This section of the dissertation focuses oowledge, theoretical and methodological data and findings. This refers to as secondary source of data that forms the basis of the research. A literature review conduction present findings relevant to research topic through an exhaustive search in electronic databases in MEDLINE, PubMed and University library. The articles published in English and 2012 onwards were included in the study. Unpublished manuscripts, abstracts and articles published in foreign languages and prior to 2010 were excluded from the study. The search was conducted by using key terms like “HIV/AIDS/AIDS”, “pandemic”, “South Africa”, “ICESCR”, “HIV/AIDS/AIDS “prevalence”, “Zimbabwe”, “policy”, “human rights”. “AND”, “NOT” and “OR” were used to narrow down the search and exclude the articles that were not included in the current study.
South Africa
According to The Joint United Nations Programme on HIV/AIDS/AIDS and AIDS (UNAIDS), in 2016, about 270 000 new infections were introduced in South Africa and about 110 000 HIV/AIDS/AIDS related deaths (unaids.org 2018). About 45% of people live with HIV/AIDS/AIDS in the country having suppressed viral loads. There are key populations who are affected with HIV/AIDS/AIDS in South Africa like sex workers (57.7%), men who have sex with men (MSM) or gay men with 26.8% prevalence (unaids.org 2018). South Africa has the largest HIV/AIDS/AIDS with 19% of people affected with the disease (unaids.org 2018). The above statistics shows that HIV/AIDS/AIDS is prevalent in this country than anywhere else battling against HIV/AIDS/AIDS. The population is receiving antiretroviral therapy (ART) and there is significant decrease in infections, however, the damage is substantial. There are high chances of developing new infections among the old age groups perpetuating increased number of HIV/AIDS/AIDS deaths. Uninfected individuals residing in a community with high ART coverage of 30-40% of HIV/AIDS positive individuals were less likely to acquire the disease as compared to communities that received low ART coverage (Insight Start Study Group, 2015).
HIV/AIDS/AIDS is a fatal disease that is not curable rather preventable. UNAIDS says that the underlying cause for this deadly disease is irrefutable. HIV/AIDS/AIDS destroys CD4+ T cells in blood cells that are crucial for the normal functioning of the immune system. Research has revealed that HIV/AIDS/AIDS+ positive individuals may carry the virus for many years before the symptoms appear or enough damage happens in the immune system for HIV/AIDS/AIDS to develop (Kurth et al. 2011).
The above statistics shows that HIV/AIDS/AIDS/AIDS epidemic is growing fast in South Africa and within five years, one will die from this disease every minute, if proper actions are not taken (Gilbert and Walker 2010). According to Kharsany and Karim (2016) out of 6000 new infections that are occurring globally in this sub-Saharan Africa, young women are bearing the disproportionate burden. Young women and adolescents of the age 15-24 years are at high risk of HIV/AIDS/AIDS infections increasing to eight folds as compared to male partners. There is a huge gap in the HIV/AIDS/AIDS prevention strategies for the women as they are unable to get access to prevention options in terms of behaviour change, abstinence, condoms and male circumcision with early treatment (Anderson et al. 2014). Furthermore, use of contraceptive techniques like condoms also doubled in the recent years in South Africa, but the method is void, as couples are not using condoms despite of being sexually active.
In South Africa, ART treatments has tremendously decreased the incidence of new infections and related deaths through delay in virus progression, however, the supply is insufficient to fight the infection as in 2010, only 5 out of 10 million people received treatment. As a result, the average life expectancy is as low as below 49 years as compared to 54.4 years of age in sub-Saharan African region (Granich et al. 2012). The communities that have high ART coverage witnessed substantial declines in new HIV/AIDS infections by 38% as compared to areas of low ART coverage (Tanser et al. 2013). However, HIV/AIDS incidences rates remain high. The high HIV/AIDS expansion and transmission in South Africa is through heterosexual sex. The concomitant HIV/AIDS/AIDS epidemic among children is through vertical transmission. Women are disproportionately affected with HIV/AIDS/AIDS accounting for 58% among the total individuals living with HIV/AIDS and have highest children affected with HIV/AIDS and AIDS related deaths (unaids 2014). Even pregnant women are not using proper drugs and that has led to an increase of chances of children diagnosed with HIV/AIDS/AIDS by 20-45% as they get the infection from their mothers (unaids 2014). A large proportion of people are still unaware of their HIV/AIDS condition and as a result, they fail to be adequately linked to treatment, care and prevention programs. Moreover, there are withstanding gaps in the efforts that is confluence of the HIV/AIDS pandemic science and knowledge marking as one of the optimistic move in our response. A geospatial prioritization with HIV/AIDS prevention could help to reduce the burden of the pandemic in this region.
HIV/AIDS/AIDS prevalence in Zimbabwe was estimated to be 14.7% in 2015 being the fifth country in the sub-Saharan Africa where approximately 1.4 million people were HIV/AIDS/AIDS+ including 77,000 children (unaids 2018). This HIV/AIDS/AIDS pandemic is mainly driven by unprotected sex between heterosexuals. This growing epidemic is mainly among key populations who are at high risk for the infection like MSM, sex workers (SWs) and people who inject drugs (PWIDs). According to National AIDS Council, Zimbabwe in 2016, HIV/AIDS/AIDS prevalence was 14.5% with high incidence among the 15-49 years age group with annual HIV/AIDS/AIDS deaths of 45,6211 and 1.4 still in need for ART (unaids 2018). The estimated number of new infections was 58, 4721 during the year 2016 as reported by NAC, Zimbabwe. HIV/AIDS causes untold suffering in the communities with children where they are mostly affected burdened with high HIV/AIDS prevalence. The estimated population of the country is 13 million where 1.1 million people were HIV/AIDS+ and out of which 151,749 were children of age <14 years (Macherera et al. 2012). The status of HIV/AIDS pandemic is heterosexually driven with high adult prevalence of 15% and 0.98% incidence. This pandemic is seems homogenous, however the HIV/AIDS hot spots are still lacking access to treatment and prevention strategies slightly higher in urban regions as compared to rural areas among the 15-24 years age groups.
Despite of high ART, many communities of Zimbabwe are still vulnerable to HIV/AIDS, as they are not adhered to this therapy regimen. Inaccessibility to ART is another major gap in treatment especially for children that in turn increases their vulnerability towards HIV/AIDS. Zimbabwean government is committed to end HIV/AIDS/AIDS by 2030 by adopting ART guidelines for increasing the accessibility to HIV/AIDS care services (Fox 2010). Despite of this fact, the country is riddled with political and socio-economic challenges in the last decade after economic and political crisis in 2000. The country faced enormous economic deterioration with worst inflation rate and as a result, there was excessive demand for foreign currencies. Zimbabwe faced acute shortages of basic commodities with unemployment levels up to more than 80% (Jerven 2009). There were low remuneration and currency shortages along with massive brain drain to unprecedented levels that had an impact on the healthcare quality and treatment coverage in relation to HIV/AIDS/AIDS programs.
Zimbabwe’s health system is experiencing challenges in the prevention and treatment of HIV/AIDS due to prevailing conditions of poor donor support and harsh economic conditions. One of the major constraints is shortage of human resources as the trained healthcare personnel are continuing to migrate to other countries and as a result, there are growing numbers of individuals succumb to HIV/AIDS/AIDS (Muchedzi et al. 2010). Moreover, there are shortage of supplies and drugs due to rising costs, fragmented procurement and inadequate foreign exchange including policies. The political climate is quite volatile in Zimbabwe and contestation on legitimacy of election has led to the polarization of the society affecting confidence of the investors (O’brien and Broom 2010). As a result, there is economic and political crisis in the country with rise in levels of poverty and unemployment having a negative influence on the HIV/AIDS/AIDS pandemic prevalence. There is more activity done in the provision of AIDS treatment, however, it is undermined by the poor quality of care provided by the public health service. There is also prevailing poor communication between interest groups and financial stability in private sectors in relation to HIV/AIDS/AIDS. There is poor central management of health service delivery with dwindling budgets and funding that is sustaining the provision of ART in the country (Chopra et al. 2009). Therefore, there is need for urgency of HIV/AIDS epidemic, equitable access to healthcare, funding, adequate monitoring and evaluation, HIV/AIDS policy and coordinated efforts can help to address the HIV/AIDS pandemic in the country.
South Africa
According to Hellandendu (2012), the high spread of HIV/AIDS/AIDS is due to prevailing dominance-subservience or unequal relationship existing between economic, gender and international relationships. Differences in gender power relations or promiscuity is given to males rather than females where they choose young women as their partners. During the economic recession in the country, many young females were forced into trafficking contributing to fast propagation of the virus. These kind of high-risk behavioural patterns are largely responsible for the greater spread of HIV/AIDS in Africa than rest part of the world. Traditional liberal attitudes that are espoused by some communities in the subcontinent like pre-marital, multiple sexual-partners and sexual activity outside marriage. The transmission is likely to occur just after few weeks of infection that increases the chances of spread especially among prostitutes carrying on sexual relationships with more than one-person promoting transmission of HIV/AIDS/AIDS (Gregson et al. 2010).
There is lack of access to information as many people are not aware of the virus and its spread and not informed about the preventative measures and transmission modes. There is inadequate information given to the people especially young people about the infection, as there are persistent HIV/AIDS misconceptions on its transmission. According to Shircliff and Shandra (2011), the structural adjustment programs create conditions that make them favourable to the HIV/AIDS epidemic through cutting health services and deepening poverty for the blacks. There is poor access to healthcare services and fragile preventative measures that contribute to increase in opportunistic infections increasing the infectivity in HIV/AIDS people. HIV/AIDS prevention services are not implemented especially mother to child transmission that increases the HIV/AIDS expansion in South Africa.
