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.