HIV programming in Bulawayo and across Zimbabwe is increasingly under strain as shrinking funding continues to cripple prevention interventions, raising concerns that hard-won gains made over decades could be reversed if sustainable, locally driven solutions are not urgently implemented.
This situation highlights a troubling contradiction between policy commitments and funding realities, where donor fatigue and budget cuts have deprioritised HIV prevention programmes.
Reflecting on Bulawayo’s 2025 third quarter HIV Programming, National AIDS Council (NAC) Bulawayo provincial manager, Sinatra Nyathi, warned that while treatment programmes remain relatively supported, prevention initiatives are bearing the brunt of declining donor funding, leaving communities vulnerable to new infections.
“One thing that was key in the sustainability roadmap was that HIV and AIDS was removed from being an emergency to being a challenge,” Nyathi said at a recent meeting with journalists.
“On its own, that speaks to resources and if something is seen as a challenge, it is regarded as something that we can live with.”
Nyathi stressed that this policy shift, while signalling progress, has also contributed to reduced urgency in funding HIV prevention, particularly from international donors who now prioritise treatment over prevention.
“We really want to make sure that political leaders keep HIV on the agenda,” she said.
“As we try to sustain programmes as a country and as provinces, at least it must remain a priority.”
Zimbabwe is now under pressure to rely more heavily on domestic funding sources, particularly the AIDS Levy, which remains the main local financing mechanism for HIV and AIDS programmes.
“There is pressure on the AIDS Levy because that is currently the only resource that is there for HIV and AIDS,” Nyathi said.
“In fact, everyone is looking at the AIDS Levy.”
Nyathi said NAC is now emphasising the need to clearly define priorities and maximise the use of limited domestic resources while shifting towards low-cost, high-impact prevention programmes that can be sustained at community level.
“As NAC, we need to target and know what we want to achieve. The emphasis really is on domestic resources that we need to maximise,” she said.
“We also need to implement high-impact but low-cost prevention programmes because, as we know, the US government is no longer supporting prevention programmes. For now, they are supporting treatment.”
The NAC official warned sidelining prevention could have serious long-term consequences, despite its proven cost-effectiveness.
“We know prevention is better than cure,” Nyathi said, noting if prevention programmes were not receiving support, there was a need to make sure “high-impact, low-cost activities are implemented and targeted at the household level.”
Nyathi said NAC is increasingly focusing on community-driven solutions that empower families, churches, neighbourhoods and local leadership structures to curb new infections.
“As NAC, we are asking, what can we do at family level, at society level, at church level, at neighbourhood level, to make sure that we control the further spread of HIV?” she said.
She added that NAC is also integrating non-communicable diseases (NCDs) into its programming, recognising that people living longer with HIV are increasingly affected by conditions such as hypertension and diabetes.
“The prevalence of NCDs right now is actually higher than HIV,” Nyathi said.
“That’s why in our programmes we are incorporating NCDs.”
Nyathi said differentiated service delivery (DSD) models are playing a critical role in easing pressure on health facilities while improving patient care.
“These are services that are tailor-made to the individual. That’s why we have multi-month dispensing. If one is HIV-positive and stable, there is no need for them to go to the clinic every month,” she said,
Under this DSD model, stable patients can collect medication for three to six months, reducing travel costs and congestion at clinics.
“The recipient of care should actually determine what works for them,” Nyathi said.
“Some people are working across borders. We even have what we call the malayitsha type of DSD, where people send malayitsha to collect their medication on their behalf.”
However, patients are still required to return periodically for viral load monitoring and clinical reviews to make sure their treatment is effective.
“All these efforts are meant to make recipients of care get the best services,” Nyathi said. “Imagine if everyone who is HIV positive in Zimbabwe is on treatment and there are no new infections. It would mean we have won the battle.”
Nyathi acknowledged that the withdrawal of some donor-funded prevention programmes also left gaps for vulnerable populations necessitating the need for home-grown solutions.
“We realise that some of the solutions were coming from the US government. It (the aid) was coming with strings attached. For some other vulnerable population, there were strings attached. Now they are saying they are no longer doing those programmes for such vulnerable communities,” she said.
Therefore the focus must now shift to strengthening family and community structures to address issues such as teenage pregnancies and risky behaviour among young people.
“As Zimbabweans, let’s put our heads together and find solutions that work for us,” Nyathi said. “How do we involve gatekeepers, parents and communities? How do we strengthen parent-to-child communication?”
Nyathi said despite funding challenges, NAC remains optimistic that Zimbabwe can meet its 2030 targets if communities take ownership of the response.
“The greatest resource that we have as a nation is human resources,” she said.
“If all of us go out and impact our families, teenagers, schools and churches, we can win this battle.”
NAC has also reviewed its strategies, including the Zimbabwe National AIDS Strategic Plan (ZNASP), which will run from 2026 to 2030.
“We have reviewed our strategies in 2025, and they are now tailored to meet the challenges we are facing,” Nyathi said.
In an interview, Bulawayo’s Provincial Medical Director, Dr Maphios Siamuchembu, also concurred shrinking funding is crippling HIV programming, with prevention interventions taking the hardest hit.
He said programmes that were once robust, such as community outreach, condom distribution and male circumcision mobilisation have been scaled down or stopped altogether due to resource constraints.
“On the ground, this has resulted in fewer prevention campaigns, reduced community engagement and a growing risk of new HIV infections, particularly among young people and key populations yet prevention remains cheaper and more sustainable in the long term,” Dr Siamuchebu.
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