HIV and hypertension, a double burden in Zimbabwe

This blogpost will summarize the topics that are covered on the blog. So, if you want to refresh your memory about the double burden of HIV and hypertension in Zimbabwe, then read on!

Introduction

Zimbabwe has high cases of HIV, which is a communicable disease, and hypertension, which is a noncommunicable disease. Both of these diseases have led to an enormous burden on the health care system and economy of the country. 

General profile of Zimbabwe

Zimbabwe is a country located in Southern Africa. Zimbabwe became independent in 1980 and has subsequently been a presidential republic. The health sector in Zimbabwe is made up of primary, secondary, tertiary and quaternary levels of care. 

The double burden of disease

In most high-income countries infectious diseases have been generally eliminated, shifting the burden of disease more to non-communicable diseases. Nowadays, middle- and lower-income countries have started to experience a similar rise in NCD. However, while higher-income countries mainly combat NCD, many middle- and lower-income countries continue dealing with infectious diseases. In Zimbabwe we can see a double burden of HIV and increasing hypertension among the whole population.

HIV in Zimbabwe

HIV stands for Human Immunodeficiency Virus. HIV undermines the immune system and ensures that the body is no longer able to properly fight pathogens. Zimbabwe has one of the greatest prevalence rates in South-Eastern Africa, approximately 13%. In 2018 the number of people with HIV was 1.3 million, these were adults between 15 and 49 years old.

Hypertension in Zimbabwe

Hypertension is high blood pressure. It is one of the main risk factors for cardiovascular diseases, which in turn can lead to severe health outcomes. Hypertension is the most common non-communicable disease in Southern Africa. The percentage of people with hypertension is 22,9. 

The interconnection between both diseases

HIV and hypertension are connected to each other at two levels. Firstly, the two diseases are interconnected at individual level. If you are infected with HIV, you have a higher chance to get hypertension. One study indicates that changes in the composition of the body cause hypertension in HIV patients. Secondly, HIV and hypertension are linked at societal level. The interconnection at this level is that the health care costs of both diseases are huge.

Interventions taken by the government

The government of Zimbabwe has some programs to fight HIV: Prevention of Mother-To-Child Transmission program, Voluntary, Counselling and Testing services, National Behaviour Change Program, Home- Based Care program and Antiviral Therapy Program. Regarding hypertension, the government unfortunately hasn’t set up that much interventions.

What can you do to prevent yourself from getting HIV and hypertension?

To prevent yourself from getting HIV you can: avoid sex, reduce your number of sexual partners, use condoms, find out your (partner’s) HIV status, stop using drugs and use medication. To prevent yourself from getting hypertension, you can do the following things: maintain a healthy weight, eat a healthy and balanced diet, avoid too much salt, exercise regularly, reduce alcohol consumption and quit smoking.

Treatment of both diseases

If you have hypertension, you can use a number of drugs (for example calcium blockers) to lower your blood pressure and to protect organs from developing consecutive diseases. Besides drugs, hypertension can also be treated through lifestyle changes. For HIV, antiretroviral therapy (ART) can be taken to suppress the disease.

Triple burden of disease

A triple burden is the prevalence of noncommunicable and communicable diseases, but also high cases of violence, mental illness, and/or injuries at the same time. Interpersonal violence is one triple burden in Zimbabwe. Another issue that HIV-infected Zimbabwe residents face are high cases of depression and common mental disorders.

You are now at the end of our last blog post. We want to thank you for reading our posts and we hope that you have learned a lot from it!

We have already discussed what a double burden of disease is but there is also a third burden of disease affecting Zimbabwe. A triple burden of disease is the prevalence of not only noncommunicable and communicable diseases but there are also high cases of violence, mental illness, and or injuries. Triple burdens are more commonly found in developing nations since they are countries that are going through the most drastic health transformations. In the case of Zimbabwe, they are showing signs of dealing with a triple burden of disease since those who are infected with HIV are more likely to suffer from mental illness and females who are HIV+ are more likely to experience interpersonal violence.

