Zimbabwe

GENEVA, 18 March 2022—UNAIDS congratulates Zimbabwe’s parliament for repealing section 79 of the Criminal Law Code, which criminalizes HIV transmission. A new marriage bill adopted by parliament that repeals the criminal code section is to be signed into law by the president. The criminalization of HIV transmission is ineffective, discriminatory and undermines efforts to reduce new HIV infections. Such laws actively discourage people from getting tested for HIV and from being referred to the appropriate treatment and prevention services.

“Public health goals are not served by denying people their individual rights and I commend Zimbabwe for taking this hugely important step,” said UNAIDS Executive Director, Winnie Byanyima. “This decision strengthens the HIV response in Zimbabwe by reducing the stigma and discrimination that too often prevents vulnerable groups of people from receiving HIV prevention, care and treatment services.”

UNAIDS has worked closely with Zimbabwe’s National AIDS Council, Zimbabwe Lawyers for Human Rights, parliamentarians, civil society activists and communities to advocate for the repeal of the law criminalizing HIV. Overly broad and inappropriate application of criminal law against people living with HIV remains a serious concern across the globe. More than 130 countries worldwide still criminalize HIV non-disclosure, exposure and transmission through either specific or general criminal legislation.

In 2019, Zimbabwe completed a legal environment assessment, which identified the criminalization of HIV transmission as a barrier to health care and a driver of stigma and discrimination for people living with HIV and other key populations. Since then, the United Nations Development Programme has worked with key populations and other stakeholders, convening meetings with parliamentarians and other partners to advance the recommendations of the legal environment assessment.

In 2018, UNAIDS, the International Association of Providers of AIDS Care and the International AIDS Society convened an expert group of scientists who developed an Expert Consensus Statement on the Science of HIV in the Context of Criminal Law. The statement calls on the criminal justice system to ensure that science informs the application of the law in criminal cases related to HIV. 

Zimbabwe has made great progress in the response to HIV over the past decade. It is estimated that 1.2 million of the 1.3 million people living with HIV in the country are now on life-saving medicines. AIDS-related deaths have decreased by 63% since 2010, with new HIV infections down by 66% over the same period.

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The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

Progress against HIV has been uneven. The gains made through people-centred approaches within the highest performing HIV programmes have been tempered by insufficient action in other countries.

Zimbabwe has been an HIV testing and treatment leader. The southern African country’s AIDS Levy has mobilized a significant amount of domestic funding, communities are strongly engaged in service delivery and international financial and technical support has been strong and consistent. Eighty-two per cent of adults living with HIV in the country have suppressed viral loads. Neighbouring Mozambique, by contrast, has lagged behind the regional average, leaving nearly half (44%) of adults living with HIV in the country with unsuppressed viral loads. Conflict, climate change, high levels of poverty and poor health infrastructure are among the country’s many challenges.

Holding her baby in her arms, Melody (Melody, pictured above, preferred to use just her first name for this story) fled her home in Harare, Zimbabwe, one night after policemen stormed in and fatally shot her husband.

“I didn’t know my husband was a criminal. One night when we were sleeping, police barged into our home and killed him,” she says.

Terrified for her own life and without any money, she sought refuge with Emma Mambo, pictured below, a peer educator and community activist in Epworth, south-east of Zimbabwe’s capital.

Ms Mambo, affectionately known as MaiTino, volunteers with Katswe Sistahood, an organization that seeks to empower young women and girls in claiming their sexual and reproductive health and rights. She works extensively with women in her community, including sex workers. She also runs a dance and drama group for adolescent girls and young women, which explores the complex issues they face through the arts.

“I don’t get paid for my work, but I love Katswe because it elevated me and made me realize I can teach and work with people. Even when I get phone calls at night for help, I don’t mind,” she says. This is despite not being formally employed and raising her daughter, Tanaka, pictured below, as a single mother.

“Some of the circumstances these women face hurt me. I even use my own money to help them even though I am struggling myself,” she continues.

After fleeing her home, Melody struggled to make ends meet for herself and her child. Soon, she went back to sex work, a life she had left behind when she got married.

Sex work for Melody and other Zimbabwean women is a difficult and dangerous industry in which to work. While gender-based violence is a global epidemic, affecting one in three women worldwide, its impacts are exacerbated for sex workers.

