HARARE, Zimbabwe – For the past two decades, 49-year-old Renious Gumbi from Mberengwa in Zimbabwe lived in South Africa, where he worked as a bricklayer.

Gumbi, who was living with HIV, received free antiretroviral (ARV) treatment from his local clinic in South Africa as, according to that country’s Constitution, “everyone has the right to have access to healthcare services”.

But worsening economic conditions and growing unemployment in South Africa have led to the formation of anti-immigrant groups such as Operation Dubula and March and March, which have blamed non-citizens for service delivery problems – although these have been caused largely by systemic corruption.

Over several months, anti-immigrant groups have blockaded many clinics and hospitals, refusing to allow non-citizens to enter.

As a result, Gumbi was unable to get ARVs since June and became seriously ill. In desperation, his wife, Senzeni, arranged for him to return to Zimbabwe using cross-border transporters known as malayitshas.

Gumbi was at last given ARVs at the Zimbabwean border with South Africa, but it was too late. He died soon after returning to the country of his birth.

“It was cruel for South African leaders to leave anti-migrant activists blocking my husband from getting his ARV treatment drugs,” Senzeni told Health Policy Watch.

“It is also heartless for the Zimbabwean government not to have a plan for its people living with HIV in South Africa when the same regime benefits from the money many Zimbabweans based in South Africa formally send to help their loved ones back home.”

Harder to get ARVs 

Access to ARV  treatment in Zimbabwe has grown more difficult since talks between the United States and Zimbabwe on future US aid for HIV and other health services broke down in February, jeopardising the HIV treatment of some 1.2 million people reliant on US aid.

A recent study also projects that approximately 75,000 Zimbabweans will contract HIV within a year if there is a complete withdrawal of the US President’s Emergency Plan for AIDS Relief (PEPFAR).

While South Africa has also been badly affected by the US decision to phase out all HIV and other health support, it was not reliant on the US to pay for antiretroviral treatment.

It is hard to estimate how many Zimbabweans are in South Africa as thousands have entered the country illegally through poorly policed borders. However, between two and three million Zimbabweans are estimated to be living in the country following the near-collapse of the Zimbabwean economy from the early 2000s. 

This has contributed to strain on the country’s health services, already damaged by systemic government corruption.

Despite the guarantees in South Africa’s Constitution, Dr Sibongiseni Dhlomo, chairperson of the country’s Parliamentary Health Portfolio Committee, told Parliament last year that non-South Africans should only be entitled to emergency health services, not comprehensive healthcare, as the country does not have “unlimited resources”. 

However, this would require changes to various laws and the Constitution. Meanwhile, in 2025 the South African High Court ruled that Operation Dudula could not bar people without South African identity documents from health facilities.

But March and March gave undocumented migrants until 30 June to leave South Africa, and have resorted to threats, violence and ongoing blockages of health facilities.

Amidst the chaos, many Zimbabweans fleeing from the flaring xenophobic tensions in South Africa have heart-rending stories.

Gilbert Muzokomba, aged 58, has lived in South Africa since 1999, and was also prevented from accessing his ARVs from a clinic in Gauteng province’s East Rand.

Five years into this 27-year-stay in South Africa, Muzokomba married a South African. In 2009, he and his wife tested positive for HIV and started ARV medication.

However, his wife died in 2020, and recently Muzokomba found himself under pressure to leave South Africa from his neighbours.

After defaulting on treatment for a very long time, he decided to head back to Zimbabwe in the hope of quickly resuming ARVs. But there was no guidance for new arrivals about how and where to get ARVs, he said.

“I left South Africa voluntarily after seeing that I might end up dying without access to my HIV treatment drugs, having been repeatedly barred from accessing the treatment by anti-immigrant groups. I had already defaulted, and my health is deteriorating fast,” Muzokomba told Health Policy Watch.

