Zimbabwe needs at least US$67 million in 2026 to sustain its HIV response after a partial suspension of the United States President’s Emergency Plan for AIDS Relief (PEPFAR), according to sources.
The funding gap could rise to US$280 million if further reductions from the US and the Global Fund occur.
Once praised as one of the best in the sub Saharan region, Zimbabwe’s HIV programme is uncertain following a “Stop Work Order” issued by the US Government on 20 January 2025.
The order has already triggered a cascade of programme suspensions, notably affecting HIV prevention services that were previously freely accessible to vulnerable populations.
Speaking during a recent National AIDS Council (NAC) media tour, NAC Bulawayo Provincial Manager, Sinatra Nyathi, painted a sobering picture of the situation.
“In July 2024, we were already discussing sustainability issues but the executive order was a bombshell, which came when we were planning,” she said. “This one was a serious disruption.”
The most immediate impact of the executive order has been on HIV prevention.
Nyathi said programmes such as Voluntary Medical Male Circumcision (VMMC), Pre-Prophylaxis (PrEP) and the DREAMS programme, which targeted adolescent girls with reproductive health and vocational skills, have all been defunded.
“They stopped funding all the prevention programmes. They are no longer supporting VMMC, PrEP, the DREAMS programme and key populations,” Nyathi explained.
“Now there are only two genders,either you are male or female, no in-between, no transgender. They are also no longer supporting the Post-Exposure Prophylaxis (PEP) programme.”
Previously free services are now available only at a cost, as Nyathi highlighted that the Population Services Health (PSH) clinics, once offering free circumcision, now charge US$20, a heavily subsidised fee compared to over US$200 in private clinics.
“Condoms are now for sale,” she added.
Zimbabwe’s HIV-positive population, around 1.3 million people, risks losing access to life-saving antiretroviral treatment (ART) and preventive drugs like PrEP.
“Imagine that service where people go by appointment, get your ART, and some of them are actually getting their treatment at home, delivered at your doorstep, but all that luxury is gone. Now we have to focus on my rights, my health, my responsibilities, where people take responsibility for their health,” said Nyathi.
She said Bulawayo alone saw 53 HIV-related programmes shrink to just seven skeletal services, with key centres like the Lobengula VMMC clinic completely shut down.
“The DREAMS programme under ZHI is totally gone. The Communities School Partnership Programme gave grants to schools, only six or ten schools received grants before the programme ended,” she said.
The Ministry of Health and Child Care’s response, shared during Nyathi’s presentation, revealed that Zimbabwe needs at least US$67 million in 2026 to sustain its HIV response.
The funding gap could rise to US$280 million if further reductions from PEPFAR and the Global Fund occur.
Zimbabwe faces a current HIV programming gap of US$13 million in 2025, which is projected to widen to US$67 million in 2026.
“For now, the key programme in place is treatment. You are assured that for now also due to donors and that we had adequate stocks. As part of stocking levels at any given time need to stock six months. We still have those,” Nyathi noted.
“Even the commodities for VMMC those that were remaining we still have them but as soon as we finish them for prevention the government has to buy more,”
The broader HIV programme’s financing is precariously dependent on external donors: the Global Fund provides 41 percent, PEPFAR – 32 percent, private sector – 21 percent, public resources – four percent and all other international partners -two percent.
“We realise as a country we are supporting about 20 percent of people on ART with our AIDS levy, but the support from the other donors was really pushing us, making us stable, but we are saying we are not giving up as a country. So Zimbabwe stands to lose 55 percent of current HIV funding by September, growing to 90 percent by December 2026, and risking reversal of commendable gains made by Zimbabwe to date that we need to jealousy guard,” Nyathi warned.
The NAC provincial manager said the Ministry of Health has developed a mitigation strategy to manage the fiscal shock and prevent further service collapse.
“Key measures include HIV commodity security -Zimbabwe has secured adequate ARVs, PREP, test kits and diagnostics through December 2025, leveraging on national and partner resources,” she said.
“Human resource optimisation – mapping of all nurses supported by partners, the proposal for a nationwide health force redeployment exercise is underway to ensure continuity of essential HIV services by reallocating Ministry of Health and Childcare personnel following the withdrawal of the owner supported carers.
“Differentiated service delivery (DSD), the multi-model dispensing of ART and PREPs has been implemented alongside the expansion of external pickup points and community refill groups to decongest facilities and ensure continuity.”
Nyathi revealed that discussions are underway to mobilise US$30 million to US$50 million annually in domestic resources, including ringfencing revenue from sugar, alcohol, fast food, and tobacco taxes for HIV-related health services, increased use of the AIDS levy to support ART and TB care, exploring funds from a Sovereign Wealth Fund and introducing targeted user fees with exemptions for vulnerable groups.
“Way forward, these measures are expected to mobilise approximately $30 to 50 million annually in domestic resources, cabinet approval is required to work with the Minister of Finance and Economic Development to implement revenue, ringfencing mechanisms and expand levy allocation.
In light of the severe fiscal threats to Zimbabwe’s HIV response and the risk to public health, the Ministry of Health noted that Cabinet is requested to endorse the proposed domestic financing measures, mandate the Ministries of Health and Finance to operationalise the ringfencing of their levies and approve an inter-ministerial taskforce to oversee implementation and transition planning.
“Given the number of lives that will be at potential risk due to lack of life-saving medicines and services, it is recommended to activate the declaratory processes of a state of emergency to enable additional resource mobilisation strategies,” Nyathi noted.
Despite the overwhelming challenges, the NAC provincial manager urged Zimbabweans to remain hopeful and proactive.
“We cannot be discouraged. We need to work and empower ourselves, say what systems can be put in place to make sure there is no further spread of HIV. We are looking for everyone to take responsibility, from household to school to church to community, all the institutions,” Nyathi said.
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