Tawanda Musarurwa
ZIMBABWE could be quietly scripting one of the most under-reported public health victories of the 21st Century.
Since the peak of the HIV/Aids epidemic in the early 2000s, the country has slashed new infections and deaths by more than half.
According to the latest Joint United Nations Programme on HIV/Aids (UNAids) Country Fact sheet for Zimbabwe (2023) and the HIV Estimates Fact sheet 2024, the country has made staggering strides:
– New HIV infections have dropped by 81 percent since 2010.
– AIDS-related deaths have declined by 66 percent in the same period.
– 1,2 million (or 92,3 percent) of people living with HIV in the country now know their status and are on antiretroviral therapy (ART).
But these achievements mask the persistent vulnerabilities faced by women, children and prisoners, for example, – populations where HIV prevalence is disproportionately high and where stigma continues to erect barriers to care.
The big picture
In 2023, 1,3 million Zimbabweans – adults and children – were living with HIV, with 15 000 new infections recorded that year (down from the 79 000 new infections recorded in 2010).
The 2023 numbers reflect an HIV prevalence of 10,5 percent among adults aged 15 to 49, placing Zimbabwe among the highest prevalence countries globally.
However, compared to 2010, this is a significant drop, thanks to robust ART coverage and improved testing infrastructure.
According to the data, approximately 91 percent of those on ART have achieved viral suppression, which is a critical threshold that dramatically reduces transmission risk.
Zimbabwe is edging closer to the UNAIDS 95-95-95 targets (95 percent know their status, 95 percent on treatment, 95 percent virally suppressed), showcasing a commendable public health infrastructure.
Yet, zooming into demographic sub-groups exposes a more nuanced reality.
Women bearing the heaviest burden
Of the 1,2 million adults living with HIV, 750 000 are women – nearly two-thirds.
Among women aged 15 to 49, the HIV prevalence stands at 13 percent, compared to 7,9 percent for men.
That gap widens even further among newly infected adults: 7 500 women were newly infected in 2023, compared to 4 400 men for ages 15 and older.
This disparity is not just about biology; it reflects deeper systemic issues.
Young women aged 15 to 24 face both higher infection rates and higher exposure to intimate partner violence.
The Zimbabwe National Statistics Agency (ZimStat)’s 2019 Multiple Indicator Cluster Survey (MICS), shows that 31,3 percent of girls aged 15 to 19 and 29,8 percent of women aged 20 to 24 have experienced recent intimate partner violence, a well-documented driver of HIV vulnerability.
While antiretroviral therapy coverage for women is impressive – 98 percent of HIV-positive women aged 15 and older are on treatment – early detection and prevention still lag, especially among adolescent girls.
And despite these numbers, only 26 percent of women living with HIV have undergone cervical cancer screening, a critical yet neglected health check given their heightened risk.
Children and the hidden threat of vertical transmission
Children represent a smaller slice of the epidemic – 70 000 children aged 0 to 14 are living with HIV – but the situation remains troubling.
In 2023 alone, 3 600 children were newly-infected, mostly via mother-to-child transmission.
Zimbabwe’s Prevention of Mother-to-Child Transmission (PMTCT) programme reports 88 percent coverage and 84 percent of HIV-exposed infants received early diagnosis.
But despite these efforts, the final vertical transmission rate stands at 7,35 percent, meaning nearly one in 13 HIV-positive pregnant women still transmit the virus to their babies.
That rate reveals cracks in postnatal follow-up and treatment adherence, especially during breastfeeding.
And while 830 000 HIV-exposed children remain uninfected, their continued vulnerability underscores the need for robust paediatric HIV services.
Sex workers and prisoners at high risk
Sex workers represent the single most affected demographic.
According to a 2023 survey, a 40,2 percent HIV prevalence for sex workers is nearly four times the national average.
While 96,6 percent of sex workers know their status and 83,4 percent are on treatment, stigma remains a major obstacle: 43,7 percent avoid healthcare due to discrimination, the 2019 MICS shows.