He was placed on a waiting list for a register for local HIV patients accessing free ARVs, but the process has taken longer than expected, costing him his health.

Delayed treatment

Meanwhile, 23-year-old Nelisiwe Mugodhi was born with HIV in South Africa, but also fled from xenophobic violence several days after she also defaulted on her treatment after being barred from a clinic in Khayelitsha, a large slum settlement in Cape Town.

Mugodhi claimed that her parents succumbed to AIDS a few years ago and, as their only child, she was able to soldier on thanks to Good Samaritans in South Africa.

But when xenophobia tensions broke out this year, Mugodhi fled to a place she barely knew.

Mugodhi said she was eventually placed on ARV treatment back home, but it took a long time and her condition had deteriorated for days, rendering her sick from bouts of diarrhoea, headaches, swollen feet and incessant coughing.

“To be honest, I don’t know if I will ever recover. I was healthy and have never fallen sick when I had access to treatment while in South Africa before the latest xenophobic tensions,” Mugodhi told HPW.

Zimbabwe’s brave face

It remains to be seen how the Zimbabwean government is going to cope with the influx of HIV positive migrants from South Africa.

For now, officials have put on a brave face. During a recent appearance in Parliament, Health Minister Douglas Mombeshora said health workers had been deployed at the country’s borders to screen returnees and identify those living with chronic conditions like HIV, diabetes and hypertension.

“We have put in place our health workers at the ports of entry to make sure that every returnee is being screened, from adults to children. So far, we have screened over 99,000 Zimbabweans,” Mombeshora said.

But the Minister also said: “We are not able to institute long-term treatment on their arrival because we need to first take baseline tests, like viral load and things like that, which cannot be done at the port of entry at the moment.” 

In late July, Médecins Sans Frontières (MSF) reported that it was running a clinic alongside the South African government’s repatriation centre in Musina, a town bordering Zimbabwe and South Africa.

MSF reported assisting people who have defaulted on ARVs and chronic medication, particularly to treat high blood pressure.

Media reports indicate that 34,000 people have returned to Malawi and 100,000 to Zimbabwe, illustrating the regional scale of displacement, according to MSF.

“More than 100,000 people fleeing or being displaced are the kind of numbers MSF see in hot conflict areas, not relatively stable democracies like South Africa,” says MSF’s Caroline Masunda. “With so many displaced people, we call on governments in the region to step up collaborative efforts to ensure continuity of care for patients”.

 Official figures show that by early July 2026, 21,000 Zimbabweans had been repatriated with government assistance, while a further 57,000 returned at their own expense.

Kensington Marufu, an HIV/AIDS activist and lawyer aged 36 who was born with HIV, says that the return of migrants from South Africa will worsen the country’s HIV crisis.

“Most of these returnees are definitely secretive about their health status, especially HIV,  which will cause problems here. They don’t know where to get help with their condition after being away from home for many years. I think these returning migrants will have a problem with adherence to treatment, which will negatively impact on their health,” Marufu told Health Policy Watch.

Marufu, who tested positive for HIV at the age of 10, is a renowned lawyer. His parents and only brother succumbed to AIDS some years ago.

Zimbabwean Pastor Reki Jimu, who has lived with HIV for decades and spearheads the fight against HIV in Zimbabwe, says he has the names of many Zimbabwean migrants now back in the country who have defaulted on treatment and are now faced with life-threatening complications.

“I know several returnees from South Africa who have defaulted on ARV treatment after getting disturbed by xenophobic tensions there. Many of these people are now hospitalised here because of missing out on opportunities to acquire their medication here,” Jimu told Health Policy Watch.

An estimated 1.3 million people are living with HIV in Zimbabwe, according to UNAIDS. But the return of the country’s migrants will swell this number and strain the country’s health system.

“I don’t know if I will survive here in Zimbabwe,” said Mugodhi.

Image Credits: Kate Stegeman/ MSF, Taduw Andre/ MSF, MSF.