As Donald Trump’s US presidency reaches its 100th day, Zimbabweans living with HIV are fearful about their futures as they struggle to get antiretroviral medication.

MWENEZI, Zimbabwe – Memory Sibanda tried three times to get antiretroviral medication from her usual clinic in February but was turned away.

The 67-year-old has lived with HIV for the past 28 years. Jobless and widowed since 2003 when her husband succumbed to AIDS, Sibanda is unable to afford to buy the medication should the government fail to supply it.

She finally received a three-month supply in late February – half the usual allocation – and is anxious about what will happen when this runs out.

“I don’t know if this reduction of our treatment pills is happening only here in our village. Nurses don’t say anything to us about what is happening with the pills. I fear we might eventually end up not receiving the drugs at all, meaning many of us might die,” Sibanda, who lives in Chomutsvairo village in the southern province of Masvingo, told Health Policy Watch.

In the capital, Harare, a similar crisis faces HIV/AIDS patients. Mavis Makumbe, 65, has depended on free ARV treatment from the government for decades. But in late February, her whole life changed when she visited the New Start Centre in the city to fetch her medication.

“I found a notice on the door saying it was closed and no longer in operation. From there, I went back home and started taking the remaining tablets, but those again were not enough,” said Makumbe, a widow who has lived with HIV for 24 years.

Fortunately, her daughter’s friends rescued her by buying six months’ allocation of ARVs. The current going rate is $20 for a month’s supply – a fortune for the average Zimbabwean, with 80% of people working in the low-income informal sector and battling huge inflationary costs each month.

This is unsustainable for Makumbe, who is also battling cancer on one of her legs.

HIV positive prisoners also told Health Policy Watch that medicines are scarce.

“Not so long ago, we were being given rations of limited ARVs. Things are now worse after America has stopped giving us aid. Even painkiller pills are now hard to find in jail,” said an HIV positive prison inmate at Chikurubi Maximum Prison in Harare.

Trump aid cuts

The ARV shortage was caused when US President Donald Trump suspended all foreign aid for 90 days with immediate effect on 20 January. The Trump administration has since disbanded the US Agency for International Development (USAID), and extended the aid cut for a further 30 days until 20 May.

“We were put in a very tough situation by the aid cut by President Trump’s government,” said Stanley Takaona, president of the Zimbabwe HIV/AIDS Activist Union Community Trust.

“The aid cut-off was a bit harsh. We are praying that both our government and the US government will put on a humanitarian face and save our lives, as people living with HIV,” added Takaona, 62, who tested HIV positive at the age of 34 and started taking ARV treatment in 2001.

The government’s pre-exposure prophylaxis (PrEP) initiative targeted at people with high exposure to HIV like sex workers has also been suspended amid the Trump administration’s global aid cuts.

In 2022, an estimated 1.3 million Zimbabweans were living with HIV, and 1.2 million were on ARVs – yet their medicine supply is now in jeopardy.

Progress under threat

Zimbabwe has made significant progress against HIV, and in 2023 it became one of only five African countries that achieved the 95-95-95 targets set by UNAIDS, with an estimated 95% of people with HIV aware of their status, 98% on treatment, and 95% of those on treatment having suppressed viral loads.

This is according to the United Nations Development Programme (UNDP), which has been the main recipient of the country’s Global Fund grant since 2009.

But with the US abandoning its commitments to combat the deadly virus abroad, activists like Sphiwe Chabikwa sees the gains made in fending off the disease being reversed.

“We are at risk. People may start dying again like what happened around 2000 and 2002 before ARVs were made available to everyone with HIV. I’m afraid,” said Chabikwa, who lives in Harare.

Chabikwa is a member of the Zimbabwe National Network of People Living with HIV (ZNNP+), the country’s network of people living with HIV.

For the past 25 years, Chabikwa has lived with HIV, and her steady access to ARVs has enabled her to manage the virus as a chronic disease.

“I get the second-line of antiretroviral treatment, but that again has had its supplies affected by the recent US aid cut. Instead of people living with HIV like me getting six months’ supplies of ARVs, this has now been reduced to three months’ supplies. That means the treatment drugs are in short supply and the authorities are trying to manage a crisis.”

Health experts predict that all the gains Zimbabwe made in defeating HIV might go to waste following the abrupt withdrawal of US aid.

Long queues now characterise the collection of HIV treatment, and patients are fearful about what the future holds for them.

Bribes for medicine

Fearing a future without ARVs, some other HIV patients admit to bribing nurses in order to get six months’ allocation of ARVs.

“Many HIV positive people in my area, including myself are now bribing nurses at local clinics in order to get the usual six months allocation of treatment drugs,” said a resident from Harare who asked to remain anonymous.

Zimbabwean nurses stationed at clinics distributing ARVs have capitalized on the patients’ fears.

“It’s our time to make money from the desperate HIV patients because our salaries alone can’t sustain us and so, with the now scarce ARVs, we just put a small fee on them for our own benefit in our backdoor deals with patients,” said a nurse at one of the clinics in Harare who spoke to Health Policy Watch on condition of remaining anonymous.

Authorities deny crisis

Yet the Zimbabwean authorities have denied that ARVs have run out. During a parliamentary question-and-answer session in February, Health Minister Douglas Mombeshora assured the nation that access to HIV treatment will continue despite global aid uncertainty.

Mombeshora claimed that Zimbabwe has secured enough stock of antiretroviral (ARV) drugs to last for the next six months. 

Despite the Minister’s assurance, HIV patients have seen their treatment allocations reduced and those living with HIV fear the worst.

However, the Zimbabwean government is developing an HIV sustainability plan to address long-term funding issues and mobilising domestic resources to maintain priority HIV programmes, according to a UNAIDS report released on 31 March.

Over the past five years, the US provided over $1 billion Zimbabwe to combat HIV.

Before widespread access to ARV therapy in Zimbabwe, AIDS was a leading cause of death and estimated 130,000 people dying from HIV-related complications in 2002 alone, according to UNAIDS.

The availability of ARVs significantly reduced AIDS deaths, with the death toll dropping to around 20,200 by 2021, according to UNAIDS. Adult HIV prevalence has fallen from its peak of 26.5% in 1997 to 11.9% in 2021.

Call on government to step up

Olive Mutabeni, executive director for Life Empowerment Support Organization (LESO), a community-based HIV/AIDS organization in Zimbabwe, has challenged authorities to step up and purchase ARVs.

“There is a need for the Ministry of Health and the National AIDS Council to address this issue of ARVs supplies urgently before we lose people,” said Mutabeni.

Mutabeni, aged 64, started taking ARVs in 2009 yet 16 years later, she is unsure of her access to treatment: “I am worried that many HIV patients like me might soon perish like flies.”

The permanent discontinuation of HIV programmes currently supported by the US President’s Emergency Plan for AIDS Relief (PEPFAR) would lead to an additional 6.6 million new HIV Infections and additional 4.2 million AIDS-related deaths between 2025 and 2029, according to UNAIDS modelling.

Image Credits: DFID, Jeff Moyo.