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Unequal Balance: HIV/AIDS and Health Care Programmes in Bulawayo, Zimbabwe

This paper explores the dimensions and shortcomings of the present HIV/AIDS policies at the national level in Zimbabwe and at the local level in its second city, Bulawayo. It is critical of the Western, medically-oriented, top-down, information-giving characteristics ofnational and local HIVIAIDS prevention programmes there and locates them within the wider socio-cultural, political and economic crises that characterise Zimbabwe today. It describes the growing prevalence of STDs during the late 1970s and through the 1980s and stresses the vulnerability of an increasing proportion of the city’s residents to HIVlAIDS infection, The paper is based on field research conducted in two of Bulawayo’s high-density suburbs, Nketa and Mpopoma, in 1999. Following an extensive literature review, 84 semi-structured household interviews examined various features of household life in Bulawayo, including information about social structure, family income, health, personal difficulties and family resources. Key informant interviews were also conducted with household heads, health workers, church leaders, government officials (health and social welfare) and NGO officers. The basic approach takes account of both the biomedical and the social dimensions of HIV/AIDS. In South Africa, President Thabo Mbeki’s interventions offered the concerned public a choice between poverty or HIV infection as the ‘real’ cause of the epidemic. Our work takes account of both the biomedical factors, including the role of HIV and the socio-economic dimension. It confirms that AIDS crosses all socioeconomic and cultural boundaries. This is a disease of the educated middle class, as well as of the uneducated poor. That said, the paper argues for recognition of the central role of poverty in increasing vulnerability to preventable infectious disease, including HIV. It advocates comprehensive programmes which range from targeting the most vulnerable to involving all sectors in a long-term, comprehensive strategy of poverty alleviation and community and household support. First,