According to Johnson, Dorrington and Moolla (2017) the high HIV/AIDS prevalence in the provinces of South Africa is due to high frequency of non-marital sexual activity and differences in male circumcision prevalence. There are differences in circumcision rates especially among the ethnic groups like Venda and Pedi belonging to Limpopo population as it occurs at early adolescence, however, Xhosa in Cape Town, about 79% of circumcision occurs at later ages and as a result, there are fewer benefits with less HIV/AIDS prevention. Similarly, Zulu in KwaZulu-Natal province has lowest fraction of male circumcision and this contributed to the severity of HIV/AIDS pandemic in South Africa. Male circumcision greatly reduces the risk of HIV/AIDS in men by about 60% as stated by WHO. They have conducted randomized controlled trials emphasizing that male circumcision is an efficacious intervention for HIV/AIDS epidemics. Another study conducted by Kalichman et al. (2018) medical male circumcision (MMC) is an effective and proven method to reduce risk of HIV/AIDS transmission from men to women. However, the beliefs, behaviour and awareness have been understudied among women. The results showed that women were unaware of the fact that MMC partially protects men from HIV/AIDS contraction and believed that circumcision reduces the need for condoms resulting in high HIV/AIDS risk.
According to Nicholas et al. (2016) migration is the single and strongest factor that has contributed to high HIV/AIDS prevalence and risk in the sub-Saharan region. Multi-faceted relationship between HIV/AIDS and migration shows a critical link to sexual networks and infection occurring with migration. This is known to increase the spread of infection intersecting with social and cultural mores, human rights and vulnerability for the migrants and their family members. According to Vearey (2012), diverse population movements and migration are associated with HIV/AIDS in South Africa internally or between borders in terms of sickness with an urgency to maintain the health of migrants increasing the burden of disease. Migration is intersecting with significant human and health rights issues that can be linked to the AIDS epidemic prevailing in the country. The migrants need to be protected from stigma and discrimination with intrusions on liberty crucial for HIV/AIDS prevention. Human rights issues include the legacy of stigma; apartheid associated with HIV/AIDS, women status and gender issues, inequality dynamics and low status of migrants. This in turn is linked with poverty and illiteracy that is associated with increased HIV/AIDS risk due to sexual activity being one of the sociological issues in HIV/AIDS expansion in South Africa. According to Vijeyarasa and Stein (2010), forced migration is strongly linked to HIV/AIDS in the form of human trafficking with precarious situation of the trafficked individual to access to treatment, HIV/AIDS testing and care. Forces of poverty and gender intersect with human trafficking make them vulnerable to migration and stigma attached to the HIV/AIDS status. Therefore, this section illustrated that geography of HV/AIDS in South Africa is a result of forced migration, poverty, apartheid, low level of literacy and high risk sex behaviours that cannot be eradicated overnight and require multi-faceted and cooperative approach.
Zimbabwe located in Southern Africa has highest HIV/AIDS prevalence due to unprotected heterosexual sex continuing to be the main mode of transmission for the new infections. The sex work is illegal with homosexuality acting as huge barriers for them and MSM from HIV/AIDS services accessibility. About three quarters of expenditures spent in HIV/AIDS comes from international donors. Like South Africa, in Zimbabwe, HIV/AIDS disproportionately affects women particularly among young women and adolescents. However, there is decline in new infections as pregnant mothers are getting accessibility to ART medicines from 61,000 to 30,000 during the year 2016 (Johnson et al. 2013). Gender inequality is present in marriages and within relationships, which is driving HIV/AIDS infections in the country. In minorities, only 23% of females are allowed to ask partners for using condom if one is having HIV/AIDS as compared to the 69% of the general population (O’Brien and Broom 2013). About one third of women have experienced sexual or physical violence preventing them from negotiating with their partners to use condom putting them at high biological HIV/AIDS risk.
Young women are exposed to high-risk sex behaviours as their male counterparts hold power in the relationships determining condom use. More than half of the sex workers are living with this disease despite of prevention programs and it is difficult to implement it in an environment where gender inequality and confiscation of condoms exist making it difficult to negotiate. In situations where a large discrepancy between males and females occurs and girls are not aware of their HIV/AIDS status, it is difficult to provide HIV/AIDS testing and counselling. Masculinity norms in the country are inhibiting men from being engaged in HIV/AIDS testing and treatment (Baral et al. 2012).
According to UNAIDs and WHO (2011) condom use in concurrent partnerships remains low despite of high availability and distribution in Zimbabwe. In 2015, knowledge regarding HIV/AIDS prevention is increasing in the country especially among men; however, they are not aware of the fact that condom use can prevent HIV/AIDS infection. Male circumcision is another way to prevent HIV/AIDS infection partially and scaling up of MMC is one of the major priority of UNAIDS. Currently, Zimbabwe is facing poor MMC coverage with only 14.3% of circumcised men of the age 15-49 years in the year 2016. Zimbabwe is one of the countries in the sub-Saharan region that has the greatest ART treatments covering over million people equivalent to 75% (Joint United Nations Programme on HIV/AIDS/AIDS and UNAIDS 2017). The country is scaling the viral load testing that is a measure of viral suppression. This is true as South Africa is leveraging market weight for reducing the testing prices making it affordable for low and middle-income countries. However, capacity challenges and weak infrastructure makes the viral load testing far from the HIV/AIDS routine testing and existing services.
Stigma and discrimination, social and cultural influences along with barriers in data collection hinders HIV/AIDS prevention and as a result, this contributes to the pandemic condition in the country. There are discriminatory attitudes towards individuals living with HIV/AIDS and that acts a major barrier in seeking HIV/AIDS healthcare services. According to Reniers and Watkins (2010) there are polygamous relationships existing in Zimbabwe that contribute to the high HIV/AIDS risk as multiple partners increases the encounter of sexually transmitted diseases (STDs). Gender-based violence (GBV) also prevails within the society and women are subjected to physical or sexual abuse (Shand et al. 2014). As witnessed in South Africa, young women in Zimbabwe are vulnerable to HIV/AIDS as they lack power to negotiate with their partners in using condoms. Moreover, the country is unaware of the demography of people living with HIV/AIDS and as a result, there are huge barriers in access to healthcare services and targeted HIV/AIDS testing, treatment and prevention. Funding is another constraint as majority of it comes from international sources and there are only 3% of funds contributing to domestic share for HIV/AIDS response. This diminishing funding from international sources for HIV/AIDS responses is posing a threat to the country’s HIV/AIDS progress in context to prevention. Therefore, the country needs to make a national investment in the HIV/AIDS for promoting efficient, effective and sustainable responses by targeting vulnerable populations and specific locations.
South Africa
South Africa transited to democratic system characterized by rights, liberal constitution and reconciliation widely appreciated as a paradigm shift in relationships from conflict to negotiations. The government is challenged to narrow down the racial disparities that existed in healthcare to a formidable new government that is able to provide effective responses to HIV/AIDS pandemic. Health, HIV/AIDS pattern and life expectancy are the factors that are affected by interactions between social, economic, behavioural, political, technology application and medical care. These social determinants greatly influence HIV/AIDS responses that need to be addressed by the government.
Several shortcomings are witnessed in the health system has contributed to the HIV/AIDS pandemic in the country. There is lack of personnel, poor administration, finances and huge gap between demand and supply that is strongly linked to HIV/AIDS expansion. In the last few decades of apartheid era, criticism prevailed with wide disparities in access to health systems (Ataguba, Akazili and McIntyre 2011). There is lack of equitable healthcare and welfare policies that respond the HIV pandemic in the country. There are imbalances in primary, secondary and tertiary facilities with slow responses. A two-tier health system continued to discriminate access to health care on the social and economic grounds that replaced the racial discrimination. It is astonishing that the South African government arrogantly denied the link between HIV infection and perpetual stigma (Bogart et al. 2013). Ineffective treatments resulted in pervasive denial and sustained responses towards HIV pandemic and stigma associated with it. The government was unable to reduce the mother to children HIV vertical transmission with poor prognosis for newborns infected during infancy or delivery. The government used biomedical approach to HIV deflecting their attention from social issues like poverty, low level of education, poor nutrition and sanitation, sexual promiscuity and high-risk sexual behaviour. These problems are endemic to the country because of economic forces that aggravated racial disparities in health care (Wabiri and Taffa 2013). Moreover, migrants have less access to treatment with deleterious influences and inadequate monitoring of ART program.
Since the beginning of HIV epidemic in the country, human rights protection has been an integral element in the HIV responses. Stigma and discrimination is associated with HIV is considered a priority in ensuring the rights of the people who are at high-risk or living with the disease (Heywood 2009). Advances have been made in understanding the impact of HIV treatment on the prevention and policy development in South Africa. ART treatment for HV prevention reinforces the basic values and principles that are related to respect and dignity of the people with HIV so that they participate in the prevention and program implementation. Human rights protection also help in making informed decisions about their health conditions and thereby protected from abuses and seek opportunities for accountability and health services. HIV treatment is not confined to prevention rather legal and community empowerment that is required for realizing the rights of the people who are affected by HIV/AIDS. Disease and death in HIV has profound implications for rights of humans recognized in the South African Constitution. The responses to rights to dignity, equality, access to health services and education is depressing in South Africa despite of sincere efforts. The right to health is not recognized fully in this country, as half of the people living with HIV have no access to ART treatment. There are human rights challenges in context to HIV treatment, as people living with HIV do not have access to HIV testing, treatment, care and counselling (Padian et al. 2011). The vulnerable groups like young women, girls, sex workers, MSM and PWID living with HIV are looked down constraining the civil society and criminalizing individuals living with HIV. Therefore, the country need to take initiatives that would be helpful in implementing the principles and policies towards HIV responses.