Zimbabwe is one of the 103 countries worldwide in which sex work is criminalized, leaving sex workers unprotected by the law and exposed to a range of human rights violations.

Studies show that sex workers often face violence from the police, clients and partners, increasing their risk of acquiring HIV. Prevalence of HIV among sex workers in Zimbabwe is exceptionally high, estimated at 42.2%. Sex workers also face stigma and discrimination or lack of privacy from health-care workers.

Says Ms Mambo, “Going to the clinic is a procedure often void of actual medical care and dignity. This is particularly true if you are a sex worker with a sexually transmitted infection. Health-care workers will spread the news.”

This can also be true of HIV treatment. Ms Mambo helped a young sex worker go for HIV testing and counselling, only to find out that she had absconded when she was supposed to collect her treatment.

“When I eventually spoke to her, she told me that the clinic has no privacy. Everyone would be able to see her get her medication. I then helped her get a transfer to collect medication elsewhere,” she says.

Working as a sex worker in Harare, Trish (Trish, pictured below, preferred to use just her first name for this story) is familiar with the dangers of the trade, including gender-based violence. Clients often misuse alcohol and become violent towards sex workers.

“When I think back to last week, I couldn’t leave my home. My eye was so swollen. You get hit to the extent that you get injured. If you report it to the police, the client can bribe his way out without the matter being even heard. You are seen as lowly and powerless because you are a sex worker,” she says.

Police also harass sex workers from doing their job, said Ms Mambo, who often gets phone calls from sex workers in jail.

“Sometimes police go into a bar and demand that everyone lies on the floor, start searching people and start beating them. If you are unlucky, they can arrest you,” she says.

Living in the reality of arrests and assault, Melody said poverty is the only reason that drove her to be a sex worker, a line of work she entered at 19 years old. Following the death of her first husband, she momentarily escaped the trade when she fell in love with a man with a formal job who could afford to look after her and her child.

However, that was short lived as her second partner was arrested for stealing from his workplace.

“I have nothing against my last partner who got arrested,” Melody says. But she has still not been able to shake off the tainted reputation she got from her first husband.

“When I am working in bars, police come and harass me because of who my first husband was,” Melody says. “The police should leave us to work freely outside of abuse. Our children need to eat and our parents need to be taken care of,” she insists.

Her personal and work experiences with men have negatively affected Melody’s perception of men. However, she says she does not fully express her pain because these are the very men who can provide her next meal.

She does not want it to be like this forever, though. “I’d be happy to get a better job that won’t expose me to danger,” she says.

Ms Mambo also dreams of a life beyond her current circumstances. “Someone offered me a piece of arable land to farm on. I am looking for fertilizers to farm potatoes because sex work and my age don’t correlate anymore,” she says.

Patson Manyati cuts an awkward and lonely figure in a room bustling with young people in their twenties. His elegant poise, greying beard and baby blue shirt place him at least 40 years too old for this scene.

Mr Manyati is on one of his first visits to the drop-in centre of Gays and Lesbians of Zimbabwe (GALZ) in Mutare, in eastern Zimbabwe. GALZ is a membership-based association that promotes, represents and protects the rights of lesbian, gay, bisexual, transgender and intersex (LGBTI) people in Zimbabwe.

While Mr Manyati may look out of place, being at GALZ is the most “comfortable” he has ever felt as a gay man living in Zimbabwe in his 60 years.  

“When I see people like me, I feel very happy,” says Mr Manyati in his musical, soft-spoken voice. His eyes don’t stop shimmering while he talks. Remarkable for someone who has grown up around pervasive homophobia. The kind of homophobia that, as recently as 2017, saw the former president describe gay people as, “worse than dogs and pigs.”

GALZ maintains that the hatred and fear caused by the late president’s particular brand of homophobia, “is still being felt in Zimbabwe today.”

While being at GALZ makes him happy, as soon as Mr Manyati ventures out beyond the gates of the premises, he must be guarded and vigilant. Beyond the insults, the threat of jail is real, as Zimbabwe punishes same-sex sexual relationships with up to 14 years imprisonment.