One triple burden that Zimbabwe faces is interpersonal violence. This is because there are high levels of violence against females who are HIV positive. There have been many studies done interviewing women who disclosed their HIV tests with spouses and most of the results contained the same conclusion – interpersonal violence is interconnected with HIV status and disclosure. In one study done in Harare, Zimbabwe, 32.8% of females reported that they experienced interpersonal violence from their spouses regarding their HIV status. Zimbabwe also suffers from high numbers of gender-based violence, which leads to an inability to negotiate condom usage, therefore, higher chances of spreading HIV. In 2017 there were approximately 740,000 women living with HIV and more than a third of them who have been married experienced physical or sexual violence from their partner. According to AVERT, “In 2015, 14% of women reported experiencing sexual violence at least once in their lifetime and 8% reported experiencing it in the last 12 months.” Women are the most affected by interpersonal violence and those who are infected with HIV are the most susceptible to violence. To address the issue of violence, Zimbabwe’s legislation passed the Domestic Violence Act in 2007 to prevent all forms of interpersonal violence, specifically gender-based violence.

Another issue that Zimbabwe residents who are infected with HIV face are high cases of depression and common mental disorders (CMD). In a similar study done in the city if Harare, they concluded that those living with HIV were significantly more susceptible to depression. Those who also suffer from mental health issues related to HIV are also more prone to using drugs and alcohol as a coping mechanism from the stress of their diagnosis (cite). There is also a significant lack of mental health professionals in Zimbabwe, so it is difficult for those who are suffering from mental illness to receive treatment. Due to the high rates of mental illness and these numbers rising, the World Health Organization has begun working with Zimbabwe’s Ministry of Health to address the gaps that their healthcare has. Their goal is to provide services at a community level since it can be difficult for families to travel to the National Hospital.

International organizations are working together with Zimbabwe’s government to tackle issues related to HIV and hypertension. To read more about what the government is doing to address these issues check out our post that discusses policies and interventions!

In the previous posts, you have read a lot about the dangers of hypertension and of HIV, and have hopefully learned about a few simple steps which you can take to protect yourself from developing any of these conditions. But even then, it may of course still be possible that you end up getting one of them, or maybe you already have, and are now looking for what to do next. In any case, while being diagnosed with a disease is never nice, it is half as bad as it sounds. Because once you are diagnosed, you can be treated, and luckily there are good treatments available for hypertension, as well as for HIV!

Treating hypertension

If you do have hypertension, it is important to lower your blood pressure, to protect organs such as your brain, heart, or kidney from developing subsequent diseases. To do so, there are a number of drugs, such as calcium blockers, available. Depending on what your individual needs are, your doctor can prescribe the fitting medication. Besides drugs however, hypertension may also be treated through life-style changes. These changes are very similar to what you have read in the post about prevention of hypertension, and include losing weight if you are obese, quitting smoking and limiting alcohol intake (if this applies to you), adapting a healthy diet with focus on fruit and vegetables and a reduced sodium intake, and getting regular exercise. Just as getting these important lifestyle factors right may prevent development of hypertension, it can also help to reverse hypertension, once you are already affected.

Treating HIV

For HIV, the story is unfortunately more complicated. However, while there may not be a simple change you can make to your diet in order to reverse your HIV-diagnosis, there are medical measures that can be taken to suppress the disease. This is known as “antiretroviral therapy”, or ART. People on ART take different medicines to help their body cope with and suppress the HIV virus. Which medicines these are, is determined by your doctor, based on interactions between drugs, your personal needs, and considering possible side effects.

The way these medicines work, is by inhibiting the virus to multiply, or to make copies of itself. By doing so, the total viral load in your body is decreased, giving your immune system the chance to recover. With the help of ART, the viral load can be decreased to undetectable amounts of HIV in your blood, at which point you are also not at risk anymore of transmitting the disease.

ART and Hypertension

HIV-positive people who are on ART have a higher prevalence for hypertension, than HIV-negative people. While there is no 100% conclusive evidence that ART causes hypertension, a number of scientific studies have proposed that there might be mechanisms, through which ART together with HIV and lifestyle factors may increase the risk of hypertension. Therefore, if you are HIV-positive and taking ART, it is especially important to maintain a healthy lifestyle, to avoid hypertension or decrease it, if you are already affected.

In blog post 5 on hypertension in Zimbabwe, an introduction has been made on hypertension. We’ve explained what hypertension is, we came across some striking numbers on the prevalence in Zimbabwe, we’ve named the main consequences that could arise due to hypertension, and we’ve considered some of the major risk factors for getting hypertension. If you would like to reread this particular blog post on hypertension again, you can click on this link.

