be 1.4% by 2010 (1).

A model in 1993 estimated that, in the absence of foreign assistance, the annual growth rate of GDP might be 25% lower in 2000 than it would have been without AIDS (2).

Economic impact of HIV/AIDS on households

In 1997, a bedridden AIDS patient was estimated to cost an additional US$ 23 - 34 per month to households (3), (4). The average cost for a funeral in 1998 was Z$ 4500 (5). In a survey in 2000 to assess the impact of adult female mortality in two districts, it was found that 65% of households where the deceased female had lived were no longer in existence (6).

Economic impact of HIV/AIDS on agriculture

A survey by the Zimbabwe Farmers’ Union and the Friedrich Ebert Stiftung Economic Advisory Group, carried out in two districts in 1997, found a reduction of 50% in smallholder production in households with an AIDS death, ranging from 29% for cattle ownership, 37% for groundnuts, 49% for vegetables, and 47% for cotton to 61% in maize (7).

Economic impact of HIV/AIDS on firms

Supply: The cost of AIDS to the National Railways of Zimbabwe in 1997 was found to be equivalent to 20% of company profits (8), (9). A 1993 study estimated that training costs, due to the replacement of skilled workers, would increase five-fold by 2000 (2).

Economic impact of HIV/AIDS on education

Supply: A model developed by UNAIDS and UNICEF in 2000 shows that, of around 2.4 million primary school students, 86 000 would have lost a teacher to AIDS in 1999 (10).

Demand: In a survey in 2000 to assess the impact of adult female mortality in two districts, it was found that 31% of households interviewed had a child who was not attending school after the death of a mother (6).

Economic impact on the health sector

Supply: Not available

Demand: In 1994/5, bed occupancy due to HIV/AIDS was 50% (3). Staff estimates were that 50-70% of bed occupancy was HIV-related in 1998 in some government hospitals. AIDS treatment costs, excluding antiretroviral therapy, as a percentage of the Ministry of Health and Child Welfare budget, are projected to be 61% by 2005 (11).

Resource gap: The scaling-up of HIV/AIDS programmes nationwide is estimated to cost between US$ 55 million and US$ 90 million per year (12).

Management and implementation of the national response to HIV/AIDS

Policy formulation

Existence of National HIV/AIDS policy (either a written document or part of one)

Yes

No

X


Comments/Key elements:
Source: UNAIDS Zimbabwe
Date: June 2000

Existence of HIV/AIDS policy in the following sectors:

Sector

Yes

No

Agriculture


X

Education

X


Health

X


Military


X

Workplace

X


Sports


X

Others



Comments/Key elements:
Source: UNAIDS Zimbabwe
Date: June 2000

Existence of HIV/AIDS-specific legislation against discrimination on the grounds of HIV

Yes

No

X


Comments/Key elements:
Source: UNAIDS Zimbabwe
Date: June 2000

Organizational structure

Existence of high-level structure in support of the national response

(e.g. National AIDS Committee/Commission, Inter-Ministerial Committee, Presidential-level bodies)

Yes

No

X


Comments/Key elements:

A National AIDS Council was established in March 2000, including representatives from government, NGOs, religious organizations, private sector, mass media. The President will be patron of the Council. The Council has a secretariat, which will operate under the Ministry of Health. The director and other staff of the secretariat are still to be appointed.

The current NACP is under the Ministry of Health. To date, it has been responsible for promoting a multisectoral response. With the creation of the National AIDS Council and secretariat, the role of this unit will change to that of coordinating Ministry of Health activities in HIV/AIDS.

Source: UNAIDS Zimbabwe

Date: June 2000

Planning and programming

Existence of national strategic plan on HIV/AIDS

Yes

No

X


Comments/Key elements: A national strategic framework for the national response to HIV/AIDS has been completed and was approved by the National AIDS Council in May 2000.

Source: UNAIDS Zimbabwe

Date: June 2000

National strategic plan on HIV/AIDS includes clearly identified priorities

Yes

No

X


Comments/Key elements: The core objective of the national strategic framework for the national response to HIV/AIDS is prevention. Focus is also given to mitigation of HIV/AIDS impact through care and psycho-social support, coordination and management of a multisectoral response, resource mobilization and community involvement.

