Zimbabwe: The challenge of stigma and discrimination

AIDS: Am I Doing Something?
Stigma and discrimination are a challenge for us all
By Tawanda Maguze
SAfAIDS

“When people talk about stigma and discrimination I wonder what they mean…I am surrounded by well-informed people, and my experience with HIV/AIDS is about care and support, stigma and discrimination is something I hear about from other people around me”.

Thandi (not real name) lost her father in 1999 to HIV/AIDS after he had been in and out of hospital. Shortly afterwards she also had to brace herself to grapple with her mother’s illness. Thandi chronicles the story of her life as being one filled with sorrow. HIV was a burden that she found sometimes too heavy to carry. Thandi watched her mother lose half her weight in less than one week, her skin became pale and at times she struggled to get up.

Fortunately, Thandi escaped the wrath of society’s usual finger pointing and condemnation. Friends and family who understood her situation surrounded her and provided support. Unfortunately, many people are not as lucky as Thandi.

Taking care of a person with HIV is not as an easy task. Yet, many people choose to travel the road alone because they fear stigmatisation from their families and communities. Too often, AIDS is wrongly viewed as a shameful condition. This perception can lead even the most dedicated caregivers to remain silent or to shun family members to avoid discrimination. Many Zimbabweans continue to suffer in silence without having help and support from those around them.

Disclosure of one’s status is often equated with ‘confessing’, as if they were guilty of something. They worry about what their neighbours and friends will say. And then, what about their relatives? What will they think? There is a Shona saying, which states ‘Nyadzi dzinokunda rufu”. It translates roughly into “shame is worse than death”. Some may feel that they would rather die than disclose their status. Yet, in Zimbabwe, every family, workplace and community has experienced HIV/AIDS. We are all affected-Why are we still afraid to talk about it?

A similar issue arises when people talk about being tested or not. Due to the stigma, many people say they would rather live in denial, never knowing their status, than be tested. With this belief, how can we respond effectively to the epidemic?

Supported by the cultural taboo of not talking about sexuality, a blanket of silence continues to cover Zimbabwe. It conceals, more than anything else the impact of the epidemic on the population. Out of a population of 12 million last year approximately 24.7 percent of the population are infected with HIV. Almost one in every four Zimbabweans is living with the HIV.

The epidemic is having a dramatic impact on the next generation. Still without adequate access to treatment or care, the HIV/AIDS epidemic is slowly creating a generation of orphans. Recent statistic indicate that Zimbabwe will have 781 000 children orphaned by AIDS by the end of 2003. These children will bear the burden of growing up without the support, love and care of parents.

For years, NGOs and Community Based Organisations have played a formidable role in fighting HIV/AIDS. Yet, the epidemic has continued to progress. It is essential that all sectors of society are involved in prevention, care and mitigation of HIV/AIDS, if we are to have any impact at all.

In 1988, December 1st was established as World AIDS Day. It is a day when the world focuses on the impact of HIV/AIDS. It is a time for the nation to examine its progress and re-evaluate its strategies for responding to the epidemic. It is a time to commemorate and remember the people who have died of the disease. World AIDS Day is an opportunity for every individual to ask what he/she is doing to address the epidemic. This year, the theme of World AIDS Day is Live and Let live. As a result, a clear focus is placed on fighting stigma and discrimination.

Research has shown that stigma and discrimination are the biggest impediments in the fight against the epidemic. In their efforts, one Zimbabwean HIV/AIDS awareness group has aptly re-defined the acronym AIDS to read ‘Am I Doing Something’. It emphasises that we are all affected, and we all need to be involved to make a difference.

Derek Bailey, producer of a popular Zimbabwean television talk show, ‘This is Life’ has had some experience with raising awareness around HIV/AIDS. His show, which targets a young audience, has aimed to provide factual information to people so that they can make informed decisions about their lives. Bailey says that it has been difficult to get people, particularly Zimbabweans, to talk freely about HIV/AIDS. He has however had some success with time.

“It hasn’t been an easy road to get people talking, in fact in the initial stages I was told by local media experts that my ideas would never work, people would never talk about AIDS on national television” says Bailey who has earned himself the title AIDS MAN.

