Zimbabwe is trying to develop a homegrown, sustainable HIV response amid growing calls by international donors for countries to take ownership of epidemic control and reduce dependence on external aid.
The shift comes at a critical time for Zimbabwe, as years of significant donor support, particularly from the United States President’s Emergency Plan for AIDS Relief (PEPFAR), the Global Fund and multilateral institutions are now recalibrated toward government-led initiatives, with a strong emphasis on sustainability and domestic financing.
A major jolt to this transition came on January 20, 2025, when US President Donald Trump issued an executive order halting certain global health programmes, including HIV prevention interventions.
The sudden freeze raised fears that hard-won gains in Zimbabwe’s national HIV response could be reversed.
“Zimbabwe has a constrained fiscal space when it comes to funding the HIV response,” acknowledged National AIDS Council (NAC) Bulawayo provincial manager Sinatra Nyathi presenting on Zimbabwe’s sustainability roadmap during a recent NAC media tour.
“Despite achieving epidemic control, we still have differential attainment across key and vulnerable populations, children, adolescent girls and young women. Issues of stigma and discrimination continue as a problem. The current stigma index report says stigma is not going down but actually going up.”
Nyathi said though Zimbabwe remains in the epidemic control phase, having met the UNAIDS 95-95-95 targets, fears remain that gains made could be reversed without a clear domestic sustainability strategy.
According to official statistics, as of 2023, Zimbabwe recorded 15 474 new HIV infections, a decline from 22 882 in 2019 and marking a 79 percent drop since 2010.
Around 1.3 million people live with HIV, 60 percent of them women, with prevalence remaining highest in the southwestern regions.
The country’s sustainability roadmap, led by the Ministry of Health and Child Care and NAC, is developed in collaboration with stakeholders including UNICEF (lead technical partner), UNAIDS, World Bank, Global Fund, USAID, PEPFAR, WHO and local civil society actors.
“The process is led by the Minister of Health and Child Care to make sure the sustainability roadmap is embedded within the Government of Zimbabwe planning process,” Nyathi said.
“The sustainability technical working group’s function was to provide overall technical guidance to the process and direction including stakeholder engagement, support sustainability assessment, development and implementation of the roadmap.”
Nyathi said Zimbabwe defined its sustainability as the country’s ability to achieve and maintain epidemic control and end AIDS as a public health threat through a resilient, transparent, and accountable health system supported by domestic resources.
The roadmap outlines several pillars such as making sure HIV remains a political priority and is embedded in national policies, data systems are strengthened to guide programme planning and monitor outcomes.
Other pillars are to transition HIV services into primary care with a focus on continuity and quality, mobilising domestic resources and improving efficiency in public health spending, promoting a rights-based approach to care and sustaining a skilled, motivated workforce aligned with national strategies.
Nyathi said Part A of the roadmap, including assessments and stakeholder consultations – was completed in 2024, with a launch originally planned for World AIDS Day.
Part B will detail implementation and resource mobilisation.
However, the US executive order has cast a long shadow as some prevention programmes closed abruptly and patients began stockpiling antiretroviral (ARV) drugs amid fears of supply disruptions.
“The government has been working on an electronic health data system, so that if one is on ART and takes their drugs in Bulawayo and tomorrow are in Beitbridge, they should be able to take them. But because of the stop work order now, people living with HIV are not sure whether they will have enough supply of drugs. So they are taking advantage to go and pick all over so that they will have a buffer,” Nyathi explained, noting the system is not yet fully functional.
Zimbabwe’s response has also included broader policy discussions, including the possible revision of the AIDS Levy and the introduction of a National Health Insurance Scheme.
“Other countries like Namibia are already implementing rural household levies to fund health insurance,” Nyathi noted.
“Zimbabwe is still in dialogue.”
PEPFAR’s role is also shifting. While it is not exiting Zimbabwe, it is transitioning from direct service provision to supporting government systems and community partners.
“PEPFAR is not going away, but would have a different role during this transition. A more pragmatic role is that the next two years of seeing the country’s operation plan cycle 2025 will be the key cycle to make investments to prepare for the transition,” Nyathi said.
Zimbabwe has made impressive strides in reducing new infections and increasing treatment access, however Nyathi said risks remain if the sustainability agenda falters.
These include fragmented data systems, uncoordinated stakeholder efforts and insufficient domestic financing.
One key shift is reframing HIV not as an emergency, but as a long-term development challenge.
“When HIV was an emergency, we relied heavily on donors. Now, we must embed HIV services into the everyday health system,” Nyathi said.
However, challenges remain and balancing urgent needs with long-term planning in a resource-limited environment is not easy.
“HIV reminded us all that sustainability is about planning for people living with HIV and there is a need to think through how the future of the AIDS movement would look like beyond 2030, especially at this point in time,” said the NAC provincial manager.
“We need to keep watch of the disease. It’s a disease difficult to control. There is a need to remain on the guard, alert and educate the new generation.”
Nyathi said a sustainable HIV response must reflect all these realities.
“We didn’t even finish the planning of 2025. There will be dramatic shifts under that 2025 plan towards simplicity and sustainability from more directive guidance to what is driven by the government’s vision,” she said, noting that implementation relies on navigating uncertainties triggered by global funding shifts.