Source: The national strategic framework for the national response to HIV/AIDS, draft/UNAIDS Zimbabwe

Date: June 2000

Existence of budget for implementation of the national strategic plan

Yes

No


X

Comments/Key elements:
Source: UNAIDS Zimbabwe
Date: June 2000

General demographic and socioeconomic indicators

Demographic Indicators

Year

Estimate

Source

Total population (thousands)

1999

11 529

UNPOP

Population aged 15-49 (thousands)

1999

5768

UNPOP

Annual population growth (%)

1990-1998

1.8

UNPOP

% of population urbanized

1998

33

UNPOP

Average annual growth rate of urban population (%)

1990-1998

3.7

UNPOP

Economic indicators

Year

Estimate

Source

GNP per capita (US$)

1997

720

World Bank

GNP per capita average annual growth rate (%)

1996-1997

-0.1

World Bank

Human development index rank (HDI)

2000

130

UNDP

% population economically active

-

-

-

Unemployment rate

-

-

-

Education indicators

Year

Estimate

Source

Total adult literacy rate

1995

85

UNESCO

Adult male literacy rate

1995

90

UNESCO

Adult female literacy rate

1995

80

UNESCO

Male secondary school enrolment ratio

1996

52.2

UNESCO

Female secondary school enrolment ratio

1996

44.5

UNESCO

Health indicators

Year

Estimate

Source

Crude birth rate (births per 1000 pop.)

1999

31

UNPOP

Crude death rate (deaths per 1000 pop.)

1999

19

UNPOP

Maternal mortality rate (per 100,000 live births)

1990

570

WHO

Life expectancy at birth

1998

44

UNPOP

Total fertility rate

1998

3.8

UNPOP

Infant mortality rate (per 1000 live births)

1999

69

UNPOP

Contraceptive prevalence rate (%)

1990-1999

66

UNICEF/UNPOP

% of births attended by trained health personnel

1990-1999

69

UNICEF/UNPOP

% of one-year-old children fully immunized-DPT

1995-1998

70

UNICEF/UNPOP

References

(1) Bonnel, R. What Makes an Economy HIV-Resistant? Draft report presented during the International AIDS Economic Network Symposium, Durban, South Africa, 7-8 July 2000.

(2) Forgy, L. The economic impact of AIDS in Zimbabwe. 1993. REDSO/ESA.

(3) Hansen, K. et al. The cost of home-based care for HIV/AIDS patients in Zimbabwe. AIDS Care 1998; 10 (6):751-9.

(4) Harnmeijer, J. The Economic Impact of HIV/AIDS on households in Zimbabwe. 1997. Waterford Kamhala, United World College of Africa.

(5) Ncube, J. Death as a profitable business venture. AIDS Analysis Africa 1997.

(6) Mutangadura, G. Household welfare impacts of mortality of adult females in Zimbabwe: Implications for policy and program development. Paper presented to The International AIDS and Economics Network Symposium, Durban, South Africa, 7-8 July 2000.

(7) Kwaramba, P. The socio-economic impact of HIV/AIDS on communal agricultural systems in Zimbabwe. Working paper 1997. Harare, Zimababwe, Zimbabwe Farmers Union, Friedrich Ebert Stiftung Economic Advisory Project. 1997

(8) National Railways Zimbabwe. Presentation at the Inter-sectoral Committee on AIDS & Employment, (National Meeting on Impact and Interventions in IDS and Employment), Jameson Hotel, Harare. 7 April 1997 (unpublished).

(9) Roberts, M. and Rau, B. Private Sector AIDS Policy African Workplace Profiles: Case Studies on Business Managing HIV/AIDS. 1997. The AIDSCAP Electronic Library.

(10) UNICEF. The Progress of Nations 2000. Background paper. New York, UNICEF, 2000.

(11) National AIDS Coordination Programme, Ministry of Health and Child Welfare. HIV/AIDS in Zimbabwe: Background, Projections, Impact, Interventions. Harare, National AIDS Coordination Programme, 1998.

(12) World Bank & UNAIDS. Costs of Scaling HIV Programmes to a National Level for Sub-Saharan Africa. Draft report, April 2000.