Health equity issues are being faced by the health system in Zimbabwe in context to HIV treatment. Poor people living in resettlement areas and growth farms are vulnerable to HIV effects. The stigma and discrimination still shroud the epidemic that remains major barrier to HIV responses prevailing in the country and most importantly, reinforced by health staffs attitudes. The rapid progress is undermined, as there is decline in care quality within the public health with financial instability and poor communication in the private sector in relation to HIV/AIDS. The treatment is chaotic and unregulated; ARVs are costly with unwarranted foreign exchanges that are resulting in inconsistent use and HIV expansion (O’brien and Broom 2010). The feasibility of treatment programs are constrained by ineffective health services and financial crisis faced by the country. The National Drugs and Therapeutics Policy Advisory Committee (NDTPAC) and The Ministry of Health and Child Welfare (MoHCW) in Zimbabwe have provided ART guidelines, however many healthcare professionals are not aware of the guidelines in prescribing this treatment.
The disease burden has increased because of increasing demand for HIV related health services like medicines and bed rates in the hospitals. Fewer resources have led to the increase in burden and equity treatment is not followed by the country. Individuals who get resistant to the first line of ARV, the expenditure for the second line of drugs is costly and that is contributing to HIV expansion. Moreover, there is no regulation of ARVs prescriptions as majority of healthcare professionals are unaware of the ART administration and treatment based on training, education and health services provided. Funding is another big constraint that the country is facing as there is insufficient funds for providing equitable HIV/AIDS treatment. There is lack of information and treatment illiteracy that is affecting the access to healthcare and impeding programs. There is inadequate monitoring and evaluation on the resources expenditure, activities and programs done that exists in the national programs. There is also lack of targeted interventions, as priorities are not set in depicting the situation, placing the activities, who to target and activities that need be implemented. The National HIV policy strategic framework was developed by Zimbabwe regarding ART drugs; however, government is silent regarding advocating it in HIV prevention (Halperin et al. 2011). The efforts are not coordinated due to lack of a national framework for ART use services and poor communication between stakeholders in public and private sectors leading to less transparency. Majority of people living with HIV are not aware of their condition due to lack of information that is an integral part of HIV treatment in response to developmental and social problem. Inadequate and poor leadership with lack of resources is the main reason for HIV expansion and inaccessibility to health services. Equitable healthcare access, strategic implementation of national framework, improvement in service delivery and mobilization of political and economic influences can be helpful in addressing the HIV urgency experienced by people living with HIV (Campbell et al. 2011).
The government of South Africa signed the ICESCR- International Covenant on Economic, Social and Cultural Rights. This advances the role of the country in protecting the rights of the poor people. The socioeconomic rights institute, explains the ICESCR, as an additional treaty that provides an individual complaint mechanism. It promotes the culture of accountability while supporting the marginalised people. These people can complain in case of the violation of the socioeconomic rights. ICESCR in regards to HIV/AIDS outlines the right to “right to the highest attainable standard of health”, “the right to education”, “the right to work” and the “right to enjoy the benefits of scientific progress and its applications”, “the right to social security”, “the right to an adequate standard of living,” “ right to participate in cultural life ”. The optimal protocol will allow people to seek justice form UN. The OP-ICESR was ratified as the government intended to reduce the poverty. The treaty ensures theevaluative assessment of the qualitative and substantive issues in regards to the economic and social rights (Nevhutalu 2016; Nkuepo 2011). The South Africa constitution provides the right to health care services. It allows people to access the basic health care for children, reproductive health and emergency services; as well as medical services for detained persons. With the help of ICESCR, an individual gets to enjoy the highest attainable standard of physical and mental health. The state is obliged to respect people’s rights as per the bill of rights (Nevhutalu 2016; Sahrc.org.za 2018).
The most important human rights issue in South Africa is the racism. It led to rise in prevalence of HIV and AIDS. There is lack of protection of human rights although there is high prevalence of adult infected with HIV. The human rights abuse is very common although it is third richest country in the continent. There is an increase in prevalence rate in women attending clinic. A greater portion of deaths is largely found among children and women and the ideas are also concentrated in the township and are attributed to the human rights violation. There are serious racial inequalities in South Africa’s health care. It led to high rate of infections in black people. It led to widespread HIV expansion (Zahn et al. 2016; Sahrc.org.za 2018).
Zimbabwe Human Rights Commission (ZHRC) penalises any discrimination on basis of gender. Just like South Africa, the gender equality is not fully guaranteed by the bill of rights. Thus, the laws are ineffectively implemented and the women are more vulnerable than men are to HIV and AIDS. Zimbabwe ratified the “Convention on the Rights of the Child”, “International Covenants on Civil and Political Right and Economic Social and Cultural Rights (ICCPR, ICESCR)” and “Convention on the Elimination of Discrimination Against Women (CEDAW)”. The country has also ratified the “international Convention on the Elimination of all forms of Racial Discrimination.” Unlike South Africa, Zimbabwe had not ratified any optimal protocols. There is need of Zimbabwe to ratify and implement the Convention on the Rights of Persons with Disabilities. The government of Zimbabwe has been unsuccessful in fully incorporating the human rights. There is prevailing discrimination of married women in spite of CEDAW and ICCPR. There is no equal employment for women. Despite the ICCPR and UDHR, there is limited prohibition of “cruel, inhuman and degrading treatment”. There is also high prevalence of the violence against women like South Africa. It also persists as political violence. There are inadequate policies on the Freedom of Movement as well as ways to repatriate the victims of rape. There are no stringent laws in regards to the trafficking of the criminal laws despite ICCPR (O’Brien and Gwisai 2017; www.hrw.org 2011).
The relationship between the HIV and human rights in both countries comes from the discrimination of the patients in the basis of race decreasing the access to health care services and education. Discrimination was also found in regards to the denial of the workplace health insurance system. It affects the people’s ability to work. Thus, to reverse the emerging spread of the infection, these rights must be protected (Zahn et al. 2016). In addition to this, another source of rapid spread of infection is the gender equality. It is very common to have gender based violence in South Africa and Zimbabwe. There is bulk of literature indicating frequent incidents of sexual assault, rape and harassment of women and schoolchildren. Many women are forced by their spouses to have sex without condom. Women face violence on suggesting their partner to use condom. This has intensified the risk of infection among women. The gender based violence is mainly propagated by the idea of masculinity among men along with the irrepressible sex drive, oppression of women, and heterosexuality. There is also great amount of stereotyping and stigma against people living with HV and AIDS in both countries (Amnesty International, 2013; Zahn et al. 2016). Talking about human and legal rights there is greater focus on the advocacy campaigns to reduce stigma and stereotype related to people living with AIDS or HIV. It can be concluded that the situation of South Africa and Zimbabwe is almost similar in regards to spread of HIV and AIDS at a rapid rate.
On analysing the existing policies in South Africa, it was found that the government is seriously determined in reversing the epidemic of HIV and AIDS. The government of South Africa has well collaborated with the civil society. It is indicating that the fight against the pandemic is the shared responsibility. It was found that South Africa has developed sound HIV and AIDS policy paying attention to the children, women and man. However, implementation has been the main challenge (Zuma et al. 2016). In 2009, “UNAIDS Action Framework: Addressing Women, Girls, Gender Equality and HIV” was introduced. It was effective in addressing the issue of the gender equality and human rights violations. These issues rendered women and girls at higher risk of HIV and AIDS. The framework was successful in addressing the needs of the marginalised women and girls. UNAIDS have developed policy called “Criminalization of HIV Transmission”. It helps punish any harmful conduct to prevent the HIV transmission. It prevents any change of risk behaviour by imposing criminal penalties (Watts and Seeley 2014; Baggaley et al. 2016). The mental health policy and Mental Health Care ACT in South Africa has helped patients of HIV/AIDS to seek rehabilitation for improving mental health. This policy was effective in increasing the number of hospital beds.
In Zimbabwe’s constitution, the right to health is not encompassed. However, the Bill of Rights ensures the “right to life” and “non-discrimination”. It helps the migrants to access the health services in country. The Public Health Act in Zimbabwe and the “Prevention of Discrimination Act” prevents the discrimination of people in the basis of nationality. Thus, the legal migrants seek health care services when infected with HIV or Aids and are protected (Migration.org.za 2018). The policy on HIV testing and treatment in this country is useful in providing the counseling, diagnostic testing and the voluntary testing services. It is effective in preventing mother-to-child transmission and provision of the antiretroviral therapy). The country has comprehensive response to HIV and the guidelines have been successfully developed. The government’s programme antiretroviral therapy is provided free of charge. However, lack of funds and limited coverage the implementation has been ineffective. WHO-recommended treatment guidelines are adopted by Zimbabwe for antiretroviral therapy. The first-line regimen is stavudine + lamivudine + nevirapine. The average cost is about US$ 220 per year per person (Batsell 2018). The National Department of Health ensures refugees and migrant population’s access to health care. The South African Refugee Act protects the rights of refugees. South African Immigration Act prevents the entry of prohibited persons in the country which is also dilemma in denying entry of HIV infected people (Decker et al. 2015).