Moreover, even though hypertension is such a big problem in Zimbabwe, not many people are aware of it and know what to do to prevent themselves from getting hypertension. Therefore, in this blog post we will explain you what to do, and what not to do, in order to prevent yourself and people around you.

1. Maintain a healthy weight.
Overweight and obesity are one of the main risk factors for getting hypertension. When there is an imbalance in the amount of energy you consume and the amount of energy you use – this can ultimately lead to the development of overweight and obesity. The amount of energy you consume depends on the amount you eat & drink, and what you eat & drink. The amount of energy you use depends on the level of physical exercise you have during a day. This lifestyle factor is therefore extensively linked to almost all of the other lifestyle factors that will be linked down below.

2. Eat a healthy and balanced diet.
Try to eat less calories, sugars and fats. Think of sugary beverages, pizza, cookies, cheese and red meat such as lamb, pork. Especially food containing high amounts of fat are “dangerous culprits”. Most of the fat-calories in a high-fat diet are immediately stored in fat-cells in the body which results in the gain of weight. Moreover, fats in a high-fat diet can cause a high level of cholesterol in the blood which will cause the blood vessels to tighten up. This in turn, is another risk factor for hypertension. Do eat plenty of fruits and vegetables, instead. Even though many fruits and vegetables contain a high amount of sugars – these sugars are almost immediately changed into fuel and power that you need to for example walk, work and exercise. Moreover, also nuts, whole grains, poultry and fish are healthy options instead of the earlier described culprits.

3. Don’t eat too much salt.
Even though salt is an important micronutrient for the body, already in 1904 the first association between salt and high blood pressure was made. A too high salt intake causes major challenges for the kidneys to excrete the high amount of salt and thereby also to remove water. This results in a higher blood pressure because of the higher amount of fluid and therefore extra tension on the blood vessels. There are multiple ways to eat less salt; firstly, don’t add additional salt to your food when cooking. Simple as that. Use herbs and other spices instead. Second, eat less processed food. These types of food often contain a lot of added salts – think of tomato ketchup, tinned and packed soups and all kinds of meat such as bacon, sausages and ham.

4. Exercise enough

In line with the first recommendation, to maintain a healthy weight, comes the recommendation to exercise regularly. The more exercise you get, the less you´ll be at risk to become overweight or get obesity. Moreover, exercise is not only a good manner to be less at risk for getting obesity and therefore getting hypertension – exercise is also a good preventative strategy for hypertension directly. Already in the 1970’s evidence was found that by means of exercising, someone’s blood pressure would lower down. You could for example go for a brisk walk for 30 minutes every day. When you’re short in time you could go jogging, for 20 min for 3 / 4 days a week. But most important – do something you enjoy: in this way it is less hard to persist.

5. Limit the amount of alcohol you drink
Another risk factor for developing hypertension is alcohol consumption. When someone drinks a single alcoholic drink, this immediately has an effect in the blood pressure. However, this increase will diminish within an hour or two. However, when drinking a continuous amount of alcohol over the course of a couple of days, this will result in a more sustained increase in blood pressure. Especially the more consistent and heavy way of alcohol consumption, called binge-drinking, increases the risk of atherosclerosis, which is the consequence of narrowing of the arteries. This in turn can result in high blood pressure because the blood has less room to flow. Moreover, since alcohol is high in sugar, it is also a risk factor for developing obesity.

6. Don’t smoke.

Tobacco smoking is another risk factor for developing hypertension. The way smoking causes this condition to arise is a complex manner – however, studies have shown that it increases the blood pressure both in an immediate as well as in a prolonged way. All the toxic substances within a cigarette will gradually cause toxicity and inflammation within the body and it will i.e. result in the buildup of plaques within the blood vessels which in turn all cause hypertension. However, the stress that could be a result when quitting with smoking, could also elevate the blood pressure. Therefore, when you already smoke it is important to know how to deal with this stress.

Even though changing people’s lifestyle on an individual level is a good way to go when talking about hypertension prevention, as mentioned in blog post 7, it is of the utmost importance that the government will take action as well. The low awareness on hypertension is mainly a consequence of lack of education and cultural beliefs that are present in Zimbabwe. In order to give you, citizens of Zimbabwe, more notion and awareness on hypertension – first the government should take action and make sure that education on this topic is arranged properly.

