The temporary closure of truck-stop clinics and the scaling back of services at crucial health centres across the country have triggered widespread alarm, raising the spectre of a resurgence in HIV infections, particularly among high-risk populations such as long-distance truck drivers, sex workers, and other vulnerable communities.
For years, these clinics have served as a vital lifeline, providing essential HIV prevention, testing, and treatment services in border towns, high-traffic areas, and underserved communities. They have been instrumental in reaching individuals who might otherwise lack access to critical healthcare, offering a range of services including HIV testing and counselling, antiretroviral therapy (ART), pre-exposure prophylaxis (PrEP), condom distribution, and screening and treatment for sexually transmitted infections (STIs).
The “America First” policy, which prioritises domestic developments and emphasises “reasonable use of taxpayer’s money,” has resulted in a significant reduction in US foreign aid, impacting billions of dollars in funding for local civil society organisations (CSOs) and development programs worldwide. The impact on Zimbabwe has been particularly devastating, given the country’s heavy reliance on US funding to combat the HIV/AIDS epidemic.
The immediate consequences of the funding cuts have been stark. Truck-stop clinics, strategically located along major transport routes, have been forced to shut their doors, leaving long-distance truck drivers without access to vital HIV prevention and treatment services. These drivers, often spending extended periods away from home and engaging in high-risk behaviours, are particularly vulnerable to HIV infection. The closure of these clinics not only jeopardises their health but also increases the risk of transmission to their partners and communities.
Similarly, Population Solutions for Health (PSH) New Start Centres, which have long been at the forefront of Zimbabwe’s HIV response, have been forced to scale back their services, temporarily halting ART and PrEP refills for patients. These centres, which typically offer a comprehensive range of integrated clinical services, are now primarily focused on HIV testing, with other essential programs such as family planning and cervical cancer screening assistance suspended.
The impact of these service disruptions is already being felt by vulnerable communities across the country. Rumbidzai, a sex worker from Epworth in Harare, has been taking antiretroviral drugs since 2017 and has relied on mobile clinics for over two years to access her medication and other essential services. Now, with the mobile clinics vanished, she fears for her life. “I don’t want to die — my children are still young. Who will take care of them?” she says, requesting only her middle name be used due to concerns about stigma.
Chipo, an outreach worker who has served sex worker communities since 2015, echoes Rumbidzai’s concerns. “The sex workers are crying; they are afraid of dying,” she says. She estimates that mobile clinics in Harare alone serve nearly 6,000 sex workers, all of whom are now left scrambling for basic health care.
The situation is further compounded by a shortage of condoms, which have become increasingly difficult to access since the funding cuts. “Local clinics only give us three to four strips per week,” Rumbidzai says. “In our trade, that’s not enough. People will take risks when supplies run out — something we desperately want to avoid.”
The potential consequences of these disruptions are dire. Without access to HIV testing and counselling, more people will remain undiagnosed, increasing the risk of onward transmission. Without access to ART, people living with HIV will see their health deteriorate, and their viral loads will increase, making them more infectious. Without access to PrEP, individuals at high risk of HIV infection will be more vulnerable to contracting the virus.
The shortage of condoms will inevitably lead to a surge in new HIV infections and other STIs, reversing the progress that Zimbabwe has made in recent years in controlling the epidemic. As Muchanyara Cynthia Mukamuri, chairperson of the Women’s Coalition of Zimbabwe, warns, “A shortage of condoms will lead to a breeding ground for infections and reinfections, affecting not just sex workers but their clients as well.”
The crisis has prompted calls for the Zimbabwean government to take urgent action to mitigate the impact of the funding cuts and ensure that vulnerable populations continue to have access to essential HIV services. In a parliamentary session, Member of Parliament for Hwange West Vusumuzi Moyo urged the Ministry of Health to seek alternative funding models and to strengthen the local healthcare system.
“Without funding for laboratory tests, HIV counselling and antiretroviral medications, many truck drivers and sex workers who rely on these clinics may not have access to crucial HIV-related healthcare services. In turn, this could result in an increase in undiagnosed HIV cases and the lack of consistency of the ART adherence, both of which contribute to higher transmission rates,” Moyo said.
He added, “With funding cuts, the sustainability of these services is at risk and the impact could be felt in high HIV prevalence, decreased access to care and return to higher transmission rates. To mitigate these effects, it is essential to explore and implore the Ministry of Health to seek alternative funding models and to strengthen our local healthcare system to ensure that the vulnerable population continues to receive the support they need in the fight against HIV/AIDS.”
However, with Zimbabwe’s economy struggling and the government facing numerous competing priorities, it remains unclear whether sufficient resources can be mobilised to fill the funding gap left by the US cuts.
The crisis has also highlighted the need for Zimbabwe to reduce its reliance on external funding and to invest in building a more sustainable and self-reliant healthcare system. As Mukamuri argues, “We need to revisit our strategies, refocus our efforts, and redirect our resources to ensure that people living with HIV are not left at the mercy of whoever decides to provide — or withhold — resources.”
In the meantime, vulnerable communities like sex workers and long-distance truck drivers are left to grapple with the immediate consequences of the funding cuts. They are facing increased risks of HIV infection, limited access to essential services, and a growing sense of despair.
Beauty Magora, a sex worker and community mobilizer, is worried about her upcoming HIV prevention treatment. She typically receives preexposure prophylaxis treatment every two months through mobile clinics, which provided the service free of charge. “I don’t know if there will be any effects if I switch to tablets,” she says, highlighting the uncertainty and anxiety that many are feeling.
The situation is a stark reminder of the fragility of Zimbabwe’s HIV response and the devastating impact that external factors can have on the health and well-being of vulnerable populations. As Rumbidzai says, “If anything, Trump should lighten his heart, because our lives are hanging by a thread.”
The long-term consequences of the funding cuts remain to be seen, but there is a growing fear that they could undermine years of progress in the fight against HIV/AIDS in Zimbabwe and lead to a resurgence of the epidemic.