In Zimbabwe, National AIDS Coordination Programme has been effective in its response to the epidemic. A multisectoral National AIDS Council works in collaboration with the governmental and nongovernmental organisations, private sector, and churches as well as people living with AIDS/HIV. The operational base for responding to the HIV and AIDS is National AIDS Policy and National Strategic Framework developed in 1999. Recent ones include national policy development, HIV surveillance activities, and comprehensive training and treatment protocols for sexually transmitted infections. These policies were successful in providing everyone with access to treatment (Chevo and Bhatasara 2012). The ratified international instruments in Zimbabwe play a persuasive value in the interpretation of the bill of rights. It includes “International Covenant on Civil and Political Rights”, “International Covenant on Economic, Social and Cultural Rights”, “International Convention on the Elimination of All Forms of Racial Discrimination”, “UN Convention Relating to the Status of Refugees”, “African Charter on Human and Peoples’ Rights”, “OAU Refugee Convention, 290 and the SADC Protocol on Health” (Migration.org.za 2018; www.hrw.org 2011).
Despite these successful policies, there are numerous difficulties experienced by the Zimbabwe’s health system. It is attributed to the harsh economic conditions. The national response to the epidemic is hindered due to the reduced donor support, shortage of the human resources, and lack of trained health personnel due to their high emigration rate. A large number of health workers also found succumbed to HIV/AIDS. Another major cause of ineffective implementation of the successfully developed policies is shortage of drugs due to rising costs. There is also inadequate availability of the distribution systems for drugs and supplies and foreign exchange reserves. It is argued by Batsell (2018) that there is need of strengthening the antiretroviral therapy services and polices in regards to payment for the services. There is need of setting criteria for people being treated in public sector. There is lack of inefficient policies in terms of antiretroviral therapy services in workplace. There is a need to strengthen the links between HIV testing services, counselling services, anti-retroviral therapy and services for mother to child transmission. Further, there are very weak development of the children and training guidelines. Another major obstacle is the stigma surrounding the HIV and AIDS preventing many people to access treatment.
South Africa
In South Africa, XIII International AIDS Conference has been first international AIDS conference to gain enormous international and pan-African coverage. Again, with the start of the Organization of African Unity (OAU), it included “HIV/AIDS in its Summit in Togo”. Later in 2000, the “United Nations Economic Commission for Africa (UNECA)” created a development forum exclusively for HIV/AIDS. The first framework plan of Action for resolving the issue of the HIV/AIDS was produced in 2001 at Abuja Summit in Nigeria, where the declaration for HIV/AIDS and Tuberculosis was also made (De Waal 2010). These events change the political landscape of HIV and AIDS in South Africa. Further, since HIV hampers the nutritional status, UNAIDS collaborated with the World Health Organization and World Food Programme to help government, civil body and other partners to handle the problems with food and nutrition (Cohn et al. 2016). The policy of “stopping violence against women & children” helped “formulate national guidelines on management of victims of violence” (Cleary et al. 2008).
Based on the policies of HIV/AIDS the programmes developed in South Africa. In South Africa there has been successful “Prevention-of-Mother-to-Child-Transmission (PMTCT) programme, Voluntary Counselling and Testing (VCT) and antiretroviral therapy (ART) services” developed. MTCT has been successful in befitting the babies of HIV positive mothers. The achievement has been indicated by 18 pilot studies in four provinces. The program of Post-Exposure Prophylaxis provides Provide ARVs to rape victims. The VCT programs have been successful in increasing the awareness of the HIV status. AIDS related Tuberculosis has been well combated in all patients with HIV positive with Tuberculosis using the AIDS/DOTS Program. Under the policy of HIV/AIDS, the “Beyond awareness campaigns” have been successful in promoting awareness and support to HIV patients. It helped distribute more than 250 million free condoms to the youth and public (Nkuepo 2011). The health care workers in South Africa have been well trained in home based care. It helped deliver chronic care to the communities and families. The home based care program has helped the AIDS sufferers and orphans. It was effective in treating the elderly and mental health users. South Africa had also developed Victim Empowerment Program under the policy, “Stopping Violence against women & children” helped reduce mortality and morbidity in last five years. The beneficiaries of program are victims of rape, women and children living with HIV/AIDS ((Nkuepo 2011).
However, there has been debate in regards to implementation challenges. The PMTCT programme provides the guidelines for the prevention of the vertical transmission of HIV. Currently in South Africa there are more than 90% of its primary health care centres offering this service. However, due to shortage of the counsellors the majority of the women attending the PMTCT services were not offered testing. The programme was implemented without proper integration into the health care system. However, this program along with the “National Health insurance” is the indicator of the access of heath care services by people (Chibango 2013; Zuma et al. 2016).
In 2006, there has been the launching of the world’s first official “HIV/AIDS Toolkit” in Zimbabwe. It has been the product of the collaborative work force between the Red Crescent societies and International Federations of Red cross, Southern Africa HIV/AIDS Information Dissemination Service and World Health Organisation. It has been effective in delivering the external support to the health care professionals and the people living with the HIV and AIDS. The guidelines on education, clinical management, AIDS counselling services at community level has been successful in responding to the pandemic (Duri, Stray-Pedersen, and Muller 2013). On researching about the Zimbabwe National HIV and AIDS Strategic Plan 2011-2015, it was found that the pan prioritised the high impact interventions with evidence-based efficacy. Within prevention the key activities include the condom promotion and distribution. The use of condom was 66.7% among women, at last sexual intercourse, aged 15-49 who had intercourse in the last 12 months, with non-cohabitating partner and a non-marital. Among the male members, 85.3% reported using condom in similar situation (Duri, Stray-Pedersen, and Muller 2013). Further, the use of WHO guidelines in Zimbabwe, for preventing the mother-to-child transmission has been effective in responding to HIV pandemic. Voluntary counselling and testing, diagnostic and screening services, HIV testing and blood screening services are mainly provided by the government or nongovernmental organisations as well as social media projects (Ciaranello et al. 2012). Zimbabwe also launched the “Caring for HIV and AIDS, Prevention and Positive Living (CHAPPL)” initiative under the “Zimbabwe Association of Christian Hospitals (ZACH)”. It is aimed for successful occupational health program for health staff for post exposure prophylaxis (Chevo and Bhatasara 2012).
There was a continuous progress in the use of condoms in2010-2015 as per the latest survey and the 2015 ZDHS data. The use of the condom has been found to be plateauing in sexually active women of 15-24 age groups. Overall Zimbabwe was found with the significant progress in the usage of condoms in sexually active population due to condom use promotional programs. The country is in position to maintain the gains and increases the usage among other population who are not using but is sexually active. There is greater investment found in the primary areas of the equity growth such as geography and gender (Mannglobalhealth.com 2018, Ciaranello et al. 2012; Batsell 2018). Considering the total market of condom in Zimbabwe, estimated 218 million condoms there was total distribution of 118 million condoms in 2016 that is 54%. It means the window for improvement is large. The national condoms plan receives up to US$10 million. For procuring condoms, 98% is used up (Mannglobalhealth.com 2018). While analysing the condom program stewardship in Zimbabwe Halperin et al. (2011) argued that the high capacity at national market, and strong leadership of the national condom program did not translate into the healthy market, which is sustainable and diversified. On the other hand there are also the economic, policies, and regulatory barriers, because of which the commercial actors are playing a limited role in the condom market. The limitations include high entry barriers for the commercial brands, and shortage of foreign exchange (McCoy et al. 2015). The market development for condoms is weak as there is weak market analytics to determine affordability. Market development is also influenced by the trade-off between the options of sustainability across different market players. There is need to address equity in the market of Zimbabwe.
There are barriers to HIV treatment of sex workers due to stigma and lack of access to ART services. It also includes supply side barriers, and humiliation by health professionals. There are also demand side barriers such as cost of transport, competing time commitments and marginalised socioeconomic position of sex workers with women being more vulnerable (Mtetwa et al. 2013; Batsell 2018). There is need of training among health workers for being sensitive and refining referral systems. There is need of protecting rights of sex workers to improve treatment. The overall treatment of HIV and AIDS people does not follow the principle of equity. Services are delivered based on the ability to pay. The Ministry of Health Zimbabwe is less focussed on setting up treatment initiatives in the areas of greatest need. Also there is lack of regulation on who prescribes the ARVs in some areas (Chevo and Bhatasara 2012). There is also lack of adequate monitoring and evaluation of the existing programmes in Zimbabwe.
There are various effective policies in South Africa and Zimbabwe against HV and AIDS but the setbacks in implementation include lack of documents to access social grants such as birth certificates, poor availability of drugs in disadvantages communities. The challenges faced by the PMTCT rollout include shortage of staff and deficit of drugs. The women are derived of VCT (Voluntary Counselling) and ART (Antiretroviral Therapy) services with most affected being the rural areas. More number of infants and babies are contacting the virus (Chibango 2013). It is because the mothers are living in very poor condition and lack access to the clean water. In such conditions, the policy on infant feeding and nutrition remain ineffective. Similarly, Rape survivors go unreported and law does not punish the perpetrators. These survivors are at high risk of HIV and AIDS. Most women are yet not able to access the TOP services (termination of pregnancy). According to Social Assistance Act, large number of orphans and vulnerable people are supposed to get the social grants. However, due to lack of relevant documents they fail to access such grants (Chibango 2013).