Everyone can contract with HIV! Besides the fact that the government should take measures for HIV prevention, it is also of utmost importance to protect yourself as an individual. Fortunately, there are measures that you can take to protect yourself against HIV infection! In this blog post the available tools to prevent yourself from getting HIV will be listed. 

1. Not having sex
Abstinence, or not having anal, oral or vaginal sex, is the only measure that is 100% effective to prevent HIV infection. By means of abstinence, it is not only possible to protect yourself against HIV, but other sexually transmitted diseases can also be prevented. In addition, it is more likely that you will have fewer sexual partners during life when you wait to start having sex. 

2. Reduce your number of sexual partners
Having few sexual partners is therefore the next measure that serves to prevent HIV. Limiting the number of sexual partners lowers your chance of having sex with someone who is already HIV-infected or has another sexually transmitted disease. The more partners, the higher the risk for HIV. Moreover, this limitation in sexual partners can lead to reduction of transmission of HIV. 

3. Use of condoms
Another preventive measure is the effective use of a condom. Because HIV is spread through body fluids, a condom is very effective. However, it is extremely important that you use condoms every time you have sexual intercourse and do it properly. If you want to know more about the use of male or female condoms, you can click on the hyperlinks. 

4. Know your (partner’s) HIV status 
It is important that you get yourself tested for HIV. In addition, it is of course important that you know your partner’s HIV status. Get yourself and your partner tested for HIV before you have sex. It is also extremely important to treat if there is another sexually transmitted disease. The chance of an HIV infection or its transmission is higher if someone has a sexually transmitted disease. 

5. Do not share injection needles 
Besides the measures related to sexual intercourse, it is also extremely important to be careful when using injection needles, for drugs for example. If you use injection needles or drugs, stopping is the best way to reduce the chance of an HIV infection. The transmission of HIV is also reduced in this way. The chance of getting HIV is particularly high when you use an injection needle after someone with HIV has used it. Moreover, it appears that people have more risky sex when they are under the influence of drugs. This therefore increases the possibility of HIV infection and transmission. Of course, it is difficult to stop or reduce the use of drugs, but there are opportunities as health care providers or counselors who can help you with this. Are you still unable to stop? Then make sure you use clean needles and never share them!

6. Use medication 
People who do not have HIV, but still have an increased risk of contracting HIV due to sex or drug use, can use a new medication method. Pre-exposure prophylaxis, or PrEP, is an HIV medicine that must be taken every day to reduce the risk of infection. Of course, it is wiser to use PrEP in combination with the other tools described above to protect yourself as well as possible. In addition, PrEP is also recommended for people who have used a drug injection needle or who have shared needles in the last 6 months, to lower the risk of transmission.

Unfortunately, it can happen that you still have got HIV. Do not fear! Go to blog post 10 and read which treatment methods exist!

As already mentioned in the previous blog posts, the prevalence of HIV and hypertension in Zimbabwe still remains quite high. In general, the government of Zimbabwe has already devoted much attention to interventions with regard to the prevention of hypertension and especially HIV.  

Previous interventions with regard to HIV

Zimbabwe is one of the 189 countries that have committed themselves to a comprehensive program of national commitment and action to fight the HIV and AIDS epidemic. Some programs that are taken by the government are: Prevention of Mother-To-Child Transmission program, Voluntary, Counselling and Testing services, National Behaviour Change Program, Home- Based Care program and Antiviral Therapy Program. These days mother-to-child transmission of HIV is very common in Zimbabwe. In 2015, mother-to-child transmission was responsible for 6,39% of all new HIV  infections. To prevent this form of transmission, in 2017, 95% of the pregnant woman received antiretroviral treatment. With regard to the Voluntary, Counselling and Testing service it is interesting to mention that, in 2016,  only 76% of women, compared to 68% of positive men was aware of their status. Broad objectives of this program emphasize the need to increase the percentage of Zimbabwean population that is aware of his or her HIV status. By scaling up the self-testing in Zimbabwe, the transmission of HIV can be overcome. In 2015, the government of Zimbabwe introduced The Zimbabwe National Behaviour Change Program. The main goal of this program is reducing the sexual transmission of HIV by addressing the key drivers such as multiple sexual partners and age different sexual relationships. The availability and distribution of condoms in Zimbabwe is good. However, the use of condoms when one or both partners have sexual relationships with other people remains low. For reducing the sexual transmission, making condoms available for everyone remains an important point of the program. In contrast to the programs mentioned above, the Home- Based Care program doesn’t focus on the prevention of HIV, but on the aftercare. The government has come to the realization that Home- Based Care plays an very important role in the response to HIV. Due to the weakening economy and the growing number of people living with HIV, the health system is not able to cope with the problem itself. The Home- Based Care serves as an extension of the healthcare system that can support people living with HIV and their families. Are you interested in the theme Antiviral Therapy, then continue reading blog post 10.   

