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PSImpact article
Harare Diary

New Life, New Start, New Deal

By David J. Olson
HARARE, Zimbabwe — Seventy adults of all ages are listening to a young man telling about how he is dealing with his HIV-positive status. They fill a large room on the fifth floor of an office building in downtown Harare. This is a regular Saturday meeting at one of the 16 New Life centers that PSI/Zimbabwe has established all over the country, usually paired with a New Start Voluntary and Counseling Center. It gives a chance for HIV-positive men and women, and the HIV-negative people who love them, to come together to share experiences, empathy and solidarity with others in a similar place in their lives. It is also a way for them to feel that HIV-positive status is not the end of the road, but more like a bump in the road, albeit a serious one.

PSI/Zimbabwe started these “post-testing support centers” in 2004 as a logical follow-on to its highly successful New Start counseling and testing centers. They answer the question: Where do people go for support and solidarity after they are found HIV-positive? New Start Centers refer people to other facilities but what does one do if there are no other facilities?

PSI’s Dr. Karin Hatzold, the German doctor who has been running New Start and New Life for the last five years (and has been in Zimbabwe, off and on, since 1996) says New Life is a decidedly unPSI-like endeavor. This is primarily HIV care, not prevention. And the health impact is harder to measure. But Karin is enthusiastic about New Life and says there is evidence that people involved in New Life are more likely to stay on anti-retroviral therapy and to use condoms than those who are not. She even thinks it might be possible to develop a DALY for it.

• • •

I’ve never been as confused about money as I am in Harare. But I’m hardly alone; everyone seems equally clueless. Zimbabwe has the highest inflation rate in the world, as high as 11,000,000%, according to media accounts. There have been several reprintings of the currency, the Zimbabwe dollar. The last one was in July of this year, when ten zeros were removed (so $100 billion became $10). This has caused mass confusion. My first three attempts to buy anything in cash ended in total failure.

In one handicraft shop, I became convinced that I could not afford to buy the smallest item in the store. Another time I tried to buy a newspaper off the street but, after asking the price, decided I could do without a newspaper that would cost me what seemed to be US $17.50. Karin told me she simply does not carry around Zim currency because it devalues on an almost hourly basis; I had to give her Zim $40 (US $.10) to tip the parking attendant.

When I asked CR Michael Chommie about ATMs, he told me that “the sole ATM has a family of five living in it. Cash is king.”

• • •

Zimbabwe is the mother of PSI voluntary counseling and testing, and the New Start network has grown to 20 centers serving a cumulative total of 1.2 million clients from its humble beginnings in 1999. They see 25,000 clients per month and provide 50% of all HIV testing in the country.

Karin showed me New Africa House VCT center in downtown Harare, the first center directly managed by PSI and the one that serves the most clients on site. It serves 2,500-3,000 clients per month and is one of only three of the 20 centers that do not do outreach (because they have so many clients walking in). Site Manager Shame Muparutsa showed me the process which takes no more than one hour and 20 minutes (including the waiting time). The cost is 50 Zimbabwe cents (less than one U.S. cent) but anyone who can’t afford that can come in for free.

We sat in on a real live pre-test group session with five men and three women all of whom appeared to be in their 20s or early 30s. Pre-test group sessions started a few years ago and have become the norm. I also went through individual post-test counseling with Counselor Loice Magwaza, a former nurse, who has at New Start since 2004. Loice is one of the 21 counselors at this center who tell people if they have been found to be HIV-positive or negative. I asked Loice is the job is stressful and she says no, partly because there is less stigma surrounding HIV and AIDS and because people realize that a positive status is not the death sentence it once was. Karin tells me that 110,000 people are on antiretroviral therapy in Zimbabwe out of the 360,000-380,000 who need it. Still, anyone found HIV-positive at this site should be able to access treatment within a month, says Karin. In the rural areas, things are not so rosy.

• • •

It is Friday, 12 September, and I am in the bar of the Harare Press Club the evening after South African President Thabo Mbeki hammered out a power-sharing agreement between President Robert Mugabe and opposition leader Morgan Tsvangirai. Zimbabwean reporters covering the long deadlocked talks are pouring in to celebrate. I ask several of them who compromised more in this agreement, Mugabe or Tsvangirai. They are unanimous that it is Mugabe. Tsvangirai’s communications director shows up. We press him for details of the agreement but he says we will have to wait for Monday’s formal announcement. This man was imprisoned by Mugabe for three months earlier this year. Now he is positively glowing. I couldn’t have picked a better night to hang out in the Harare Press Club.

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