The economic cost of the HIV and AIDS in both South Africa and Zimbabwe is significant. There was reduced labour supply in South Africa due to the HIV pandemic due to increased morbidity and mortality. In the health sector of South Africa, the 20% of student nurses are HIV positive. There is a decrease in the labour productivity due to long period of illness in both countries. More than 30% of the population of South Africa are affected with HIV, which is drastically affecting the size and composition of labour force (Poku 2017). The labour market in Zimbabwe and South Africa is impacted due to absenteeism, loss of skills and experience. The large companies are also recruiting the semiskilled un-skilled workers, which is predominately decreasing the production cost. There is increased labour turnovers and raised employee benefits in Zimbabwe. This is constraining fixed investments due to adverse affect on the profits and corporate savings in South Africa (Cross and Whiteside 2016; Duri, Stray-Pedersen and Muller 2013). The rising health care costs are reducing the competiveness and profits. With increasing deaths of employees, due to AIDS, there is fall in productive labour force. There is fall in the tax revenues, thereby declining the government’s income, and the government is forced to spend more due to rising prevalence of the HIV and AIDS (Bärnighausen et al. 2012). Ultimately, it gave rise to the fiscal crises in South Africa and Zimbabwe.
All the factors have economic impact but on quantifying the impact, it was found that there is negative effect on the growth of GDP per capita and it is substantial in South Africa when compared to Zimbabwe. The pandemic has also reduced the average national growth rate by 2-4% in Africa. The economic consequences will be long term and thus the key industries require targeted training of skills. There are various ethical dilemmas arising due to aim of maintaing the economic stability and importing the expensive antiretroviral drugs for highly productive socioeconomic groups (Smith et al. 2015). There are many economic models developed and are on the verge of implementing the sustainable medical programmes. Both in Zimbabwe and South Africa there was decrease in the exports while the imports increased. The strategic sector in South Africa like the mining department is affected making the expert earnings severe. This led the government budget to come under pressure. It caused defaults on the debt repayments. There is need of more economic assistance from the international countries. It is because the pandemic can affect the individual firms on both the supply side and the demand side. There is an increased demand for the role of the government in the public health in Zimbabwe. Investment by government has dramatically reduced due to rising expenses of HIV and AIDS affecting the macroeconomic outlook. There has been some economic relief due to government based HIV education and prevention campaigns in both South Africa and Zimbabwe (Poku 2017; Duri, Stray-Pedersen and Muller 2013).
Overall, economic influence indicates that the life expectancy at birth will be 10th lowest in South Africa by 2045-2050. By 2050 the population in South Africa and Zimbabwe, the population will be 44% and 20% smaller respectively. With the increase in the government spending and decreasing life expectancy will severely impact the gross domestic product. The economic growth rate of South Africa and Zimbabwe would be 1.47 and 0.56% lower. With the heath care for HIV being more expensive than any other health conditions, the financial pressure on the health care would be severe in next 10 years (Chevo and Bhatasara 2012). Overall the chain of effects may transform themselves into severe economic impact both in Zimbabwe and South Africa. Since there is no cure yet for HIV and AIDS both South Africa and Zimbabwe seems to lag behind in its response to pandemic. There is need of greater investment for second line drugs, if resistance develops for ARV medications (first line therapy) (Mtetwa et al. 2013). The government in both areas must continue with its focus and work on grants, and allocated funds. Health complications due to HIV and AIDS with greater intensity should be given greater focus. There is need of greater focus on the socio-economic variables and HIV/AIDS while dealing with poverty and enhancing economic growth.
Considering the political economy of the HIV/AIDS in South Africa and Zimbabwe, it can be interpreted that there are rapid changes occurring in response to HIV and AIDS. There are various policies and programs existing to effectively response to the pandemic. However, there are various barriers still exiting in place. It demands consideration of the interdependence of violence, mobility, and inequality. The power social determinates of disease are overlooked by focussing more on treatment and behaviour change. It is vital to understand the people’s suspicion and denial in HIV treatment. People can understand the incompressible issues by clarifying the subjective and objective dimensions of the epidemic and its reality. The effective AIDS related politics demonstrates a politics of recognition. In recent times, the increasing debates related to HIV and AIDS have increased the public awareness of health inequalities. It has advanced the battle for social rights. The political powers of South Africa and Zimbabwe initially lacked a good leadership. In recent times, they are under pressure of epidemic accepted a prominent role for nongovernmental organizations. Thus, the multispectral approach from NGOs, faith based organisations, private sector have led to effective response towards HIV/AIDS.
Conclusion
HIV is a global burden that results in million of deaths and emerging new infections every year. Two-third of the infections occurs in sub-Saharan region and this risk has localized the epidemics resulting in pandemic in the populous countries. In countries like South Africa and Zimbabwe, this disease is having a major impact on the economic and social development. Furthermore, the people living with HIV have little access to healthcare services resulting in HIV expansion. HIV+ individuals are stigmatized and compromised their ability to lead a quality life as right to health. The individuals affected with HIV need to be protected from discrimination and have access to treatment and care. ICESCR also outlines that every individual has the right to enjoy health and lead a life of dignity and respect. Unfortunately, this scenario is not witnessed in the countries, South Africa and Zimbabwe. Therefore, the research question aimed at exploring the evidences that is right to health being exercised in these countries by the health systems in relation to HIV pandemic. Considering this situation, the aim of the dissertation was to investigate the impact of healthcare systems on the HIV pandemic prevailing in these two countries. Moreover, the objectives of the dissertation were to analyse the political and economic influences on the HIV pandemic in these two countries. For fulfilling the aims and objectives of the dissertation, a systematic literature review was conducted to consider the literature on impact of existing policies and updated programs in these two countries. The literature review highlighted the fact that there are various shortcomings in these two countries with imbalances in healthcare facilities along with funding crisis. In South Africa, the government is denying the fact that there is a strong link between HIV infection and prevailing stigma. Moreover, the government is not taking active initiatives to concentrate on the social and economical issues like poverty, poor nutrition, low-level education and high-risk sexual behaviour. In Zimbabwe, there is health inequity and no regulation on ART along with funding constraints affecting the access to HIV healthcare services. The policy framework is weak with poor leadership that is the main reason for HIV expansion in the country. From the literature review, six themes were deduced pertaining to gender inequality, human rights abuses, grants issues as economic challenges, ineffective implementation of HIV policies, inadequate ART treatment and lack of prevention program. The countries need to implement effective HIV prevention strategies that comprises of biomedical, structural and behavioural interventions. From the above research, it can be concluded that right to health notion has influenced health systems in South Africa and Zimbabwe in relation to HIV/AIDS pandemic. The human rights are violated and the comprehensive group of people are unable to reach out to the HIV services as they are subjected to stigma and discrimination. Due to lack of strategic framework and policies, funding crisis, the right to health is not exercised in these countries due to economic and political influences. Therefore, the countries need to address and commit to the people living with HIV in providing them access to health and prevention strategies in relation to HIV pandemic.
References
African Commission on Human and People’s Rights. 2013. A Press Statement on the Regional Seminar on Key Human Rights Issues Affecting Women Living with HIV in Africa. Access date: 12th June 2018. Retrieved from: https://www.achpr.org/press/2013/10/d176/
Amnesty International (2013). Amnesty International’s Annual Report 2013: The State of the World’s Human Rights: South Africa. [ebook] London: Amnesty International Ltd. Available at: Amnesty International. https://amnesty.org/en/region/south-africa/report-2013 [Accessed 13 Jun. 2018].
Anderson, S.J., Cherutich, P., Kilonzo, N., Cremin, I., Fecht, D., Kimanga, D., Harper, M., Masha, R.L., Ngongo, P.B., Maina, W. and Dybul, M., 2014. Maximising the effect of combination HIV/AIDS prevention through prioritisation of the people and places in greatest need: a modelling study. The Lancet, 384(9939), pp.249-256.
Apollo, T., Takarinda, K., Mugurungi, O., Chakanyuka, C., Simbini, T. and Harries, A.D., 2010. A report on the Zimbabwe Antiretroviral Therapy (ART) programme progress towards achieving MGD6 target 6B: achievement and challenges. The Central African journal of medicine, 56(1-4), pp.12-14.
Armstrong, R., Hall, B.J., Doyle, J. and Waters, E., 2011. ‘Scoping the scope’of a cochrane review. Journal of Public Health, 33(1), pp.147-150.
Ataguba, J.E., Akazili, J. and McIntyre, D., 2011. Socioeconomic-related health inequality in South Africa: evidence from General Household Surveys. International journal for equity in health, 10(1), p.48.
Auerbach, J.D., Parkhurst, J.O. and Cáceres, C.F., 2011. Addressing social drivers of HIV/AIDS for the long-term response: conceptual and methodological considerations. Global public health, 6(sup3), pp.S293-S309.
Avert 2017. HIV and Aids In Zimbabwe. Access date: 13th June 2018. Retrieved from: https://www.avert.org/professionals/hiv-around-world/sub-saharan-africa/zimbabwe
avert.org 2018. HIV prevention programmes overview. [online] AVERT. Available at: https://www.avert.org/professionals/hiv-programming/prevention/overview [Accessed 13 Jun. 2018].
Baggaley, R., Dalal, S., Johnson, C., Macdonald, V., Mameletzis, I., Rodolph, M., Figueroa, C., Samuelson, J., Verster, A., Doherty, M. and Hirnschall, G., 2016. Beyond the 90?90?90: refocusing HIV/AIDS/AIDS prevention as part of the global HIV/AIDS/AIDS response. Journal of the International AIDS Society, 19(1).
