Five Questions with Lillian Chinyanganya, EGPAF-Zimbabwe Country Manager

1. How did you end up in public health??

I always say to my friends that we think that we look for our purpose, our destiny, but instead it finds us through the little things that we're passionate about. ?

When I was in junior school, I lived?near an orphanage. There were a lot of children who ended up being there because their parents died of HIV and AIDS. I used to walk there and play with those children. I thought that when I grow up I was going to be a doctor for these children.??

After I got my medical degree, I was working in the largest hospital in the country when our economy literally collapsed. I remember that nurses would not come to work because they didn’t have transport. You would write a treatment plan for patients, but there would be no medicines, there was no basic equipment.??

So I felt that no matter how good a doctor I was, if I am working in a system that is not functioning, there's really little you can do.?

The situation in my country really drove me to public health to try to fix as much as we can and support ailing and failing health systems—because at the end of the day, it's the patients and it's the most poor, the most vulnerable that actually suffered the most.??

When the world of public health opened up to me, I fell in love.?

2. What is the state of pediatric HIV right now in Zimbabwe?

Zimbabwe is now one of the countries that is classified as near or at epidemic control according to the PEPFAR classification, meaning we are nearing the vision of the Sustainable Development Goals to end AIDS by 2030. ??

We are still only linking 65% of children to antiretroviral medication, as opposed to 95% of adults. Once we locate children, they are almost always linked to treatment, but there remains a gap in terms of finding them. And then we are talking about linking them to the first line of treatment, which is the first defense of medicines.

However, some children don't do too well. It may be for various reasons. It could be poor adherence. It could be they just don't do well with the medicine.? If children fail on the first line of treatment and they don't get access to second or third line, they are at high risk of developing AIDS and dying.

We are addressing the gap in?tracking those children. Obviously, the goal is to make sure that we don't have any children failing, but they do fail, and they still will need support.??

3. Are you excited about ICASA coming to Zimbabwe???

ICASA is a really exciting to have this opportunity to have all the wonderful partners, implementing partners, donors, and to get to hear all the wonderful work that people have been done and have an opportunity to showcase what we can about our beautiful country and about the great strides that we've done and the work that is currently on hold.??

EGPAF is key to the different conversations that are going on. We're part of the technical team and the core secretariat of the Global Alliance that was launched to end AIDS in children by 2030. We'll be showcasing the work that EGPAF-Zimbabwe and the other EGPAF countries have been doing across the years—taking stock of the successes that we've had in managing HIV and AIDS and defining what the next steps are.?

Learn more about EGPAF's engagement at ICASA.

4. What are your thoughts on the importance of maintaining focus and funding on HIV???

We've done extremely well overall in closing the tap when it comes to HIV. Many countries are reaching the 95-95-95 targets, meaning that 95% of the population has been tested for HIV, 95% of those who test positive are on treatment, and 95% of those on treatment are virally suppressed.??

Across the HIV cascade children have not done well at all, and I think that was one of the motivations behind the launch of the Global Alliance.??

We’ve been hearing the conversation around the PEPFAR reauthorization challenges, but when you decide that HIV is not as big of a problem, you just don't pull up stakes. Instead, you look where the gaps are and where there's still a need and there's a transition. PEPFAR has already started to fashion a sustainability plan, but I think that to abruptly pull out could actually be quite disastrous for the millions of people on treatment.???

One of the things that have been lacking in the sustainability talk has been the financial aspects. Where will the money come from to support poor and vulnerable people who have been supported through PEPFAR???

There are a lot of good models that have been put out, like using national health insurance, public private partnerships, but I think they need to be at a stage where they've been seen to be successful, rolled out successfully. We are not there yet.?

?5. How do you relate to Elizabeth Glaser? ?

One thing that really strikes me about Elizabeth’s life is that it began as a fight of a mom for her own child. But it then became bigger than that. She realized that it wasn't just her own child. ?

There are mothers who have the same kind of pain that Elizabeth had when she looked at the situation for her own child.

But those mothers are very limited as to what they can do either because the, they are economically disadvantaged, they're educationally disadvantaged, they're geographically disadvantaged, and they don't know where to start.??

I think as we have that unique privilege to be able to join the fight of the mothers, different mothers, particularly the vulnerable mothers in our society, to help ensure that we in and we help fight for the survival of their children to ensure that their children have access to HIV treatment, to ensure that those that are on HIV are doing well and we don't have their children dying unnecessarily when help is out there.??