Tawanda Musarurwa

CHECK POINT DESK

“EVEN when people know about HIV and take risks, there are still many reasons why some men might not go for testing.

“Sometimes it’s not about the person, but the situation around them. Maybe the clinic is too far, or they can’t afford transport,” says a social worker who works for a non-governmental organisation that operates in different provinces across the country.

“Some fear being seen there; others worry what the community will say. Some may feel pressure to act strong and avoid testing.

“And even though people have heard about HIV, there’s still a lot of confusion out there. So, it’s not just one thing, it can be a mix of different challenges that hold people back.”

While Zimbabwe has made significant progress in the fight against HIV/AIDS, achieving an 81 percent reduction in new infections since 2010 and moving steadily towards the 2030 target of a 90 percent reduction, new data indicates that young women are still more likely to get tested than young men.

As of 2023, statistics from the Ministry of Health and Child Welfare showed that around 1,3 million adults and children were living with HIV in the country, with 92,3 percent (or 1,2 million) of people living with HIV knowing their status and on antiretroviral therapy (ART).

But, the gender gap in HIV testing has the potential to fuel undetected infections.

The latest Zimbabwe Demographic and Health Survey (ZDHS) 2023-2024 reveals a troubling paradox: Although HIV knowledge among young people is widespread, testing coverage is stagnating — or even declining — especially for key risk groups.

While overall prevalence has plateaued and treatment coverage has improved, the data uncovers a quieter crisis: Young men, rural youth and those with lower education remain underserved in HIV testing.

Young men falling through the cracks

According to the latest ZDHS, in the past 12 months, only 37 percent of sexually active young men (aged 15 to 24) have been tested for HIV and received their results.

For young women, that figure is 58 percent.

This is a significant difference.

Since 2015, testing coverage in the country has actually decreased for both genders: Down from 63 percent to 58 percent among young women and from 39 percent to 37 percent for men.

This trend of young men escaping the radar was confirmed by a 2021 multi-authored study, titled “Progress toward the 90-90-90 HIV targets in Zimbabwe and identifying those left behind”, which was published on the HHS Public Access.

“A higher proportion of HIV-positive women were aware of their status (80,1 percent) than men (72,1 percent),” reads part of the study.

“Awareness of HIV-positive status was lowest among those aged 15-24 years (60,3 percent).”

The drop is especially concerning given how central HIV testing is to the country’s prevention and treatment strategies.

This gender testing gap is an epidemiological blind spot.

Young men’s avoidance of clinics creates pockets of undiagnosed HIV in communities, particularly rural areas, where transmission can simmer unseen, even as national figures improve.

Why are young men lagging behind?

Part of the answer may lie in gendered norms around health-seeking behaviour.

Young men are less likely to interact with health services and often view testing as something to be done only when symptoms appear.

Combine this with stigma and poor access to youth-friendly services, especially in far-flung areas, and the outcome can be predictable: Lower testing rates, even among those at risk.

Another possible explanation is that some men discreetly buy HIV self-test kits from pharmacies, avoiding testing at public health facilities.

Geographical disparities

A 2025 study titled “Assessing regional variations and sociodemographic barriers in the progress toward UNAIDS 95-95-95 targets in Zimbabwe”, published in the Communications Medicine journal, which carried geospatial maps of Zimbabwe’s HIV indicators, showed significant regional disparities and identified key geographical priorities.

The study, which used the 2020 Zimbabwe Population-based HIV Impact Assessment (ZIMPHIA) as its primary dataset, revealed a geographical mismatch in HIV testing versus burden, that is, the country’s southern provinces — Matabeleland South and southern Midlands — had the highest HIV prevalence (greater than 16,7 percent), and also the highest undiagnosed rates (greater than 13,4 percent).

This indicates severe testing gaps where the epidemic is most concentrated.

At the same time, the northern provinces — Mashonaland Central and Mashonaland East — showed lower prevalence (lower than 13,4 percent) and lower undiagnosed rates (lower than 9,1 percent).