Baral, S., Beyrer, C., Muessig, K., Poteat, T., Wirtz, A.L., Decker, M.R., Sherman, S.G. and Kerrigan, D., 2012. Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis. The Lancet infectious diseases, 12(7), pp.538-549.
Bärnighausen, T., Bloom, D.E. and Humair, S., 2012. Economics of antiretroviral treatment vs. circumcision for HIV prevention. Proceedings of the National Academy of Sciences, 109(52), pp.21271-21276.
Barr, D., J Amon, J. and Clayton, M., 2011. Articulating a rights-based approach to HIV/AIDS/AIDS treatment and prevention interventions. Current HIV/AIDS/AIDS Research, 9(6), pp.396-404.
Batsell, J., 2018. AIDS, politics, and NGOs in Zimbabwe. In The African state and the AIDS crisis (pp. 75-94). Routledge.
Bekker, L.G., Venter, F., Cohen, K., Goemare, E., Van Cutsem, G., Boulle, A. and Wood, R., 2014. Provision of antiretroviral therapy in South Africa: the nuts and bolts. Antiviral therapy.
Bogart, L.M., Chetty, S., Giddy, J., Sypek, A., Sticklor, L., Walensky, R.P., Losina, E., Katz, J.N. and Bassett, I.V., 2013. Barriers to care among people living with HIV in South Africa: contrasts between patient and healthcare provider perspectives. AIDS care, 25(7), pp.843-853.
Broder, S., 2010. The development of antiretroviral therapy and its impact on the HIV-1/AIDS pandemic. Antiviral research, 85(1), pp.1-18.
Callaghan, M., Ford, N. and Schneider, H., 2010. A systematic review of task-shifting for HIV/AIDS/AIDS treatment and care in Africa. Human resources for health, 8(1), p.8.
Campbell, C., Skovdal, M., Madanhire, C., Mugurungi, O., Gregson, S. and Nyamukapa, C., 2011. “We, the AIDS people…”: how antiretroviral therapy enables Zimbabweans living with HIV/AIDS to cope with stigma. American journal of public health, 101(6), pp.1004-1010.
Centers For Disease Control and Prevention (CDC). 2011. CDC’s HIV Prevention Programs in South Africa. Access date: 13th June 2018. Retrieved from: https://www.cdc.gov/globalhealth/countries/southafrica/what/youth_prevention.htm
Centre for Human Rights, University of Pretoria. 2004. HIV AIDS and Human Rights in South Africa. Access date: 12th June 2018. Retrieved from: https://www.africaportal.org/publications/hiv-aids-and-human-rights-in-south-africa/
Chevo, T. and Bhatasara, S., 2012. HIV and AIDS programmes in Zimbabwe: implications for the health system. ISRN Immunology, 2012.
Chibango, C. 2013. South Africa’s HIV and AIDS Policy and Legislation: An Analysis. [online] Gjournals.org. Available at: https://www.gjournals.org/GJMS/GJMS%20pdf/2013/August/052413638%20Chibango.pdf [Accessed 10 Jun. 2018].
Chopra, M., Lawn, J.E., Sanders, D., Barron, P., Karim, S.S.A., Bradshaw, D., Jewkes, R., Karim, Q.A., Flisher, A.J., Mayosi, B.M. and Tollman, S.M., 2009. Achieving the health Millennium Development Goals for South Africa: challenges and priorities. The Lancet, 374(9694), pp.1023-1031.
Ciaranello, A.L., Perez, F., Engelsmann, B., Walensky, R.P., Mushavi, A., Rusibamayila, A., Keatinge, J., Park, J.E., Maruva, M., Cerda, R. and Wood, R., 2012. Cost-effectiveness of World Health Organization 2010 guidelines for prevention of mother-to-child HIV transmission in Zimbabwe. Clinical Infectious Diseases, 56(3), pp.430-446.
Cleary, S., Boulle, A., Castillo?riquelme, M. and Mcintyre, D., 2008. The burden of HIV/AIDS in the public healthcare system. South African journal of economics, 76(s1).
Cohn, J., Whitehouse, K., Tuttle, J., Lueck, K. and Tran, T., 2016. Paediatric HIV/AIDS/AIDS testing beyond the context of prevention of mother-to-child transmission: a systematic review and meta-analysis. The Lancet HIV/AIDS/AIDS, 3(10), pp.e473-e481.
Cross, S. and Whiteside, A. eds., 2016. Facing Up to AIDS: The socio-economic impact in southern Africa. Springer.
Daily News Live. 2017. Zim introduces better ARV drug. Access date: 13th June. 2018. Retrieved from:https://www.dailynews.co.zw/articles/2017/10/16/zim-introduces-better-arv-drug
De Waal, A., 2010. Reframing governance, security and conflict in the light of HIV/AIDS: A synthesis of findings from the AIDS, security and conflict initiative. Social Science & Medicine, 70(1), pp.114-120.
Decker, M.R., Crago, A.L., Chu, S.K., Sherman, S.G., Seshu, M.S., Buthelezi, K., Dhaliwal, M. and Beyrer, C., 2015. Human rights violations against sex workers: burden and effect on HIV. The Lancet, 385(9963), pp.186-199.
Duri, K., Stray-Pedersen, B. and Muller, F., 2013. HIV/AIDS: The Zimbabwean situation and trends.
Fonner, V.A., Armstrong, K.S., Kennedy, C.E., O’Reilly, K.R. and Sweat, M.D., 2014. School based sex education and HIV prevention in low-and middle-income countries: a systematic review and meta-analysis. PloS one, 9(3), p.e89692.
Fox, A.M., 2010. The social determinants of HIV/AIDS serostatus in sub-Saharan Africa: an inverse relationship between poverty and HIV/AIDS?. Public Health Reports, 125(4_suppl), pp.16-24.
Gilbert, L. and Walker, L., 2010. ‘My biggest fear was that people would reject me once they knew my status…’: stigma as experienced by patients in an HIV/AIDS/AIDS clinic in Johannesburg, South Africa. Health & social care in the community, 18(2), pp.139-146.
Granich, R., Kahn, J.G., Bennett, R., Holmes, C.B., Garg, N., Serenata, C., Sabin, M.L., Makhlouf-Obermeyer, C., Mack, C.D.F., Williams, P. and Jones, L., 2012. Expanding ART for treatment and prevention of HIV/AIDS in South Africa: estimated cost and cost-effectiveness 2011-2050. PloS one, 7(2), p.e30216.
Gregson, S., Gonese, E., Hallett, T.B., Taruberekera, N., Hargrove, J.W., Lopman, B., Corbett, E.L., Dorrington, R., Dube, S., Dehne, K. and Mugurungi, O., 2010. HIV/AIDS decline in Zimbabwe due to reductions in risky sex? Evidence from a comprehensive epidemiological review. International journal of epidemiology, 39(5), pp.1311-1323.
Gruskin, S., Ferguson, L., Alfven, T., Rugg, D. and Peersman, G., 2013. Identifying structural barriers to an effective HIV/AIDS/AIDS response: using the National Composite Policy Index data to evaluate the human rights, legal and policy environment. Journal of the International AIDS Society, 16(1).
Halperin, D.T., Mugurungi, O., Hallett, T.B., Muchini, B., Campbell, B., Magure, T., Benedikt, C. and Gregson, S., 2011. A Surprising Prevention Success: Why did the HIV/AIDS/AIDS epidemic decline in Zimbabwe?. PLoS medicine, 8(2), p.e1000414.
Harling, G., Newell, M.L., Tanser, F., Kawachi, I., Subramanian, S.V. and Bärnighausen, T., 2014. Do age-disparate relationships drive HIV incidence in young women? Evidence from a population cohort in rural KwaZulu-Natal, South Africa. Journal of acquired immune deficiency syndromes (1999), 66(4), p.443.
Hellandendu, J.M.A., 2012. Contributory factors to the spread of HIV/AIDS/AIDS and it impacts in sub-Saharan African countries. European Scientific Journal, ESJ, 8(14).
Heywood, M., 2009. South Africa’s treatment action campaign: combining law and social mobilization to realize the right to health. Journal of Human Rights Practice, 1(1), pp.14-36.
Independent. 2018. Africa’s new affordable HIV treatment deal under threat from US budget cuts. Access date: 12th June 2018. Retrieved from: https://www.independent.co.uk/news/world/africa-hiv-aids-drugs-treatment-deal-under-threat-us-budget-cuts-a7960391.html
Insight Start Study Group, 2015. Initiation of antiretroviral therapy in early asymptomatic HIV/AIDS infection. New England Journal of Medicine, 373(9), pp.795-807.
Jerven, M., 2009. The relativity of poverty and income: how reliable are African economic statistics?. African Affairs, 109(434), pp.77-96.
Jewkes, R.K., Dunkle, K., Nduna, M. and Shai, N., 2010. Intimate partner violence, relationship power inequity, and incidence of HIV/AIDS/AIDS infection in young women in South Africa: a cohort study. The lancet, 376(9734), pp.41-48.
Johnson, L.F., 2012. Access to antiretroviral treatment in South Africa, 2004-2011. Southern African Journal of HIV Medicine, 13(1).
Johnson, L.F., Dorrington, R.E. and Moolla, H., 2017. HIV epidemic drivers in South Africa: A model-based evaluation of factors accounting for inter-provincial differences in HIV prevalence and incidence trends. Southern African Journal of HIV Medicine, 18(1).