Previous interventions with regard to hypertension

With regard to hypertension, the government of Zimbabwe unfortunately hasn’t come up with that many  interventions. Although the government does recognize the growing importance of combating non- communicable diseases such as hypertension, there is limited government funding for the management of them. According to the WHO, the budget for tackling communicable diseases in Zimbabwe equals 4,4 million and for non- communicable diseases 757.000. Despite the fact that more and more people recognize the importance of combating non- communicable diseases, there still remains a major gap with regard to the money that is made available for this. Around 60,5% of the small budget is also used for employment costs. Therefore, the health system of Zimbabwe is highly dependent on donor funding and individual payments. Without these payments, there is just not enough money available for tackling non- communicable diseases such as hypertension.  

Previous research shows that the awareness, treatment and control of blood pressure in Zimbabwe is very low. The lack of knowledge was frequently associated with lack of education and the existence of cultural beliefs which influences attitudes and practices on hypertension. Also, dietary risk factors were associated with lack of knowledge. Furthermore is the health service inaccessible and the treatment costly and inadequate. Therefore, it is important that the government of Zimbabwe comes up with a national policy that focuses on the prevention by encouraging prudent dietary habits, controlled alcohol and salt consumption, and ideal weight. If the budget allows, future interventions should also focus on these factors.  

As mentioned in earlier posts, there exists an important link between HIV and hypertension. Therefore, it is important that the government not only developes interventions for both HIV and hypertension separately, but also combined ones.

All in all, there can be said that awareness with regard to the prevention and risks of HIV and hypertension is very important. Are you interested in what you can do to prevent yourself from getting HIV and hypertension? then proceed to blog posts 8 and 9.      

HIV and hypertension have internal connections between each other at two different levels. Firstly, the two diseases are interconnected at individual level. As already mentioned in an earlier post, if you are infected with HIV, you have a greater chance to get hypertension than if you do not have an HIV infection. Moreover, if you have HIV and high blood pressure together, you are more likely to have cardiovascular events compared with when you only have HIV or hypertension. Cardiovascular events are incidents that lead to injury to the heart muscle. Besides this, having both HIV and hypertension also leads to a higher risk of death from all causes, in comparison to having only one of the two diseases.

What causes high blood pressure in HIV patients?

Between 13 and 49% of people with HIV suffer from hypertension. But what is the reason for this? One study suggests that changes in the composition of the body result in hypertension in HIV patients. These body changes include central obesity and localized loss of fat tissue caused by stavudine. Stavudine is a medication that prevents and treats HIV. So, the use of this medicine creates a risk for high blood pressure and should therefore be avoided. Another study found that HIV patients treated with antiretroviral therapy, a therapy that suppresses the function of a virus, also are at increased risk of getting hypertension, compared with patients that are not treated with this therapy. Antiretroviral therapy can affect blood pressure levels directly or indirectly. Furthermore, there are a few risk factors that may cause hypertension if you have HIV. These factors consist of age, gender, body mass index (a measure of body size), activation and deficiency of the immune system and lastly chronic inflammation.

The interconnection at societal level

In the second place, HIV and hypertension are linked at societal level. The interconnection at this level is that the costs of health care are big for both diseases. The health care system of Zimbabwe in terms of HIV exists of prevention, treatment care, community services and surveillance. Regarding hypertension, the country does the same to manage this disease. This care is very expensive. Thus, these diseases together pose a serious economic burden in Zimbabwe, since it is a country with limited financial resources.

Another connection between the diseases is the fact that they have the highest prevalence in the country. As you could read in previous posts, HIV and hypertension are the most common in Zimbabwe. This also links the diseases with each other. Since HIV patients have a higher chance of getting hypertension, the prevention of HIV could lead to a decrease in both of the diseases. Therefore, Zimbabwe needs to focus on prevention of HIV in order to reduce the double burden of disease.   

