February 2016

Men Play a Crucial Role in Ending Pediatric HIV in Zimbabwe

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Community Mobilization

At 83, Chief Chiveso has seen many changes in Chiveso Village, which is located in Mashonaland Central Province in northeast Zimbabwe — close to borders with Mozambique and Zambia.

One of the biggest changes was the arrival of a deadly new virus more than 30 years ago. HIV touched every family in Chiveso. The chief himself lost two grown children, a son and a daughter. By 2000, more than one-quarter of all adults in Zimbabwe had been infected with HIV, including half of expectant mothers. Children were frequently born with the virus, and the villagers of Chiveso regularly walked in funeral processions for toddlers.

“Because they had died…my own children…I was motivated that I should start working with people that know more about HIV. I said to myself, ‘If I just keep quiet about those two children of mine, I will have more deaths in my area,’” says Chief Chiveso.

By custom, men in rural Zimbabwe do not involve themselves in family health matters. This often meant that family members did not get tested for HIV and that treatment was delayed or avoided. It also promoted murkiness and stigma about HIV, increasing the risk that a pregnant woman living with the virus would not get the support that she needed to prevent transmitting the virus to her child — who then might not get tested and treated.

The reality is that HIV is almost entirely preventable in children. When a pregnant or breastfeeding woman follows prevention of mother-to-child transmission of HIV (PMTCT) protocols, she can reduce the chance of infecting her baby to almost zero.

“It was up to me to help my people in the right way so that they continue to have children who live and are there tomorrow and in future generations. They are our future leaders, doctors, and teachers,” says the chief.

Today, the children of the village are thriving, and those funeral processions are fading into memories. The fight is not yet over, but victory is in sight, and Chief Chiveso looks back at how the fight against HIV galvanized his community.

The chief began encouraging pregnant mothers in the village to book early for antenatal care and to get tested for HIV so that they know their status. He also encouraged men to get tested, to accompany their wives to antenatal and postnatal appointments, and to be otherwise engaged in the health of every family member — including themselves.

“My role is [that] I go to the communities and talk to them about HIV,” says Chief Chiveso. “That’s my major role. Because I have knowledge now and I don’t see any reason why others should not have that knowledge.”

The chief turned to the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), a key partner to Zimbabwe’s Ministry of Health and Child Care (MOHCC) in PMTCT and pediatric HIV care and treatment. Chief Chiveso gained a better medical understanding of the virus, and he took his knowledge to the airwaves with television and radio awareness campaigns. He also began hosting community advocacy meetings with other leaders and community members.

“We invited [the chiefs] to test for HIV,” says Chief Chiveso. “They came. All the chiefs were tested for HIV. After that, the chiefs motivated us that we should go further to the communities. We had programs. People in the communities went for HIV testing.”

Those traditional leaders signaled to their communities that HIV cannot be a hidden condition. They were openly tested for HIV and openly discussed the virus — making their villages safe spaces in which to ask questions, get tested, seek treatment, and disclose HIV status. And many men looked to their leaders and took on new responsibilities for family health.

“Our chiefs are really important in the community,” agrees Angela Mushavi M.D., the MOHCC coordinator for PMTCT and pediatric HIV. “They lead by example.”

Over a five-year period, mother-to-child transmission of HIV has dropped from 30 percent to about 6 percent.

In 2011, MOHCC and EGPAF scaled up its efforts to end pediatric HIV, nationally, with the financial assistance of the Children’s Investment Fund Foundation (CIFF). Under the leadership of Agnes Mahomva, M.D., EGPAF worked with MOHCC to set measurable goals to dramatically reduce HIV in children and keep their mothers alive and healthy. They focused on strengthening the national health system — with integrated maternal and child health as a primary component.
Over a five-year period, mother-to-child transmission of HIV dropped from 30 percent to about 6 percent.

“That is amazing,” says Dr. Mahomva. “Everybody in Zimbabwe is celebrating.”

Zimbabwe is now on track to be one of the first countries in sub-Saharan Africa to be certified by the World Health Organization for virtually eliminating mother-to-child transmission of the virus. This shift happened because international partners and the Zimbabwe government pooled financial and technical resources and set smart goals.

As importantly, it happened because traditional leaders like Chief Chiveso joined forces with health professionals and volunteers.

“I don’t want any more deaths in this community due to HIV,” says Chief Chiveso. “We simply cannot allow a child to risk being born HIV-positive because a father does not want to go and get an HIV test with his wife. We must change our ways or else we perish.”


The video below explains the pediatric AIDS counter-revolution in Zimbabwe from the perspective of the health professionals who planned and implemented it.


This piece was originally posted by EGPAF on Medium.