Johnson, L.F., Mossong, J., Dorrington, R.E., Schomaker, M., Hoffmann, C.J., Keiser, O., Fox, M.P., Wood, R., Prozesky, H., Giddy, J. and Garone, D.B., 2013. Life expectancies of South African adults starting antiretroviral treatment: collaborative analysis of cohort studies. PLoS medicine, 10(4), p.e1001418.
Joint United Nations Programme on HIV/AIDS and UNAIDS, D., 2017. Geneva; 2017.
Joint United Nations Programme on HIV/AIDS/AIDS (UNAIDS).; The Gap Report ISBN: 978-92-9253-062-4.; 2014. [Accessed on 12 July 2015].
Kalichman, S., Mathews, C., Kalichman, M., Eaton, L.A. and Nkoko, K., 2018. Male circumcision for HIV prevention: Awareness, risk compensation, and risk perceptions among South African women. Global public health, pp.1-9.
Kang’ethe, S. M., & Chikono, G. (2014). Exploring feminization of HIV/AIDS/AIDS in Zimbabwe: A literature review. Journal of Human Ecology, 47(2), 139-145.
Kennedy, C.E., Medley, A.M., Sweat, M.D. and O’Reilly, K.R., 2010. Behavioural interventions for HIV positive prevention in developing countries: a systematic review and meta-analysis. Bulletin of the World Health Organization, 88(8), pp.615-623.
Kharsany, A.B. and Karim, Q.A., 2016. HIV/AIDS infection and AIDS in Sub-Saharan Africa: current status, challenges and opportunities. The open AIDS journal, 10, p.34.
Kurth, A.E., Celum, C., Baeten, J.M., Vermund, S.H. and Wasserheit, J.N., 2011. Combination HIV/AIDS prevention: significance, challenges, and opportunities. Current HIV/AIDS/AIDS Reports, 8(1), pp.62-72.
Macherera, M., Moyo, L., Ncube, M. and Gumbi, A., 2012. Social, cultural, and environmental challenges faced by children on antiretroviral therapy in Zimbabwe: A mixed-method study. International Journal of MCH and AIDS, 1(1), p.83.
Mannglobalhealth.com. 2018. Mann Global Health| Zimbabwe Case Study. [online] Available at: https://mannglobalhealth.com/wp-content/uploads/2017/11/MGH_Condom-Case-Study_Zimbabwe_Final_091117.pdf [Accessed 10 Jun. 2018].
Mantell, J.E., Needham, S.L., Smit, J.A., Hoffman, S., Cebekhulu, Q., Adams?Skinner, J., Exner, T.M., Mabude, Z., Beksinska, M., Stein, Z.A. and Milford, C., 2009. Gender norms in South Africa: implications for HIV/AIDS and pregnancy prevention among African and Indian women students at a South African tertiary institution. Culture, health & sexuality, 11(2), pp.139-157.
Mathers, B.M., Degenhardt, L., Ali, H., Wiessing, L., Hickman, M., Mattick, R.P., Myers, B., Ambekar, A. and Strathdee, S.A., 2010. HIV prevention, treatment, and care services for people who inject drugs: a systematic review of global, regional, and national coverage. The Lancet, 375(9719), pp.1014-1028.
Mayosi, B.M. and Benatar, S.R., 2014. Health and health care in South Africa—20 years after Mandela. New England Journal of Medicine, 371(14), pp.1344-1353.
Mayosi, B.M., Lawn, J.E., Van Niekerk, A., Bradshaw, D., Karim, S.S.A., Coovadia, H.M. and Lancet South Africa team, 2012. Health in South Africa: changes and challenges since 2009. The Lancet, 380(9858), pp.2029-2043.
McCoy, S.I., Buzdugan, R., Padian, N.S., Musarandega, R., Engelsman, B., Martz, T.E., Mushavi, A., Mahomva, A. and Cowan, F.M., 2015. Uptake of services and behaviors in the prevention of mother-to-child HIV/AIDS/AIDS transmission (PMTCT) cascade in Zimbabwe. Journal of acquired immune deficiency syndromes (1999), 69(2), p.e74.
Meintjes, G., Moorhouse, M.A., Carmona, S., Davies, N., Dlamini, S., Van Vuuren, C., Manzini, T., Mathe, M., Moosa, Y., Nash, J. and Nel, J., 2017. Adult antiretroviral therapy guidelines 2017. Southern African Journal of HIV Medicine, 18(1), pp.1-24.
Merriam, S.B., 2015. Qualitative Research: Designing, Implementing, and Publishing a Study. In Handbook of Research on Scholarly Publishing and Research Methods (pp. 125-140). IGI Global.
Meyer-Rath, G., Johnson, L.F., Pillay, Y., Blecher, M., Brennan, A.T., Long, L., Moultrie, H., Sanne, I., Fox, M.P. and Rosen, S., 2017. Changing the South African national antiretroviral therapy guidelines: The role of cost modelling. PloS one, 12(10), p.e0186557.
Migration.org.za 2018. MIGRANTS’ RIGHT TO HEALTH In Southern Africa. [online] Migration.org.za. Available at: https://www.migration.org.za/wp-content/uploads/2017/08/Migrants-Right-to-Health-in-Southern-Africa.pdf [Accessed 10 Jun. 2018].
Mill, J.E., Edwards, N., Jackson, R.C., MacLean, L. and Chaw-Kant, J., 2010. Stigmatization as a social control mechanism for persons living with HIV/AIDS/AIDS and AIDS. Qualitative Health Research, 20(11), pp.1469-1483.
Moher, D., Shamseer, L., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., Shekelle, P. and Stewart, L.A., 2015. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic reviews, 4(1), p.1.
Mtetwa, S., Busza, J., Chidiya, S., Mungofa, S. and Cowan, F., 2013. “You are wasting our drugs”: health service barriers to HIV treatment for sex workers in Zimbabwe. BMC public health, 13(1), p.698.
Muchedzi, A., Chandisarewa, W., Keatinge, J., Stranix-Chibanda, L., Woelk, G., Mbizvo, E. and Shetty, A.K., 2010. Factors associated with access to HIV/AIDS care and treatment in a prevention of mother to child transmission programme in urban Zimbabwe. Journal of the International AIDS Society, 13(1), p.38.
Myers, J.L., Well, A.D. and Lorch Jr, R.F., 2013. Research design and statistical analysis. Routledge.
Neuman, W.L., 2013. Social research methods: Qualitative and quantitative approaches. Pearson education.
Nevhutalu, H.K., 2016. Patient’s rights in South Africa’s public health system: Moral-critical perspectives (Doctoral dissertation, Stellenbosch: Stellenbosch University).
News Day. 2015. HIV-related stigma still rife in Zim. Access date: 12th June 2018. Retrieved from: https://www.newsday.co.zw/2015/09/hiv-related-stigma-still-rife-in-zim/
Nicholas, P.K., Mfono, N., Corless, I.B., Davis, S.M., O’Brien, E., Padua, J., Ahmed, S., Sheldon, L.K., Oas, K., Sadler, L. and Nicholas, T.P., 2016. HIV vulnerability in migrant populations in southern Africa: Sociological, cultural, health-related, and human-rights perspectives. International Journal of Africa Nursing Sciences, 5, pp.1-8.
Njeuhmeli, E., Forsythe, S., Reed, J., Opuni, M., Bollinger, L., Heard, N., Castor, D., Stover, J., Farley, T., Menon, V. and Hankins, C., 2011. Voluntary medical male circumcision: modeling the impact and cost of expanding male circumcision for HIV prevention in eastern and southern Africa. PLoS medicine, 8(11), p.e1001132.
Nkuepo, H. 2011. Importance of South Africa’s Ratification of the ICESCR and OP CESCR and the Link between Economic, Social and Cultural Rights and MDGS. SSRN Electronic Journal.
O’Brien, S.M. and Gwisai, M., 2017. Living with HIV and Advocating for Health Rights in Urban Zimbabwe. Politikon, 44(2), pp.247-263.
O’brien, S. and Broom, A., 2010. The prevalence and politics of HIV/AIDS/AIDS in Zimbabwe: Examining the ideological, political and historical factors behind the ‘decline’. Politikon, 37(2-3), pp.311-330.
O’Brien, S. and Broom, A., 2013. Gender, culture and changing attitudes: experiences of HIV in Zimbabwe. Culture, health & sexuality, 15(5), pp.583-597.
Padian, N.S., McCoy, S.I., Karim, S.S.A., Hasen, N., Kim, J., Bartos, M., Katabira, E., Bertozzi, S.M., Schwartländer, B. and Cohen, M.S., 2011. HIV prevention transformed: the new prevention research agenda. The Lancet, 378(9787), pp.269-278.
Padilla-Díaz, M., 2015. Phenomenology in educational qualitative research: Philosophy as science or philosophical science. International Journal of Educational Excellence, 1(2), pp.101-110.
Poku, N.K., 2017. The political economy of AIDS in Africa. Taylor & Francis.
Rehle, T.M., Hallett, T.B., Shisana, O., Pillay-van Wyk, V., Zuma, K., Carrara, H. and Jooste, S., 2010. A decline in new HIV/AIDS/AIDS infections in South Africa: estimating HIV/AIDS/AIDS incidence from three national HIV/AIDS/AIDS surveys in 2002, 2005 and 2008. PloS one, 5(6), p.e11094.
Reniers, G. and Watkins, S., 2010. Polygyny and the spread of HIV in Sub Saharan Africa: a case of benign concurrency. AIDS (London, England), 24(2), p.299.