Beyond jail, there is the everyday lived experience of discrimination, violence and hate crimes with which LGBTI people must contend—not only in Zimbabwe, but also in the 69 countries worldwide that criminalize same-sex sexual relationships.

And even in countries that don’t, like neighbouring South Africa. While same-sex marriage is legal and LGBTI rights are constitutionally enshrined, being gay is dangerous. In the first half of 2021, there has been a spate of murders of young gay men and an outcry from the LGBTI community for the government, media and public to take hate crimes more seriously.

Under these conditions, it is an act of defiance just to exist and, even more so, to be deliberately happy.

Happiness is something Mr Manyati has tried to carve out for himself, despite the odds.

Born in Mutoko, a small town in Zimbabwe’s Mashonaland East Province, Mr Manyati says his parents expected him to get married in his twenties to a woman and to carry on the family name as one of the seven Manyati sons.

While his parents insisted on marriage for some time, Mr Manyati stood his ground. As the sole caregiver for his parents and siblings, they eventually gave in and he lived his life single, never coming out to his parents. 

“I couldn’t get married because I have the body of a male but, inside, I feel like a female. I know I am … I feel … like a female. So why should I marry a female?”, he says, visibly grappling with complex concepts about his gender identity without the vocabulary to do so.

Here at GALZ, everyone tells him “who they are,” says Mr Manyati. Perhaps with a few more visits and more interaction with the young people around him, who are so much more self-assured in their sexual orientation and gender identity, it may not be too late for Mr Manyati to give name to his feelings.

GALZ is a lifeline for its members. It offers regular clinic days at its Harare drop-in centre and referrals at its other drop-in centres, in Mutare and Masvingo, for a range of health-care services, including HIV prevention and treatment. It also provides critical counselling services and safe spaces for LGBTI people to socialize and relax, away from the “harsh” streets.

The leadership at GALZ says that things are slowly getting better for LGBTI people in Zimbabwe.

In 2017, GALZ was included as an official participant in the funding proposal developed for the Global Fund to Fight AIDS, Tuberculosis and Malaria. This helped to secure US$ 2 million for programmes that serve gay men and other men who have sex with men, the largest investment ever in an HIV and sexual and reproductive health response for the community. The funding resulted in the three GALZ drop-in centres.

The National AIDS Council (NAC) of Zimbabwe has a key populations forum, supported by UNAIDS, and of which GALZ is a member. The NAC is visibly working to improve the health and well-being of key populations even while their activities remain criminalized.

Despite progress, the lingering stigma and discrimination that the LGBTI community faces in Zimbabwe has resulted in Mr Manyati and people of his generation leading an isolated life. 

“It makes me feel safer to rather stay by myself,” says Mr Manyati, adding that all his peers and friends from the LGBTI community have since died. “Sometimes I cry,” he sighs.

When Mr Manyati’s friends were alive, they would live their lives to the fullest, even though the law was a constant threat and they remained unlucky in love with the men they encountered. 

“[You would know] he doesn't really like you because he has another love somewhere and you are just one on the side. In the end, he gets married and leaves you,” says Mr Manyati of these encounters.

Mr Manyati is adamant that he is “too old” to look for love now, and that he would rather focus on looking after his health as one of the estimated 1.4 million Zimbabweans living with HIV.

Mr Manyati discovered he was living with HIV when he developed a cough five years ago. He went to a local nongovernmental organization, New Start, for an HIV test and after a course of tuberculosis treatment he was initiated immediately onto HIV treatment. His health is his main priority.

“I continue with HIV treatment. That’s how I’m looking healthy now,” Mr Manyati concludes, eyes still shimmering.

* Not Yet Uhuru is a quote by the Kenyan freedom fighter Oginga Odinga. Uhuru is a Swahili word meaning “freedom”; thus, it loosely means “not yet free”. It is a hashtag routinely used by GALZ in its social media posts.

Adolescent girls and young women must boldly and unapologetically seek sexual and reproductive health and rights information and services. The stigma and harmful gender norms associated with sexual and reproductive health and rights are not going anywhere, says Nyasha Phanisa Sithole, a Zimbabwean sexual and reproductive health and rights leader.