For prisoners, the HIV prevalence is 16,7 percent.
Still, the country has achieved an impressive 98,2 percent ART coverage in prisons, with 164 100 condoms distributed in 2021. This suggests targeted interventions can be highly effective, even in constrained settings.
Is prevention the missing piece?
Despite gains in treatment and testing, prevention efforts appear to be lagging.
Zimbabwe’s condom use at last high-risk sex stands at 79 percent, but that data comes from the 2015 Zimbabwe Demographic and Health Survey (DHS) survey – a reminder that updated behavioural data is sorely needed.
Only 30 396 people received pre-exposure prophylaxis (PrEP), a surprisingly low number given Zimbabwe’s 1,3 million HIV-positive population.
Meanwhile, HIV knowledge among young people aged 15 to 24 is dangerously low; according to the data, just 46,44 percent can correctly identify prevention methods.
Who pays?
Zimbabwe spent US$276 million on HIV programmes in 2023, from international sources.
HIV expenditure from domestic public sources and domestic private sources was not reported.
If the country is highly dependent on donor funding for HIV programmes, that places it in a precarious position in a world of shifting geopolitical alliances and donor fatigue. US President Donald Trump has rolled back a number of USAID programmes. USAID, through the President’s Emergency Plan for AIDS Relief (PEPFAR), has been providing financial support to the country to combat HIV/AIDS, supporting treatment, prevention and strengthening health systems.
While the extent of the roll-back is not yet fully clear – and to what extent it will, the PEPFAR funding towards Zimbabwe will be reduced – the geopolitical shifts show the need for Zimbabwe to ensure sustainable financing for HIV/AIDS programmes.
Earlier in February, Health and Child Care Minister Dr Douglas Mombeshora told Parliament that the country had ARVs supplies for the next six months.
“As a matter of policy, we already have supplies of the ARVs for the next six months and procurement processes to get drugs that will last until the end of the year are already under way,” he said.
The Minister also said 31 percent of the ARVs in the country were procured through US funding, which means the USAID roll-back should not gravely affect Zimbabwe’s ARVs supplies in the long-run.
But HIV/AIDS programmes – as the UNAIDS 95-95-95 targets (testing, treatment and suppression) show – have a broad scope.
The stigma barrier
Finally, stigma and misinformation remain silent but powerful forces.
According to 2019 MICS data, 26 percent of Zimbabweans aged 15 to 49 would not buy food from someone with HIV, and 10,1 percent believe children with HIV should not attend school with HIV-negative peers.
While these figures may seem small, they represent over 1,5 million people in a country of 16 million.
What next?
Zimbabwe’s HIV story is one of progress – but also of polarisation.
The numbers show that the country has done an extraordinary job of building treatment infrastructure and scaling up ART.
But prevention, gender equity, stigma reduction and targeted interventions for key populations can be better.
If Zimbabwe is to truly “end AIDS by 2030,” as global targets urge, it must address not just the virus, but the social architecture around it: the violence, the stigma, the funding gaps and the silenced stories of those most affected.
Zimbabwe is among the countries whose programmes are key to ending the HIV/AIDS epidemic.
“Botswana, Eswatini, Rwanda, the United Republic of Tanzania and Zimbabwe have already achieved the “95-95-95” targets.
“That means 95 percent of the people who are living with HIV know their status, 95 percent of the people who know that they are living with HIV being on lifesaving antiretroviral treatment and 95 percent of people who are on treatment being virally suppressed,” said UNAIDS executive director Ms Winnie Byanyima in a 2023 report titled ‘The Path That Ends AIDS’.
“A further 16 other countries, eight of them in sub-Saharan Africa, the region which accounts for 65 percent of all people living with HIV, are also close to doing so.”
The epidemic is clearly shrinking, but it is not yet over.
ORIGINALLY PUBLISHED IN THE HERALD – https://www.heraldonline.co.zw/zim-makes-remarkable-progress-in-hiv-fight/