Ritchie, J., Lewis, J., Nicholls, C.M. and Ormston, R. eds., 2013. Qualitative research practice: A guide for social science students and researchers. Sage.
Robeyns, I., 2011. The capability approach. Handbook of economics and ethics, 39.
Sahrc.org.za 2018. Chapter 4 Right to Health – Period: April 2000 – March 2002. [online] Sahrc.org.za. Available at: https://www.sahrc.org.za/home/21/files/Reports/4th_esr_chap_4.pdf [Accessed 13 Jun. 2018].
Saul, B., Kinley, D. and Mowbray, J., 2014. The international covenant on economic, social and cultural rights: commentary, cases, and materials. OUP Oxford.
Shand, T., Thomson?de Boor, H., van den Berg, W., Peacock, D. and Pascoe, L., 2014. The HIV Blind Spot: Men and HIV Testing, Treatment and Care in Sub?Saharan Africa. IDS Bulletin, 45(1), pp.53-60.
Sharp, P.M. and Hahn, B.H., 2011. Origins of HIV/AIDS/AIDS and the AIDS pandemic. Cold Spring Harbor perspectives in medicine, 1(1), p.a006841.
Shircliff, E.J. and Shandra, J.M., 2011. Non?Governmental Organizations, Democracy, and HIV/AIDS Prevalence: A Cross?National Analysis. Sociological Inquiry, 81(2), pp.143-173.
Smith, J.A., Sharma, M., Levin, C., Baeten, J.M., van Rooyen, H., Celum, C., Hallett, T.B. and Barnabas, R.V., 2015. Cost-effectiveness of community-based strategies to strengthen the continuum of HIV care in rural South Africa: a health economic modelling analysis. The lancet HIV, 2(4), pp.e159-e168.
Smith, M.B., Nelson, H.D., Haney, E., Pappas, M., Daeges, M., Wasson, N. and McDonagh, M., 2014. Inclusion and Exclusion Criteria.
Taffa, N., 2017. Sexual activity of out-of-school youth, and their knowledge and attitude about STDs and HIV/AIDS in Southern Ethiopia. The Ethiopian Journal of Health Development (EJHD), 12(1).
Tanser, F., Bärnighausen, T., Grapsa, E., Zaidi, J. and Newell, M.L., 2013. High coverage of ART associated with decline in risk of HIV/AIDS acquisition in rural KwaZulu-Natal, South Africa. Science, 339(6122), pp.966-971.
Tellalian, D., Maznavi, K., Bredeek, U.F. and Hardy, W.D., 2013. Pre-exposure prophylaxis (PrEP) for HIV infection: results of a survey of HIV healthcare providers evaluating their knowledge, attitudes, and prescribing practices. AIDS patient care and STDs, 27(10), pp.553-559.
The Guardian. 2016. No cash, no cure: Zimbabwe’s hospitals buckle amid economic crisis. Access date: 12th June 2018. Retrieved from: https://www.theguardian.com/world/2016/jul/14/no-cash-no-cure-zimbabwes-hospitals-buckle-amid-economic-crisis
The Zimbabwean. 2014. HIV positive students suffer discrimination. Access date: 12th June 2018. Retrieved from: https://reliefweb.int/report/zimbabwe/hiv-positive-students-suffer-discrimination
Toloie-Eshlaghy, A., Chitsaz, S., Karimian, L. and Charkhchi, R., 2011. A classification of qualitative research methods. Research Journal of International Studies, 20(20), pp.106-123.
UN AIDS. 2018. African human rights body urges renewed efforts on human rights in response to HIV. Access date: 12th June 2018. Retrieved from: https://www.unaids.org/en/resources/presscentre/featurestories/2018/january/20180130_african-human-rights
UNAIDs, U. and World Health Organization, 2011. Global HIV/AIDS response: epidemic update and health sector progress towards universal access: progress report 2011. Global HIV/AIDS response: epidemic update and health sector progress towards universal access: progress report 2011.
UNAIDS. 2018a. HIV treatment now reaching more than 6 million people in sub-Saharan Africa. Access date: 12th June 2018. Retrieved from: https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2012/july/20120706prafricatreatment
unaids.org 2018. South Africa. [online] Unaids.org. Available at: https://www.unaids.org/en/regionscountries/countries/southafrica [Accessed 10 Jun. 2018].
Unaids.org. 2018. Right to health. [online] Available at: https://www.unaids.org/en/resources/documents/2017/20171120_right_to_health [Accessed 27 Feb. 2018].
UNICEF. (2018). A South African Perspective On Gender Inequality, Violence, Sexual Health and HIV/AIDS. Access date: 06.11.2018. Retrieved from: https://www.unicef-irc.org/article/917-a-south-african-perspective-on-gender-inequality-violence-sexual-health-and-HIV/AIDS.html
United Nations Development Programme. 2018. A Chance to Live: HIV treatment reaches 1 million in Zimbabwe. Access date: 12th June 2018. Retrieved from: https://reliefweb.int/report/zimbabwe/chance-live-hiv-treatment-reaches-1-million-zimbabwe
Vearey, J., 2012. Learning from HIV: exploring migration and health in South Africa. Global public health, 7(1), pp.58-70.
Vijeyarasa, R. and Stein, R.A., 2010. HIV and Human Trafficking–Related Stigma: Health Interventions for Trafficked Populations. Jama, 304(3), pp.344-345.
Viljoen, F., 2012. International human rights law in Africa. Oxford University Press on Demand.
Vivancos, R., Abubakar, I., Phillips-Howard, P. and Hunter, P.R., 2013. School-based sex education is associated with reduced risky sexual behaviour and sexually transmitted infections in young adults. Public Health, 127(1), pp.53-57.
Wabiri, N. and Taffa, N., 2013. Socio-economic inequality and HIV in South Africa. BMC public health, 13(1), p.1037.
Watts, C. and Seeley, J., 2014. Addressing gender inequality and intimate partner violence as critical barriers to an effective HIV/AIDS/AIDS response in sub?Saharan Africa. Journal of the International AIDS Society, 17(1).
Woods, K. 2014. Human rights. Palgrave Macmillan.
www.hrw.org 2011. Universal Periodic Review of Zimbabwe-Human Rights Watch’s Submission to the Human Rights Council – March 2011. [online] Human Rights Watch. Available at: https://www.hrw.org/news/2011/03/29/universal-periodic-review-zimbabwe [Accessed 13 Jun. 2018].
Young, S.D., Hlavka, Z., Modiba, P., Gray, G., Van Rooyen, H., Richter, L., Szekeres, G. and Coates, T., 2010. HIV/AIDS/AIDS-related stigma, social norms and HIV/AIDS/AIDS testing in Soweto and Vulindlela, South Africa: NIMH Project Accept (HPTN 043). Journal of acquired immune deficiency syndromes (1999), 55(5), p.620.
Zahn, R., Grosso, A., Scheibe, A., Bekker, L.G., Ketende, S., Dausab, F., Iipinge, S., Beyrer, C., Trapance, G. and Baral, S., 2016. Human rights violations among men who have sex with men in Southern Africa: comparisons between legal contexts. PloS one, 11(1), p.e0147156.
Zimbabawe Stigma Index Research Report. 2014. The Zimbabwe People Living With Hiv Stigma Index. Access date: 12th June 2018. Retrieved from: https://www.hindawi.com/journals/isrn/2012/609128/
Zimbabwean HIV/AIDS and Human Rights Charter. 2018. Zimbabwean HIV/AIDS and Human Rights Charter. Access date: 12th June 2018. Retrieved from: https://archive.kubatana.net/docs/hr/zlhr_zim_hivaids_hr_charter_060527.pdf
Zuma, K., Shisana, O., Rehle, T.M., Simbayi, L.C., Jooste, S., Zungu, N., Labadarios, D., Onoya, D., Evans, M., Moyo, S. and Abdullah, F., 2016. New insights into HIV/AIDS/AIDS epidemic in South Africa: key findings from the National HIV/AIDS/AIDS Prevalence, Incidence and Behaviour Survey, 2012. African Journal of AIDS Research, 15(1), pp.67-75.
Zw.one.un.org. 2018. Millennium Development Goals Overview | UN in Zimbabwe. [online] Available at: https://www.zw.one.un.org/togetherwedeliver/millennium-development-goals-overview [Accessed 1 Mar. 2018].
Essay Writing Service Features
Our Experience
No matter how complex your assignment is, we can find the right professional for your specific task. Contact Essay is an essay writing company that hires only the smartest minds to help you with your projects. Our expertise allows us to provide students with high-quality academic writing, editing & proofreading services.
Free Features
Free revision policy
$10Free bibliography & reference
$8Free title page
$8Free formatting
$8How Our Essay Writing Service Works
First, you will need to complete an order form. It's not difficult but, in case there is anything you find not to be clear, you may always call us so that we can guide you through it. On the order form, you will need to include some basic information concerning your order: subject, topic, number of pages, etc. We also encourage our clients to upload any relevant information or sources that will help.
Complete the order form
Once we have all the information and instructions that we need, we select the most suitable writer for your assignment. While everything seems to be clear, the writer, who has complete knowledge of the subject, may need clarification from you. It is at that point that you would receive a call or email from us.
Writer’s assignment
As soon as the writer has finished, it will be delivered both to the website and to your email address so that you will not miss it. If your deadline is close at hand, we will place a call to you to make sure that you receive the paper on time.
Completing the order and download