Bailey says if people are empowered with the right information there will be less stigma. He revealed that stigma from his experiences arises from ignorance about the disease.

“I remember at one time after a recording when this young girl of about 9, 10 came to me and said she just wanted to hold my hand, she obviously wanted someone who cared and was ready to understand her, sadly two weeks later she died of an AIDS related illness people living with HIV/ AIDS need our love care and support”. His show has been instrumental in stimulating dialogue about HIV/AIDS within families, schools as well as work places.

As December 1st approaches, it is important for all Zimbabweans to consider what they are doing to mitigate the epidemic. For the sake of future generations, we should strive for a time when everyone feels free to openly talk about HIV/AIDS. Through open dialogue and support, we can reduce stigma and discrimination and provide better care to our friends and families living with HIV/AIDS.

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Returning Traditional Foods to Zimbabwean Kitchens
By Tawanda Maguze

People living with HIV/AIDS (PLWHAs) in Murewa, Zimbabwe are benefiting from a small local initiative, which encourages growing and preparing traditional foods as a means of improving their nutrition and the quality of their lives.

The community group, “Mangwana Ndiwe Nhasi Ndini” (translated directly means ‘Tomorrow it is you, Today it is me’) seeks to empower local villagers with knowledge on how they can take better care of their relatives and friends living with HIV and AIDS. The group provides locals people with information on traditional recipes, which supplement a balanced diet for PLWHAs.

“We recognise the challenges that care givers are faced with in providing basic food stuffs for people living with AIDS because food has became very expensive, so we thought it best to find cheaper alternative food stuffs that are locally available to ensure that the immune systems of people living with AIDS are not further compromised by low nutrition levels” said Eunice Murefu a village health worker who is the nutritionist for the group.

She was speaking during the World AIDS Day National Commemorations held in Murewa, were people involved AIDS programs and various non-governmental organisations exhibited their products and services to the thousands of visitors.

Some of the traditional recipes being encouraged by the group are sadza (maize meal porridge), maheu (traditional yeast drink), samp, mangai (broiled dried corn), maputi (popcorn) and mbwirembwire (ground popcorn). One may notice that all the dishes mentioned are products of corn maize, a staple of the Zimbabwean diet. The variation in preparation is helps to break the monotony and encourage the appetite of a person living with AIDS.

For improved energy and strength, the group prescribes peanut butter, roasted pumpkin seeds, and a preparation called “mabumbe”, made from dried and pounded seeds of the mapudzi fruit, which is then made into a paste and baked. The majority of the foods that the group prescribes are very easy to grow. The group also recommends wild plants and fruits such as mushrooms (howa), matamba (African oranges), and nyevhe (a wild plant similar to clover). Some of these foods are considered to have medicinal properties.

Mrs Murefu said that many people in Murewa had begun to shun traditional foods in favour of processed foods bought from the local grocery shops. She remarks that to some extent many of them do not even know how to prepare some of the traditional dishes. Therefore, the ‘Mangwana Ndiwe Nhasi Ndini’ Group gathers knowledge of these foods and their methods preparation from vana Ambuya and vana Sekuru (Grandfathers and Grandmothers), and pass it on to group members as well as the rest of the community.

“Each community needs to tap into the wisdom of the elderly to find ways of overcoming the problems of providing people living with AIDS with sufficient food incorporated in a balanced diet”, Murefu said. “Sometimes here in rural communities people rush to say someone living with HIV and AIDS needs a healing ceremony to regain weight and strength, when in fact all they need is good, nutritious food of which the regular food may too expensive for the care giver, hence the need to re-introduce traditional foods.”

Once the knowledge has been collected, the group’s nutritionist, Mrs Murefu accesses the foods with the help of other experts to determine its nutritional value and to the best means of preparing food so that the nutritional value is not lost. The group has developed a food square to ensure that all the foodstuffs identified are classified in the four food groups so they prescribe a complete, balanced diet to a caregiver.

The group ‘Mangwana Ndiwe Nhasi Ndini’ took the occasion of the World AIDS day to share with visitors from the rest of Zimbabwe, their community’s experience and response to the epidemic. It is also an opportunity for them to impart their knowledge on how to make use of locally available foods to enhance the lives of those living with HIV and AIDS.

