Zimbabwe's HIV Gains Face a Test as Young People Grow Complacent About Prevention

When Shaun Moyo began nursing at Parirenyatwa Hospital in Harare in the late 1990s, the epidemic was not an abstraction. Patients filled the wards, she recalls, and funerals had become an ordinary part of life. Today she is 48 and works locum shifts at two major public hospitals in the city, and what she sees in younger people worries her.

The country she works in has changed enormously. Antiretroviral treatment has transformed life for people living with HIV, and young people now have condoms, pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP) and other options available to them. UNAIDS estimates that annual new infections in Zimbabwe fell from 79,000 in 2010 to 15,000 in 2023. Among people aged 15 to 24, the drop was from an estimated 27,000 to 4,400.

Yet clinicians and advocates fear that progress is not secure. Dr Misheck Ruwende, a Zimbabwean family physician who campaigns against HIV stigma, said in a public address on Twitter in September that the country risked losing gains built over decades. He said it was sad that this was happening just as the best prevention options existed, from rapid testing to injectables. In the late 1990s and early 2000s, he noted, none of that was available, and it now looked as though the success was being reversed.

Moyo's frustration is personal. Seeing young people who have condoms, ARVs and PrEP, she said, makes her furious, because in the 1990s every weekend meant a trek to the cemetery rather than a wedding. She believes effective treatment has led some to underestimate infection, since HIV is no longer widely seen as a death sentence. She recalled a Facebook exchange involving her son and his friends in which one comment suggested that getting high blood pressure was worse than HIV. The reporting is clear that these are individual observations, not scientific evidence of shifting attitudes among young people.

The concern reaches beyond Zimbabwe. UNAIDS estimated that 210,000 adolescent girls and young women aged 15 to 24 acquired HIV worldwide in 2023, 160,000 of them in sub-Saharan Africa. Nearly 60 percent of the global total occurred in Eastern and Southern Africa. In neighbouring South Africa, 7.7 million people were living with HIV in 2023. In Gauteng province, 167,109 males attended public health facilities between April and December 2023, and 67,400 were treated for Male Urethritis Syndrome, which is associated with sexually transmitted infections. The provincial health department said its incidence rose from 12 percent in 2020 to 15 percent in 2023, though the condition is not itself a measure of HIV infection.

Dr Linda-Gail Bekker, a South African HIV physician-scientist, co-authored the report on the PURPOSE 1 trial of lenacapavir, an injectable prevention drug given twice a year. In the Phase 3 trial's primary analysis, none of the 2,134 women who received it acquired HIV. Bekker argues that such advances must be paired with messages that reach young people, and that beating the old drum about the horrors of HIV and shouting about condoms is not necessarily going to cut it. She wants accurate information, accessible services and non-judgemental, adolescent-friendly care, including practical advice on PrEP.

Funding has made this harder. In March 2025, UNAIDS reported that disruptions to US-funded HIV programmes in Zimbabwe had affected services for key populations, including PrEP, testing and counselling.

In Harare, 23-year-old peer educator Angela Gutu is trying a different route. Working with the municipality, the health ministry, nongovernmental organisations and churches, she helps organise pop-up health services at markets, transport hubs, university campuses and sporting events. Young people can pick up HIV self-testing kits and condoms, and mobile health workers refer them for PrEP and other care. Gutu says some young people find it intimidating to ask for a test at a clinic, fearing judgement or harsh treatment. Her approach, she said, is about speaking young people's lingo and taking away the stigma.

Officials say they are also moving services outward. Dr Innocent Hove, Provincial Medical Officer for Harare Metropolitan Province, told reporters at an August meeting that HIV among young Zimbabweans is an urgent priority. The government is decentralising PrEP, PEP, testing and treatment, along with screening and treatment for sexually transmitted infections and tuberculosis. Mobile healthcare trucks are reaching places such as informal mining communities and remote artisanal gold-mining sites. Whether those services are consistently available, affordable and free of stigma will determine their effect.

Bongani, who plans to volunteer as a peer educator through the health ministry's programme in January, put the stakes plainly: his generation was born with the best prevention tools, and it would be a tragedy if AIDS deaths made a comeback because of reckless behaviour.