Analysis of the study’s results suggests that Matabeleland South should have the highest priority for HIV testing interventions insofar as it has the highest prevalence nationwide (greater than 16,7 percent) and the worst undiagnosed rates (greater than 13,4 percent).

Knowledge not translating to action

The latest ZDHS also reveals another sobering insight: 50 percent of young women and 49 percent of young men aged between 15 and 24 have comprehensive knowledge of HIV prevention.

But knowing does not always lead to doing.

In Matabeleland South, only 25 percent of young men have basic HIV prevention knowledge, which is the lowest in the country.

Young people in rural areas are far less likely to know how HIV is transmitted or prevented.

This mirrors a broader pattern: HIV knowledge and testing rates climb with education level and household wealth.

For instance, urban youth are significantly more likely to get tested and use condoms than their rural counterparts.

Among sexually active youth, condom use at last sex is 88 percent in urban men compared to 79 percent in rural men and 62 percent among urban women compared to 52 percent in rural women.

So, while urban Zimbabwe is moving towards prevention, rural youth — especially the less educated — are stuck in a cycle of poor knowledge, limited testing and risky behaviour.

Missing a hint?

Sexually transmitted infections (STIs) often act as early warning signs for increased HIV risk.

Yet, despite 3 percent to 4 percent of all sexually active men and women reporting symptoms of STIs in the past year, many of these cases appear to be missed opportunities for testing.

The STI prevalence is notably higher among the 20 to 24 age group and among divorced, separated or widowed individuals — precisely the demographics that should be targeted for aggressive testing and counselling.

The data is damning: 11 percent of women and 5 percent of men reported having abnormal genital discharge or sores — classic STI symptoms — yet testing among these groups remains inconsistent.

If HIV testing was routinely offered at STI clinics or when symptoms are reported, testing coverage could dramatically improve.

But clearly, these connections are not being made systematically enough.

Risky behaviour without testing

While 12 percent of young men report having multiple sexual partners in the past year (compared to just 2 percent of young women), many are not seeking out testing, even though their behaviour places them at high risk.

Worse still, while 73 percent of young men with multiple partners used a condom at last sex, only 37 percent have tested for HIV in the same period.

This discrepancy suggests overreliance on condoms without confirmation of one’s HIV status — a fragile line of defence in a country where consistent condom use is not guaranteed.

Interestingly, condom use is higher among men and women with higher education and in urban areas, reinforcing how geography and access shape sexual health decisions.

Early sex, late awareness

The survey also highlights troubling trends around sexual initiation.

Forty-three percent of young women aged 18 to 24 report having had sex before the age of 18, compared to 30 percent of men.

The likelihood of early sexual debut is highest among those with only primary education: A staggering 72 percent of these young women had sex before 18.

And yet this same group is among the least likely to know how HIV is transmitted or how to get tested.

The combination of early sexual debut, low education and poor HIV knowledge creates a dangerous mix.

Despite decades of investment, data from the survey indicates that HIV testing campaigns may be hitting a wall when it comes to young men, rural communities and the less educated.

To this extent, knowledge is no longer the only hurdle.

As suggested by the social worker, the problem extends to behavioural, structural and even psychological issues.

In particular, young rural men with low education, those initiating sex early and those showing STI symptoms are not being reached.

While Zimbabwe’s HIV response has saved countless lives, the ZDHS (2023-2024) exposes critical gaps — particularly among young people, men and rural populations. And without urgent, targeted interventions, these groups will continue to fall behind, risking a resurgence of HIV transmission.

This concern has been heightened by recent aid suspensions by the United States.

“Zimbabwe has experienced disruptions in testing of pregnant women during prenatal care, early infant diagnosis, paediatric HIV treatment services and the sample transport system,” said UNAIDS in March.

Unless these emerging HIV testing gaps are closed, the country’s quiet progress could unravel — one untested youth at a time.

ORIGINALLY PUBLISHED IN THE HERALD – https://www.heraldonline.co.zw/hidden-gaps-in-zims-hiv-testing-who-is-being-left-behind/