“What we want care givers to know is that they can get adequately provide for their PLWHAs regardless of where they live. All they need is to identify traditional foods, with the assistance of someone trained in nutrition and fit the foods into a food square to avoid malnourishment, and the PLWHAs will derive absolute benefit”said Mrs Murefu.

She also added that caregivers should avoid giving PLWHAs fried foods and too much sugar because these have a detrimental effect on their health. The group’s food stand at the World AIDS Day National commemorations in Murewa attracted a lot of attention, as people were keen to have a taste of the traditional cuisines on display.

Murefu urged all the young and middle aged people to encourage the elderly in their communities to pass on their knowledge about traditional foods and recipes. The recipes that have long since left our kitchens may provide a cheap and nutritious diet that can significantly improve the quality of life for PLWHAs in their community.

Mixed feelings about World AIDS Day Commemorations
By Tawanda Maguze
Zimbabwe

The World AIDS Day Commemorations in Murewa, Zimbabwe were met with mixed feelings from people living with HIV/AIDS (PLWHAs). The day was commemorated through drama, poetry, dance and songs, which promoted anti-stigma messages. Although the performances were an opportunity to showcase key messages about HIV/AIDS, PLWHAs felt that the day should have been more dedicated to them. They felt it should have been a time to reflect on HIV and AIDS and strategise for future responses to the epidemic.

Believe Dhliwayo, an HIV/AIDS activist said that while the performing arts are necessary to provide entertainment, there was also need to include people living with AIDS in the program by giving them a chance to speak at the occasion. This was a sentiment echoed by other PLWHAs attending the event.

“For me, the World AIDS Day is a time to reflect seriously on interventions that have been used during the year as well as the impact of mitigation and prevention measures as such we should be given a chance to speak. There seems to be a misconception that people living with HIV and AIDS are dumb cannot think for themselves and they need someone to speak on their behalf”

Some PLWHAs expressed their gratitude to the organisers for taking the time and effort to remember them. “We are deeply indebted to the National AIDS Council (NAC) and the Ministry of Health for hosting such an occasion for us, this serves to show that you are with us even though at times we may feel left out the decisions that government makes, but I must say NAC has been with us all the way and their efforts are beginning to change our lives for the better” said one PLWHA who identified herself as Muteketo.

Guest of honour at the event, Minister Health and Child Welfare, Dr David Parirenyaytwa spoke at length about the government’s efforts to mitigate the impact of the epidemic. “Zimbabwe is one of the countries worst affected by HIV and AIDS. Its socio-economic blow is far reaching, affecting not only those affected with HIV but their communities and the country as a whole” Currently, Zimbabwe has an estimated 1,82 million people living with HIV and AIDS representing almost 20% of the total population, cast against backdrop of less than 180 000 people who know their status.

Stigma and discrimination were highlighted as the main reasons why people shuned HIV testing. This adds to the many difficulties involved in getting the counselling and the care that they need. Parirenyaytwa called upon all sectors of society, including government to help reduce stigma and discrimination by providing information, education and communication.

“I encourage all government departments and the business sector to set up comprehensive workplace programmes for HIV prevention, care and mitigation in the workplace.”

The Zimbabwean government through the Ministry of Health and Child Welfare has set up more than twenty-one centres country-wide to offer prevention and treatment of opportunistic infections, while 174 health institutions provide activities to prevent parent-to-child transmission of HIV.

Dr Parirenyatwa also said that the Zimbabwean government expects to put more than 260 000 people with AIDS on treatment with ARVs by the year 2005 through an initiative which is in line the World Health Organisation’s objective of providing ARV treatment for more than 3 million people by the year 2005. It is hoped that improved access to treatment will increase openness and help fight stigma and discrimination.

The World AIDS Day in Zimbabwe provided an opportunity for people from all walks of life to come together and recognise the impact HIV/AIDS on the country. Various organisations used the event to distribute literature and prevention messages. With greater assistance from the government and wider recognition of the need to reduce stigma and discrimination, Zimbabweans are looking forward to a more effective response to HIV/AIDS epidemic in the future.

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* Tawanda Maguze, SAfAIDS