Are you now curious about what already is done by the government of Zimbabwe to tackle HIV and hypertension in the country? Then you definitely need to read the next post!

Hypertension is the major cause of premature (earlier) death in the world, with an estimated 1,13 billion people living with the condition.

But what is hypertension exactly? Very simply said, hypertension is the same as high blood pressure, meaning that the blood that flows through people’s blood vessels forces a too high pressures on these vessels. It is one of the main risk factors for developing cardiovascular diseases, which in turn can cause severe health outcomes such as a heart attack, stroke or heart failure.

Many different factors can contribute to the development of hypertension, but several are in particular responsible. In general these factors are related to poor behaviour and attitudes. Think of, poor dietary patterns, physical inactivity, obesity, tobacco smoking, extensive alcohol consumption and stress. However, also someone’s genetic predisposition could be an important determinant for the risk of developing hypertension.

Besides that, even though hypertension is a health problem that is present in almost all groups of society, some people are particularly at high risk of developing the condition. The risk of developing hypertension for example increases with an increasing age. Moreover, also women face a higher risk for developing the condition, as well as people living in urban areas in comparison to people living in rural areas.

Hypertension is the most common non-communicable disease (NCD) in Southern Africa. The overall prevalence (meaning the percentage of people with the disease within a region) is 22,9%. Since the fast rise of NCDs in the last couple of decades, hypertension is believed to be one of the main drivers of this NCD-epidemic in the Southern African region. When comparing the average prevalence of hypertension in Southern Africa with that of Europe, it becomes clear the Southern Africa is facing a major problem regarding this diseases. In Europe the percentage of people living with hypertension is between 9 and 20%, which is way lower than the average of Southern Africa (22,9%). However, some countries take the lead and have even a higher prevalence. A good example of such country is Zimbabwe, where 30% of the population has to deal with the disease.

Due to the fact that hypertension often manifests without any symptoms, many people don’t realize they’re dealing with the condition. For that reason, hypertension often stays undiagnosed. Therefore, there is great uncertainty whether this 30% prevalence in Zimbabwe is actually true. Because of the fact that people stay undiagnosed, the real prevalence could be way higher. Moreover, as if this is not bad enough already, the high prevalence rate in Zimbabwe seems to keep on rising. This was already the case between 1990 and 1997 when the prevalence increased from 1000 to 4000 per 100.000 people. When nothing is done to overcome this problem, the future doesn’t look favourable, and the high burden will only become worse. Hypertension is therefore a health threat that should be taken seriously. 

However, even though all earlier described risk factors are also apparent in Zimbabwe, people living in Zimbabwe don’t have much knowledge on what hypertension is, and how they can prevent themselves from getting it. There is, so said, little awareness regarding this problem. This results in inadequate treatments, not so many preventation- and control programmes, and a weak and negligent government response.

In order to overcome the problem of hypertension that has an impact on so many people, this problems should be tackled. Therefore, during some of our coming blog posts we will start raising more awareness regarding this problem, and discuss how people, just like you, can lower their risk for developing hypertension. Moreover, we will discuss some ways in which the government should take its responsibility by implementing new policies. So, be sure to keep on following us.

What exactly is HIV? Let’s explain this first!
HIV stands for Human Immunodeficiency Virus. This virus is violent against human body cells, which normally protect us against infections. HIV weakens our immune system and ensures that the human body is no longer able to properly fight pathogens. Due to HIV the human body becomes more susceptible to other diseases and infections. The transmission proceeds through contact with the body fluid of a HIV-infected person, like unsafe sex or by sharing materials for drug injection for example.

Unfortunately, HIV cannot be cured. Once the human body is infected with HIV, it is lifelong. However, there is medication for HIV. Due to antiretroviral therapy, it is possible that HIV-infected people live a long and healthy life and prevent HIV from being transmitted through sexual contact. Moreover, there are efficient methods that prevent HIV through sexual contact or drug use. It is extremely important to treat HIV. If this is not the case HIV can cause AIDS, which eventually leads to death. 

