A new HIV Prevention & Accountability report developed by Frontline AIDS and community partners in Zimbabwe show that while the government is making positive progress in areas of HIV prevention, these are not enough to curb the increasing number of people being infected with HIV each year.
Zimbabwe is making positive progress in several areas of HIV prevention. Between 2020 and 2022 the number of new HIV infections reported in Zimbabwe has reduced by 7%. And there have been 73% fewer HIV infections reported among children between 2010 and 2022.
It has recently developed a new Monitoring and Evaluation (M&E) framework and is actively working on establishing a national digital health strategy, as well as taking commendable steps towards closing the gap in service coverage for adolescent girls and young women and adolescent boys and young men through public (social) contracting.
While progress towards HIV prevention in Zimbabwe is moving in the right direction, the HIV Prevention & Accountability report developed by Frontline AIDS and community partners has highlighted a number of barriers preventing the country from progressing further.
These barriers have the ability to reverse the gains achieved by Zimbabwe's health budget, compromising the sustainability of the country's HIV response and reducing the likeliness of Zimbabwe meeting its target to reduce new HIV infections to 14,000 annually by 2025.
Shrinking civil space
Civil society and community organisations play an essential role in the HIV response, particularly in reaching people who face stigma, discrimination or criminalisation, or who are otherwise left behind.
But in 2023, Zimbabwe introduced the Patriotic Act which presents huge limitations for civil society organisations (CSOs) when it comes to civic space. Under these new laws, civil society and community organisations working in HIV prevention can also be prosecuted and threatened.
The Act has also resulted in changes to the registration of non-governmental organisations (NGOs), which has created more bureaucracy and discrimination against key population-led organisations - limiting their ability to hold government to account.
Within the report, Frontline AIDS partners recommend that Zimbabwe repeals the Patriotic Act, removing barriers to civic space and recognising the vital role that civil society has in engaging government on accountability.
Growing anti-rights movements
Zimbabwe has shown some commitment to human rights by repealing Section 79 of the Criminal Code on the wilful transmission of HIV.
Research has highlighted an organized and well-funded anti-rights and anti-LGBTQ+ movement which is rapidly gaining influence across Africa, including Zimbabwe, posing a major threat to HIV prevention progress.
The growing movements are threatening access to sexual reproductive health and rights (SRHR) services for youth in Zimbabwe, as well as LGBTQ+ communities and people who use and inject drugs.
Within the report, Frontline AIDS community partners have urged the Zimbabwean government to stand up against anti-rights narratives and to defend HIV prevention services as they are essential for protecting the health and wellbeing of all communities.
Restricted access to prevention technologies
Zimbabwe set a precedent in Africa for the speedy approval of both Cabotegravir Long-Acting Injectable PrEP (CAB-LA), the long-acting injectable PrEP, and the Dapivirine ring (DVR), when these technologies were added to the Guidelines for HIV Prevention, Testing and Treatment of HIV in Zimbabwe in 2022.
However, access to these commodities is being limited due to funding, sustainability, demand creation, the licensing of distributors, and the poor dissemination of guidelines across communities.
The same can be said for condoms. Condom use across Zimbabwe is high, attributed to the implementation of a total market approach, effective awareness campaigns and specific population targets. But there are concerning challenges with stock outs due to delays in shipments, as well as policies prohibiting the distribution of condoms in schools and prisons, limited funding and myths/misinformation around free condoms – meaning that they are not as accessible as they should be.
Tensions in political leadership
HIV response in Zimbabwe is coordinated by NAC, and decentralised through Provincial AIDS Action Committees (PAACs) and District AIDS Action Committees (DAACs). They are responsible for supporting the coordination of the response at provincial and district level.
The new report has highlighted that tensions exist between NAC and PAACs/ DAACs, due to the NAC having more high-level staff than DAACs and PAACs, leading to a resource imbalance.
The DAACs and PAACs are therefore underfunded and provinces with higher HIV prevalence often receive lower allocations compared to NAC.
The report urges more open solidarity between these entities, to rebuild this fragile political environment,
Lack in government funding
Over the years, the proportion of government budget allocated to the health sector in Zimbabwe has fallen below the Abuja Declaration target of 15%, at 11% in 2023.
As such, the report recommends an increase domestic funding for health to reach the 15% Abuja Declaration target.
It also remains unclear whether the government still plans to roll out the National Health Insurance (NHI) scheme scheduled for 2025, and whether service packages for key populations will be included.
Lois Chingandu, Director of External Relations, Frontline AIDS, said: "It is important that countries do more when it comes to investing in HIV prevention methods but also show stronger leadership in countering anti-rights narratives within their countries. Well-funded and highly organized movements are promoting anti-gender and anti-LGBTQ+ narratives which have resulted in 7 out of the 10 countries we have recently analysed criminalizing people who engage in same-sex sexual acts.
"While progress has been made, barriers to HIV prevention remain. Today's reports highlight the need for further investment to prevent HIV but also the need for much stronger leadership when it comes to countering anti-rights narratives if the global community is to strengthen and progress the HIV response across these nations.
In Zimbabwe especially, it's vital that we see an increase in domestic funding, a quick repeal of the Patriotic Act, and a much sturdier political environment, in order for the country to make further progress in the area of HIV prevention and to get close to meeting it's 2025 HIV infection targets."
Prof Nana Poku, Chair of Frontline AIDS, said: "Today's landmark report shows that while governments across Africa and in India have made important steps towards reducing the number of people newly acquiring HIV, much more can and needs to be done in the fight against HIV.
"Our reports highlight that all nine of the African countries analysed are presently failing to meet the target of spending 15% of their national budgets on health, as outlined in the 2001 Abuja Declaration. With effective tools and approaches to prevent HIV, including exciting new prevention technologies, it is vital that governments take the requisite steps in order to stop more people newly acquiring HIV around the world."