Zimbabwe Seeks Youth-Friendly Approach to Protect HIV Prevention Gains

Zimbabwe is working to preserve a sharp decline in new HIV infections by making prevention services easier for young people to understand, access and use.

The country has more prevention options than during the height of the HIV epidemic, including condoms, pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), rapid testing and injectable prevention. But health professionals and peer educators say availability alone may not be enough if services are difficult to reach or young people fear judgment from providers.

New infections have fallen

UNAIDS estimates show that annual new HIV infections in Zimbabwe declined from 79,000 in 2010 to 15,000 in 2023. Among people aged 15 to 24, estimated annual infections fell from 27,000 to 4,400 over the same period.

Dr Misheck Ruwende, a Zimbabwean family physician and advocate for reducing HIV stigma, has warned that the country could lose some of the progress made over several decades.

“The sad part is that this is coming at a time we have the best options to prevent HIV, from rapid testing, PrEP, condoms, PEP to injectables,” Ruwende said in a September public address on Twitter.

He added that Zimbabwe appeared to be reversing some of its recent success, a concern he linked to the challenge of sustaining prevention efforts.

Reaching young people beyond clinics

Health workers and peer educators are taking information and supplies into places where young people gather. Pop-up services at markets, transport hubs, university campuses and sporting events provide HIV information, self-testing kits, condoms and referrals.

Angela Gutu, a 23-year-old peer educator in Harare, works with the Harare municipality, the health ministry, nongovernmental organisations and churches to organise such services.

“It’s about speaking young people’s lingo, taking away the HIV stigma,” Gutu said. She also said fear of judgment or harsh treatment by health workers can discourage young people from seeking HIV and sexually transmitted infection services.

Dr Linda-Gail Bekker, a South African HIV physician-scientist, said prevention programmes need to combine scientific advances with communication that reflects how young people make decisions about sex and relationships.

“Beating the old drum about the horrors of HIV, and shouting to youths about condoms is not necessarily going to cut it,” Bekker said. She called for accurate information, accessible services and nonjudgmental support rather than relying only on fear-based messaging or traditional pamphlets.

Services expanded outside conventional facilities

Dr Innocent Hove, Provincial Medical Officer for Harare Metropolitan Province, said Zimbabwean authorities are decentralising PrEP, PEP, HIV testing and treatment, as well as screening and treatment for sexually transmitted infections and tuberculosis.

Mobile healthcare trucks are also being used in areas where conventional facilities are difficult to access, including informal mining communities and remote artisanal gold-mining sites.

However, the effect of mobile and decentralised services will depend on whether they remain consistently available and reach people most in need. A UNAIDS report from March 2025 said disruptions to US-funded HIV programmes in Zimbabwe affected services for key populations, including PrEP, testing and counselling.

New prevention technology

Bekker was also a co-author of reporting on the PURPOSE 1 Phase 3 clinical trial, which examined lenacapavir administered twice a year as an injectable HIV prevention drug. In the primary analysis, none of the 2,134 women who received the drug acquired HIV.

The development adds to the range of prevention tools available to young people, although health workers continue to stress the importance of making those tools understandable and accessible.

Shaun Moyo, a 48-year-old nurse who works locum shifts at two major public hospitals in Harare, began nursing at Parirenyatwa Hospital in the late 1990s. She recalled a time when HIV patients filled hospital wards and funerals were common.

“In the 90s every weekend was a trek to cemeteries, not weddings,” Moyo said. She contrasted that experience with the access many young people now have to condoms, antiretroviral medicines and PrEP.

Antiretroviral treatment has transformed the lives of people living with HIV, but falling infection rates do not mean the threat has disappeared. Zimbabwe’s continuing progress will depend on whether prevention services remain available, confidential and responsive to young people’s concerns.