Figures and more
Zimbabwe has one of the highest prevalence rates in South-Eastern Africa, approximately 13%. In 2018 the amount of people living with HIV was 1.3 million, these were adults between 15 and 49 years old. The prevalence is unequal between men and women. The affected women rate is higher, 16% women against 12% men. Figures from UNAIDS show that 38.000 people were newly infected with HIV in Zimbabwe. The incidence rate among the vulnerable population was almost 2.8% for all ages. Additionally, the Global Burden of Disease Study shows that HIV is the leading cause of premature death in Zimbabwe. The Years of Life Lost (YLLs) due to HIV is 29%. In addition, HIV is the major cause of Disability-adjusted Life Years (DALYs) in Zimbabwe. In the rank where 1 is the best condition and 15 the worst, HIV ranks 15 DALYs. Furthermore, it appears that the number of people who finally died as a result of AIDS-related illness is 22.000. 

Who are at risk?
The biggest cause why HIV is spread all over Zimbabwe is because of unsafe heterosexual intimacy. It appears that mainly the vulnerable groups are responsible for the growing epidemic of HIV. Women are one of the most important risk groups. In 2017 at least 740.000 female were HIV-infected. The main cause for this is the gender inequality and the physical and sexual violence that women face in Zimbabwe. Another important risk group are young people, often due to lack of knowledge. Furthermore, UNAIDS figures show that at least 56% of all sex workers in Zimbabwe are HIV-infected. The vulnerability of sex workers is increased, because sex work is illegal in Zimbabwe. As a result of this, sex workers make almost no use of health services. They are often afraid of being arrested. Finally, men who have sex with men are also vulnerable for HIV-infection. This is also because of homosexuality for men is prohibited in Zimbabwe. They cannot use either the health services. With this reason most of the vulnerable groups often do not know that they are infected, and this leads to the point that they do not receive the needed treatment thereby deteriorating their health situation.

Would you also like to know more about hypertension in Zimbabwe? Keep on reading!

In the past decades, there has been an increasingly talk of an emerging double burden of disease. Especially in the context of low and middle-income countries you might have come across this term before. But what does a “double burden of disease” actually entail? The basis of this new concept lies in the classes of disease which can be distinguished. The broadest classification of disease is a separation into communicable diseases (CD’s) and non-communicable diseases (NCD’s). Communicable diseases are also called infectious diseases and can be transmitted from one person from another via pathogens such as bacteria, viruses, funghi, or parasites. Think for example of the HIV virus, or the flu. Non-communicable diseases on the other hand can not be transmitted from person to person and are rather the result of genetic, physiological, environmental and behaviours factors. Think for example of diabetes as a result of obesity and poor diet or cancer due to exposure to chemicals, as found in cigarettes, but also of neurodegenerative diseases such as Alzheimer’s disease.

In most high-income countries infectious diseases have been widely eradicated, shifting the burden of disease more towards lifestyle-dependent and non-communicable diseases. This can be due to a more sedative lifestyle, more available processed and unhealthy foods, and a longer lifespan, allowing for more time for NCD’s such as Alzheimer’s or cardiovascular disease to develop. Following recent trends of globalization and changes in socio-demographic patterns more towards those of higher-income countries, middle- and lower-income countries have started to experience a similar increase of NCD. However, while higher-income countries mainly have to fight against those NCD and can focus their resources preventing and curing them, many middle- and lower-income countries continue to carry the burden of high rates of infectious diseases. This results in a population vulnerable to a wider range of diseases, as well as in a large pressure on the public health system, as challenges have to be met on both ends of the spectrum of disease.

So where does Zimbabwe stand in all of this? When comparing health data from 2007 with data from 2017, it can be seen, that even though death due to HIV decreased drastically by almost 83% from 2007 to 2017, HIV was still the leading cause of death for both years. In 2018, there were 1.3 million people living with HIV, and among adults the prevalence (or percentage of HIV-positive people) was 12.7% of the whole population. At the same time, Zimbabwe has seen an increase in hypertension, one of the key NCD’s, and risk factor for many other NCD’s such as stroke or coronary heart disease. With a prevalence of 30%, hypertension is a health threat which has to be taken seriously. While we can therefore see a double burden of HIV and increasing hypertension among the whole population, there is also a significant overlap of affected patients. A study found the prevalence of hypertension to be 45.4% among HIV patients, as compared to the 30.5% in uninfected people of the same age group. HIV and hypertension in Zimbabwe is therefore an example of a double burden not only on a population level, but also on an individual level. The two diseases respectively their prevention therefore need to be tackled in a linked approach. In our next posts, we will look at the exact backgrounds of both diseases within the country and the challenges they pose to the health system, and explore possible ways to prevent them.