By By Crucial Kawanga
Zimbabwe has one of the highest HIV prevalences in sub-Saharan Africa. at 12.8%, with 1.4 million people living with HIV in 2020.
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The HIV epidemic in Zimbabwe is generalised and is largely driven by unprotected heterosexual sex. Heterosexual people in stable unions account for around 55% of all new HIV infections. Women are disproportionately affected, particularly adolescent girls and young women. However, there are growing epidemics among key populations, such as sex workers and men who have sex with men, who are at higher risk of HIV. Information on these populations is lacking as only a minimal amount of data is collected and reported in national documents.
In 2019, there were 40,000 new HIV infections, down from 62,000 in 2010. Behaviour change communication, high treatment coverage and prevention of mother-to-child transmission are all thought to be responsible for this decline. Deaths from AIDS-related illnesses continue to fall – from 54,000 in 2010 to 20,000 in 2019.
Zimbabwe is making strong progress towards the UNAIDS 90-90-90 targets. As of 2019, 90% of people living with HIV in the country were aware of their status, and 94% of those diagnosed were on treatment. Of the people diagnosed and on treatment, 86% are virally suppressed, meaning that they are likely to be in good health and wont to pass HIV on to anyone else. Overall, this equates to 85% of all people living with HIV in Zimbabwe being on treatment and 73% of all HIV positive people being virally suppressed.
Groups most affected by HIV in Zimbabwe
The Zimbabwean HIV epidemic is largely driven by unprotected heterosexual sex. But there are now growing epidemics among certain population groups who are at higher risk of HIV (often referred to as ‘key populations’). National data on these populations is sparse. Only a minimal amount of data is collected and reported in national documents.
Women
An estimated 730,000 women were living with HIV in Zimbabwe in 2018.5 In the same year, 19,000 women became HIV positive, compared to 14,000 men.6 Gender inequality is present within relationships and marriages, and drives HIV infections. For example, only 69% of men believe a woman has the right to refuse her husband sexual intercourse if she knows he has sex with other women. Although in the minority, 23% of females believe women do not have the right to ask their partner to use a condom if he has a sexually transmitted infection (STI).7
Around 20% of women who have been married have experienced physical or sexual violence from their partner in the past 12 months.8 Overall, 14% of adult women reported experiencing sexual violence at least once in their lifetime and 8% reported experiencing it in the last 12 months.9 This prevents many women from being able to negotiate using a condom and puts them at higher biological risk of HIV.
In terms of broader reproductive health, Zimbabwe fares better. Zimbabwe has the lowest reported unmet need for family planning among married women in sub-Saharan Africa (15.2%).10
These factors help to create a situation in which women are disproportionately affected by HIV compared to men. For instance, the 2015/16 Population-Based HIV Impact Survey found HIV prevalence among adults who had intercourse before the age of 15 years was nearly three times as high for women (25%) than for men (9%). Among people reporting two or more sexual partners in the 12 months before the survey, prevalence was more than twice as high among women (31%) as among men (12%).11
Young people
In 2018, around a third of all new HIV infections in people above the age of 15 in Zimbabwe were among young people (under the age of 24). There were 9,000 new infections among young women, more than double the number of new infections among young men (4,200).12
Around 59% of young people surveyed by the country’s 2016 population-based HIV impact survey had tested for HIV, however, young men were less likely to test than young women (52% compared to 65%).13 Among young people living with HIV, 60% were aware of their status, much lower than the proportion of adults aware of their status overall. The proportion of young people on treatment and virally suppressed is also lower.14
Young people are more likely to engage in risky sexual behaviours than older adults, making them vulnerable to HIV, yet they have less frequent contact with the healthcare system in general, including HIV prevention and treatment services.
In 2015, 17% of young women (aged 15-19) in Zimbabwe reported having had sex with a man 10 years older in the past 12 months. Intergenerational relationships (with older partners) are thought to be one of the main drivers of new HIV infections in young women. In these relationships, older partners are more likely to determine condom use, and are also more likely to have HIV than women’s younger peers.15
In Zimbabwe, only 42% of young women and 47% of young men have comprehensive knowledge about HIV, limiting their ability to take control of their sexual health.16
Sex workers
There are around 44,500 female sex workers Zimbabwe, around 40% of whom are living with HIV.17 18 This is concerning in an environment where sex work is illegal, condoms are being confiscated and gender inequality makes condom negotiation difficult.
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