Title: Allowable deaths, Leave-no-one-behind and the value of human life in Zimbabwe. What actions to accelerate early progress on the implementation of SDGs
Funder: Economic and Social Research Council

Abstract: countries in Southern Africa account for over 50% of HIV infections worldwide, with 9 of the region's 14 countries registering an adult HIV prevalence rate of over 10%. Although advances in HIV treatment have kept people well and stemmed infections, 2 million get infected yearly, 38 million live with HIV, and over 20 million don't access antiretroviral therapy (ART) (UNAIDS 2016). Research tracking the latest data on donor government funding to address the HIV epidemic in low and middle-income countries shows a decrease in donor funding from US$8.6 billion in 2014 to US$7.5 billion in 2015 (Kates et al 2016). UNAIDS (2016) estimates that resources to address the epidemic need to rise from US$19 billion in 2015 to US$26.2 billion in 2020 to reach global SDG targets by 2030. The Zimbabwean situation is severe. With more than 75% of its population experiencing poverty, 15% of its adult population living with HIV (ZimSTAT 2015), it accounts for 5% of all new infections in Africa. Zimbabwe's total years of life lost due to premature mortality increased by over 150% between 1990 and 2010 because of HIV/AIDS, yet domestic funding for HIV remains insignificant(IHME 2014). The uncertainty of donor government funding, the largest ART contributor in Zimbabwe and other low-income countries, aggravates HIV challenges. But, it is not all PLHIV who struggle to access ART, it is the poorest, sexual minorities, female sex workers, prisoners, women and children who have it the hard way (Machingura 2016). Unless inequality in ART access is tackled, these vulnerable social groups will continue to constitute an ever-growing marginalized group of those left behind. Such inequalities will undermine progress on AIDS eradication and poverty reduction, creating the kind of social tensions and political dynamics that can derail the SDG agenda, and drive countries away from positive engagement in international processes. Building on my doctoral research, the proposed work confronts these challenges in two ways. Firstly, the work sets out to engage political, academic, media and policy audiences to further conversation on leaving no one behind using my doctoral research findings as a starting point. Specifically, the work will engage with the MoH, NAC; and UZ in Zimbabwe; UKZN-South Africa; SADC-Botswana; ECSA-HC Tanzania and civil society working with PLHIV. It will also involve the University of Manchester, and global think tanks. This international network will assist to leverage and build impact opportunities to bring back political and policy attention on HIV allowable deaths. Secondly, the work aims to pin down the priorities of the marginalized groups of PLHIV by digitizing and weighting their priorities through community level data traces. These will be linked with big data through wellbeing weighting economic techniques and transformed into a community HIV outcome measure (CHOM) to strengthen understating on what matters for the most vulnerable and how data uptake by those most vulnerable could improve patient choice. This approach is significant especially when data traces are the condition to access free health care and a pathway to addressing inequality at the community level where the need is greatest. This work, unique in its approach, combines high-quality research with communications work, high-level political and academic networking, strategic convening and policy advice, dissemination and public engagement on what it means to confront allowable deaths and to 'leave-no-one-behind.' This work will maintain the momentum for action needed to continue dialogue on HIV and also demonstrate relevance in the implementation of SDGs and tracking progress for marginalized social groups. The work aims to put the lives of the poorest at the center and to show how their views and values can be better incorporated into policy making.


Research activity codes: 8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE;8.4 RESEARCH DESIGN AND METHODOLOGIES (HEALTH SERVICES)
Health categories: INFECTION