“If you are afraid of stigma, then you will not be able to access these services because we are not going to have a stigma-free environment any time soon,” she says. 

Working as a sexual and reproductive health and rights advocate and a regional lead for young women’s advocacy, leadership and training at the Athena Network, Ms Sithole believes everyone has a role to play in changing the status quo and influencing decision-making.

“My story is common. It is that of a 16-year-old adolescent girl who needed access to HIV prevention commodities, but only had condoms available and, in rare cases, pre-exposure prophylaxis,” Ms Sithole says, reflecting on her experience as an adolescent.

Despite this common story, the need for comprehensive HIV, sexual and reproductive health and rights and sexual and gender-based violence services in the eastern and southern African region is critical.

Adolescent girls and young women aged 15–24 years account for 29% of new HIV infections among adults aged 15 years and older in the eastern and southern African region, when they only comprise 10% of the population. This means that there are 3600 new HIV infections per week among adolescent girls and young women in the region, which is more than double that of their male peers (1700 weekly).

The stigma and discrimination that young people face, particularly adolescent girls and young women, to access sexual and reproductive health and rights services creates barriers at various levels, including the individual, interpersonal, community and societal levels. 

Furthermore, documented health rights abuses include the unauthorized disclosure of health status, being denied sexual and reproductive health and rights services and related psychological violence.

In 2014, Ms Sithole went undercover as a secret client at a youth-friendly health centre in Harare, Zimbabwe’s capital city, in a district with residential areas and schools. The first person she encountered at the centre was a nosy security guard.

“He asked me: ‘What do you need?’ A health screening, I replied. Then he asked, “Asi wakarumwa?” Meaning, “Have you been bitten?” In Shona, this is street language for someone who has a sexually transmitted infection,” she recalls.

Had she not been well-informed, Ms Sithole says she would have felt scared. “It’s something that can scare you or put you off to say, “It’s just a security guard, why are they mocking me or my situation?” Because imagine if I really had a condition that I wanted to manage, what would happen then?” 

Ms Sithole said health-care workers sometimes look at adolescent girls and young women accessing sexual and reproductive health and rights services with disdain and judgement and ask, “How old are you and what do you need the condom or contraception for?”

Considering the stigma attached to accessing sexual and reproductive health and rights services, community organizations play a critical role for adolescent girls and young women. Organizations empower them with sexual and reproductive health and rights information and service referrals. 

However, COVID-19 greatly impacted how these organizations work in Zimbabwe, which enforced lockdown restrictions to curb the spread of the virus.

“I think all governments weren’t fair when they clamped down restrictions on each and every organization that was working in communities,” Ms Sithole says, adding that it negatively impacted young people’s access to sexual and reproductive health and rights services.

To mitigate these risks, the Global HIV Prevention Coalition, co-convened by UNAIDS and the United Nations Population Fund, came on board to provide financial and technical support to the Athena Network in 10 countries, including Zimbabwe, to establish What Girls Want focal people in each country. During the COVID-19 pandemic, the focal people, who are adolescent girls and young women, mobilized their peers to conduct dialogues via WhatsApp to discuss the issues they face and seek peer support.

Ms Sithole says governments should invest in policy change and development to create an enabling environment where adolescent girls and young women can access sexual and reproductive health and rights and HIV information and services.

Despite the stigma and discrimination attached to seeking sexual and reproductive health and rights services, Ms Sithole says adolescent girls and young women should realize their power and use their agency to get what they need.

“Think about your life because your life is more important than anything else. So, no matter what happens, if you know there is a service you can access, go for it,” she advises.

As the COVID-19 pandemic scales across Zimbabwe, there were numerous calls from global partners, including the United Nations Secretary-General, for the expanded use of tele-health and innovative technology solutions to limit congestion in health care systems and the adverse effects of potential disruptions to health care caused by lockdowns.

In response to the call, UNAIDS provided guidelines and financial support for the procurement of equipment and the training of online counsellors from the Zimbabwe National Network of People Living with HIV (ZNNP+) to establish a call centre to respond to inquiries from people living with HIV across the country.

The call centre platform is a national surveillance and information system which will ensure that challenges faced by people living with HIV are captured in real time and HIV services to boost COVID-19 testing, isolation, contact tracing and treatment are deployed efficiently.

