Zimbabwe’s fight against HIV and AIDS continues to face new challenges, with the National AIDS Council (NAC) in Bulawayo calling for a return to the basics, reminding communities how HIV is transmitted, how it can be prevented and why treatment adherence remains critical.
The call comes as Zimbabwe faces what NAC describes as a constrained HIV funding environment following the withdrawal of United States government support for a number of programmes, while health officials are raising concern over rising sexually transmitted infections (STIs), substance use and new HIV infections.
NAC Bulawayo Provincial Manager Sinatra Nyathi said the availability of antiretroviral drugs (ARVs), which have transformed HIV from a potentially fatal condition into a manageable one, appears to have created a perception among some people that HIV is no longer a serious threat.
“We need to go back to the basics, where we need to give people basic information about HIV, how it’s transmitted and how we can prevent it,” Nyathi said during a recent media tour organised by NAC as part of its efforts to strengthen public awareness and media engagement on HIV and AIDS prevention, treatment, care and support in Bulawayo Metropolitan Province.
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Nyathi stressed that while ARVs have improved the quality of life of people living with HIV, they do not cure the virus.
The concern, according to NAC officials, is the success of HIV treatment may create complacency around prevention, at a time when resources for the national response are becoming increasingly constrained.
Zimbabwe has spent decades building its HIV response, with prevention programmes, testing and treatment helping to reduce the impact of the epidemic.
NAC officials, however, said maintaining those gains will require communities to take greater responsibility for preventing new infections and adhering to treatment.
Nyathi said poor adherence to first-line treatment can result in patients moved to second- or third-line regimens, placing additional demands on already constrained resources.
“The issue is as you go up the ladder with the treatment, it means you are getting more toxic drugs and those drugs are also expensive as you go along the ladder of the treatment,” she said.
She urged people living with HIV to remain on first-line treatment where it remains clinically appropriate.
“Prevention is better than cure. Even if you have ARVs and you are on the first line, it’s best you remain on the first line because it is cheaper for the country and more friendly to the body than the second line and third line,” Nyathi said.
NAC stated treatment is only one part of the equation.
The provincial manager said the withdrawal of United States government funding had resulted in the loss of several partners and programmes, including prevention initiatives.
She recalled former Health Minister Dr David Parirenyatwa’s repeated emphasis on prevention, using the analogy of a leaking tap to explain why the country needed to focus on stopping new infections rather than only treating those already infected.
“When you go to your office and find there is water all over, what do you do first? You need to stop the tap which is leaking,” Nyathi said.
“At this stage we really need to identify all the taps where HIV is still leaking.”
NAC programmes officer, Douglas Moyo, weighed in that one of those leaks could be the gap between knowledge and behaviour.
He said many people could recite basic information about HIV but that knowledge did not necessarily translate into safer sexual behaviour.
“Just like we get used to the teachings in the Bible. Some people have become so used to the Bible that they can recite verses. But what does that mean? Do we change our behaviour after reciting those verses, knowing them by heart?” he asked.
Moyo said the same problem could apply to HIV.
“If you ask people around about HIV, they can tell you everything. But are they practising safe sex? Are they protecting themselves? Are they thinking about protecting the next person?” he said.
He said NAC was therefore questioning whether HIV messages had become so familiar that they were no longer changing behaviour.
“Is it the packaging of our message that people don’t understand? Is it because our people are used to the message that it no longer has a meaning, but we can just relate to it?” he asked.
One of the clearest warning signs, Nyathi added, was the continued occurrence of STIs.
“We are just not winning. We are getting more and more cases of STIs, which really shows that our people are not protected,” she said.
“Condoms are there, but we still have a lot of STIs. I don’t know what we can do to make sure our people are aware. STI is a proxy. If I have an STI, it means I can easily get HIV.”
The continued availability of condoms through the public sector is also uncertain, according to Nyathi, who said communities may increasingly have to take greater responsibility for purchasing their own protection.
“We still have condoms in the public sector, but we are not sure whether we will continue having them,” she said.
“We really need to teach our communities to take responsible actions in order to stop HIV at personal level, at family level, at community level and basically at national level.”
The funding squeeze, according to Moyo, is also felt beyond the direct provision of HIV services.
He said organisations affected by the loss of donor support had employed people who contributed to the National AIDS Trust Fund through the AIDS levy, meaning job losses could also affect future inflows.
“At the same time, we are already under-resourced, not only by the US funding, but if you look at the numbers of people that have lost employment, who were employed by those organisations that have shut, those employees were paying AIDS levy,” he said.
“That means that the AIDS levy inflows have been affected.”
Moyo said this raised a broader question about how Zimbabwe would sustain the gains made in its HIV response if external support continued to decline.
“Looking into the future, how do we sustain these programmes? How are you going to sustain the gains that we have made as a country?” he asked.
He said Zimbabwe could no longer rely solely on donors to carry the HIV response.
“This time we are looking at you. We are not looking at the donor beyond the borders. We are saying, what can you do? What can you do at your home?” Moyo said.
The officials also identified drug and substance use as another threat to HIV prevention, particularly among young people.
Nyathi said people under the influence of drugs or alcohol may be less able to make informed decisions about sexual behaviour, potentially increasing their vulnerability to HIV and other STIs.
She said communities needed to pay greater attention to young people and the environments in which they were growing up.
“We really need to start warming even the issue of drug and substance,” Nyathi said.
Her concern extends to families, which she urged to become more engaged in understanding what young people are exposed to.
She pointed to the growing use of drug-detection measures in schools as an indication of how serious the problem has become.
“If the schools have to use trained dogs to sniff drugs, honestly, should we look for those dogs even within our own homes?” Nyathi asked.
Her argument was that families should not assume problems such as drug use exist only at schools or elsewhere in the community, but should also examine what is happening within their own homes.
“Let’s start at the family level. Where is my child right now and what’s happening with my child? No matter what age,” she said.
NAC believes the HIV response therefore needs to extend beyond clinics and treatment centres. Families must talk openly about prevention, communities must confront risky behaviour, people living with HIV must adhere to treatment and policymakers must find sustainable ways of financing the response.
With Zimbabwe targeting the elimination of AIDS as a public health threat by 2030, Nyathi said complacency could undermine years of progress.
“We need to really work outside the box for us to meet the 2030 targets. We want to make sure HIV and AIDS is not a public health threat, but we are realising that the forces against them are too much,” she said.
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