Zimbabwe: rare bright spot for AIDS

Changes have been made in the country, and the effects are becoming known.

MCCLATCHY NEWSPAPERS

HARARE, Zimbabwe — In southern Africa for the past two decades, casual sex helped to fuel the worst epidemics of HIV and AIDS in the world. In Zimbabwe, however, fewer people are taking chances anymore, making this otherwise beleaguered nation an unlikely bright spot in Africa’s battle against AIDS.

“Search every guy’s wallet and you’ll find a condom,” said Tinashe, a bespectacled, easygoing administrative assistant in Harare, who like many people agreed to discuss his personal life on condition that his last name be withheld to shield his privacy. “No one is having sex without a condom. People are scared of HIV.”

That generational shift toward less casual sex and widespread condom use among young Zimbabweans has helped reduce HIV infections here even as they keep rising in neighboring countries.

A look at the numbers

According to the most recent estimates by the Joint U.N. Program on HIV/AIDS, 1.5 million Zimbabwean adults were living with HIV in 2005, down from 1.6 million in 2003. In every other country in southern Africa — home to 2 percent of the world’s people but one-third of all HIV cases — the number of infected people rose slightly or held steady.

“It really is a success story in a bleak situation,” said Michael Chommie, the country director for Population Services International, an American nonprofit group that promotes condom use.

Much of the decline, however, is because of people infected with the virus dying — at a rate of more than 3,000 each week — because antiretroviral drugs are unavailable or unaffordable. Nearly 600,000 Zimbabweans died of AIDS-related illnesses from 2004 to 2006, the third worst toll after India and South Africa, according to U.N. figures. Many HIV carriers also have fled the country, part of a nationwide exodus of more than 3 million people since Zimbabwe’s economic free fall began.

Moreover, even with fewer new cases, 1 in 5 Zimbabweans has HIV, among the highest rates in the world.

Still, experts say that fewer Zimbabweans are contracting the virus now, thanks to near-universal awareness of AIDS and the risks of unprotected and casual sex.

Last year, epidemiologists from Imperial College in London documented a dramatic reduction in the number of sexual partners among men in the eastern countryside of Manicaland. They also found that far fewer teenagers — boys and girls — had become sexually active.

Experts suggest that sex has become another casualty of the country’s eight-year economic depression, which has shrunk the economy by nearly half. Few men have the money to support extramarital affairs or, for bachelors, the late nights on the town often required to woo a woman.

“You have to spend to get sex,” said Richard Chimbiri, who writes a column on HIV for the Financial Gazette, an independent newsweekly. “Some guys would have four or five girlfriends if they could. But the economic situation and the risk of HIV — it’s all conspiring to make people change their attitudes.”

Young people say they’ve also been scared straight by losing so many loved ones to AIDS, a phenomenon that researchers call “the funeral effect.”

“You can point to anyone here, and they have a very close relative who died of AIDS,” Tinashe said.

Hitting home

Tinashe’s older brother contracted HIV while he was living in South Africa, but as the virus ate away at his body he refused to acknowledge that he was ill. In September 2003, when he returned to Zimbabwe for Tinashe’s college graduation, the family was shocked at how sickly he looked.

At Christmastime, at their mother’s urging, Tinashe’s brother checked into a hospital. But it was too late. He died three months later, at 38.

“He was in denial. It was a guy thing,” Tinashe said. “Guys his age would brag about how many girls they slept with, and of course they never used condoms.”

Those cavalier attitudes have changed. Tinashe, who has a steady girlfriend, said he’s never had unprotected sex. He figures that his friends are the same way, because he’s seen packs of condoms in their bedrooms.

In national surveys dating to 1999, more than 70 percent of Zimbabwean men report using condoms when they have sex outside of marriage or long-term relationships. In some neighboring countries with major epidemics, such as Lesotho and Mozambique, those figures are below 50 percent.

In this nation of fewer than 11 million people, Zimbabweans bought 90 million condoms last year, one of the highest rates anywhere, according to Population Services International. Three-packs sell for 1,000 Zimbabwean dollars, less than a book of matches.

Condom use partly explains Zimbabwe’s recent gains against HIV, said Simon Gregson, the lead author of the Manicaland study. “But ... reductions in casual partnerships has been the single most important factor,” he said.

Zimbabwean health officials have begun to highlight the dangers of casual sex. Before the economic crisis, Zimbabwe boasted among the best education and health-care systems on the continent, which may have helped safe-sex messages make an impact starting in the late 1990s.