The call centre will cover Zimbabwe’s ten provinces and will track specific indicators integrated into a data store which will assist in collating and analysing data received from the sub-national levels.

The collected data will be used to inform advocacy for issues like multi-month dispensing of antiretroviral medicines, access to viral load testing and access to HIV prevention and management.

“We welcome this initiative as it is user-friendly; people are able to call for free and have their issues addressed,” says Tatenda Makoni, Executive Director of ZNNP+.

The platform will assist the national network of people living with HIV in being proactive to serve the needs of its constituency. The platform will not end with COVID-19 but will focus on HIV services to boost testing, contact tracing and treatment capacities in Zimbabwe. Lessons learned from the call centre will be used to inform replication in other sectors and regions.

Ronie Zuze believes in the power of information. Not only did it save them (Ronie uses the pronouns them/they/their), they are convinced that it can change lives and mindsets.

As the first born, their father was ecstatic when he was told he had a son, they recounted. “I was born with ambiguous genitalia, so doctors assigned the male gender,” Ronie said.

Ronie grew up as a boy until the age of 16 years.

“That’s when my body started developing some female features, despite the fact that I associated myself with being a boy,” the Zimbabwean said.

Ronie’s father panicked and sent Ronie to live in another town with his former wife.

“My father became very confused and fearful of the stigma and discrimination,” Ronie said, “so he sent me away.”

Ronie’s mother cautioned them—she immediately told they must now be a girl—to be careful around other people. “Sleepovers and contact sports were forbidden,” Ronie recalled.

Ronie believes the shame around who they were propelled them into a tailspin of denial and self-hate. “I attempted to kill myself two to three times and consumed excessive amounts of alcohol and drugs,” Ronie said.

They started seeking out help on the Internet, convinced there were others in the same situation, which led to a slew of information about what it meant to be an intersex person.

Intersex people are born with any of several variations in sex characteristics, including chromosomes, gonads or genitals that do not fit the typical definitions of male or female.

“The flood of information empowered me to understand who I was,” Ronie said. “I stopped being shameful of myself.”

Most of the people they engaged with were in Europe or North America. “If 1.7–2% of the global population is intersex, then I knew there must be more than just me in Africa,” Ronie said, brushing aside a dreadlock.

Ronie joined a local group for lesbian, gay, bisexual, transgender and intersex people and initially self-identified as a lesbian, but it did not feel right. Even the community didn’t understand intersex people, Ronie said. That’s when they decided to become a voice for people like them and started an organization, the Intersex Community of Zimbabwe, in 2018. Ronie now identifies as non-binary.

“As an activist, it means I empower other intersex people, I speak for those who cannot speak out, I encourage them to be proud and I provide information to them as well as support them,” Ronie said.

Ronie spends a lot of time with other intersex people and their immediate families. They pound the pavement telling parents to let nature take its course and not rush into assigning one gender to their intersex children. They believe an intersex person should decide for themselves when they are old enough to make that decision.

“I know there is a lot of stigma and misconceptions about intersex bodies, but parents need not panic,” Ronie said. “I want intersex people to know there is nothing to be ashamed of, so be proud.”

If you drive through Zimbabwe on a typical Saturday or Sunday, you will see many places of religious worship. Some are static structures, while others are mobile. Some services are held under trees or in open spaces.

Many people in Zimbabwe follow a religious faith. The Apostolic community is a major religious sect that discouraged its members from seeking medical care, including HIV services, preferring to use prayer for healing―this led to many people becoming ill and dying from preventable diseases. However, with the implementation of so-called health kiosks, the community is now encouraging its members to access medical care.

David Adashe (not his real name), an Apostolic leader in Gokwe North, explained that health kiosks staffed by church volunteers trained by the Zimbabwe health ministry helped his congregation to access much needed information on HIV prevention. He described it as like, “Going from a thick cloud of darkness into a plane of light of splendour.”

Ms Adashe said that his congregation’s views about seeking medical assistance from health facilities have changed. They now seek out medical care, receive counselling from trained volunteers and are referred to a health facility for additional services, if needed. “I was naive and reluctant to take health issues seriously, but since the emergence of the health kiosk programme, I am now more empowered. I’m now encouraging my family to access health services from the clinic,” he said.

Since March 2018, World Vision Zimbabwe, in collaboration with the Ministry of Health and Child Care, has been empowering faith leaders like Mr Adashe and church volunteers through training and creating safe spaces to bring health information and services to their congregations.

A health kiosk volunteer in Gwanda said, “As a volunteer, I observed that previously it was difficult for some individuals to travel to the local clinic on their own to seek medical advice, but since the programme started it is easy now, since they can access the information on their doorstep through the health kiosks.”

Many faith worship centres participating in the health kiosk programme have seen a threefold increase in the uptake of HIV and health information. Half of the people requesting information on HIV take an HIV test and receive their results. People who test positive for HIV are referred for antiretroviral therapy and supported to stay in care through the help of the trained church volunteers.

Faith leaders and church volunteers are essential in controlling the HIV epidemic. They provide care for their members, create safe space for information-sharing and are trusted by their members. Regular contact with the congregations enables the volunteers to bridge the gap in services for those who need them the most. The health kiosks also serve as effective and sustainable platforms to bring together both faith and non-faith communities to address the health needs of their members and to provide safe spaces to engage on other health matters.

“The findings from the health kiosk programme are promising for addressing the HIV epidemic. This is a key example of community-led responses by, for and within faith communities providing safe spaces and support for their members. These kinds of responses are essential for ending new HIV infections and AIDS-related deaths and critical for reaching universal health coverage,” said Laurel Sprague, Chief of the UNAIDS Community Mobilization, Community Support, Social Justice and Inclusion Department.

According to a recent emergency appeal from the United Nations, around 5.3 million people in Zimbabwe are estimated to be in need of urgent humanitarian assistance.

The ongoing economic crisis, compounded by erratic weather conditions in recent years, has led to increased food insecurity and a lack of access to basic essential services, including health care. The appeal is requesting a total of US$ 234 million, including US$ 37.4 million for urgent health needs, to help 2.2 million of the worst affected. The appeal aims to complement Zimbabwe’s ongoing and planned programmes.

Erratic weather conditions, including late onset of rains and below-average rainfall, are affecting farmers and pastoralists across southern Africa, including Zimbabwe. This in a region where agriculturalists are still recovering from a severe El Niño induced drought in 2015/2016. Unpredictable rainfall patterns and a lack of pasture has weakened livestock and outbreaks of crop pests and livestock diseases are prevalent in many districts.

The deteriorating humanitarian situation and the country’s worsening economic circumstances, including currency volatility, are adding to an already difficult situation for Zimbabwe’s 1.3 million people living with HIV.

Household food insecurity and limited access to hygiene, sanitation and water can have a disproportionate impact on people living with HIV. HIV medication should not be taken on an empty stomach. Attacks of severe diarrhoea, cholera or other gastrointestinal infections can accelerate progression to serious AIDS-related illnesses if left untreated. In 2018, Zimbabwe recorded its second biggest cholera outbreak in its recent history. The country is also facing thousands of cases of typhoid fever.

Meanwhile, the lack of access to foreign exchange has significantly reduced stocks of essential medicines, diagnostics and other medical supplies. Some private pharmaceutical suppliers now only accept United States dollars and their prices have dramatically increased. In these circumstances, many people, including people living with conditions such as HIV and tuberculosis, are unable to pay for medicines and basic health services. Where clinics do have availability, many people cannot afford the cost of transport. Lack of adherence to treatment puts patients’ health at risk and may lead to drug resistance.

The fragile situation in Zimbabwe also increases the risk of HIV infection, especially for women and girls, refugees and the internally displaced. During periods of humanitarian emergency, where populations are on the move, girls are particularly vulnerable to family separation, early marriage, teenage pregnancy, gender-based violence and extreme coping mechanisms, including transactional sex.

“UNAIDS is very concerned about the worsening humanitarian situation in Zimbabwe, where people living with HIV are disproportionately affected by food insecurity and shortages of essential medicines,” said UNAIDS Executive Director, Michel Sidibé. “UNAIDS stands ready to work with all national and international partners to ensure that we mitigate the effects of the current situation so that people can access essential services, including HIV treatment and prevention services.”