Zimbabwe's Hard-Won HIV Gains Face a Test: Reaching Young People With Prevention

When Shaun Moyo started nursing at Parirenyatwa Hospital in Harare in the late 1990s, the effects of the HIV epidemic were visible in the hospital wards and beyond them. Patients filled the wards, she recalls, while funerals had become a familiar part of everyday life.

Nearly three decades later, the picture has changed. Antiretroviral treatment has transformed the lives of people living with HIV. Condoms, pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP) and other prevention options also give young people more ways to protect themselves.

But Moyo, now a 48-year-old nurse working locum shifts at two major public hospitals in Harare, worries that some young people may not fully appreciate the risks. Her concern reflects a wider challenge for Zimbabwe: how to protect hard-won progress against HIV while ensuring that young people understand, can access and are willing to use the prevention tools available to them.

Dr Misheck Ruwende, a Zimbabwean family physician and advocate for reducing HIV stigma, shares that concern. In a public address on Twitter in September, he warned that the country risked losing some of the gains made over 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. 'It wasn't like that in the late 90s to early 2000s. It looks like we are now reversing all this huge success we had notched in recent times,' he added.

The scale of Zimbabwe's progress is clear in the national figures. UNAIDS estimates that annual new HIV infections fell from 79,000 in 2010 to 15,000 in 2023. Among people aged 15 to 24, infections declined from an estimated 27,000 to 4,400 over the same period.

But falling infections do not mean the threat has disappeared. The challenge is to sustain those gains among young people navigating relationships, economic pressures and uneven access to youth-friendly health services. It is a challenge shared across a region that continues to carry a heavy burden of HIV.

For Moyo, the contrast between the epidemic she witnessed as a young nurse and the attitudes she encounters today can be difficult to accept. 'Seeing today's youth who are blessed with condoms, ARVs and PrEP meds makes me furious,' she said. 'In the 90s every weekend was a trek to cemeteries, not weddings.' She believes the availability of effective treatment has changed how some young people perceive HIV; because the virus is no longer the immediate death sentence it was once widely understood to be, she worries that some underestimate the consequences of infection. Moyo recalled conversations involving her son and his friends on Facebook, where one comment suggested that 'getting blood pressure is worse than HIV'.

Her observations are personal, not scientific evidence of changing attitudes among young people. But they point to a difficult public health task: explaining why prevention remains important even though treatment has made HIV a manageable chronic condition for many.

The concern is not confined to Zimbabwe. UNAIDS estimated that 210,000 adolescent girls and young women aged 15 to 24 acquired HIV worldwide in 2023. Some 160,000 of those infections were in sub-Saharan Africa, while nearly 60 percent of the global total occurred in Eastern and Southern Africa. South Africa, Zimbabwe's neighbour, illustrates the continuing scale of the epidemic in the region; UNAIDS estimated that 7.7 million people were living with HIV there in 2023.

For Dr Linda-Gail Bekker, a South African HIV physician-scientist and co-author of the report on the PURPOSE 1 clinical trial, the response must combine scientific advances with prevention messages that speak to young people. The Phase 3 trial examined lenacapavir, an injectable HIV prevention drug administered twice a year. In its primary analysis, none of the 2,134 women who received the drug acquired HIV.

Bekker argues that medical advances must be matched by communication that resonates with young people. 'Beating the old drum about the horrors of HIV, and shouting to youths about condoms is not necessarily going to cut it,' she said. She believes prevention efforts need to move beyond fear-based messages and give young people accurate information, accessible services and the freedom to make informed decisions without judgement.

That task has become more difficult amid funding pressures. UNAIDS reported in March 2025 that disruptions to US-funded HIV programmes in Zimbabwe had affected services for key populations, including access to PrEP, testing and counselling. Bekker has also raised concerns about whether prevention information reaches young people in ways they find relevant; traditional pamphlets and warnings about abstinence or faithfulness may fail to engage those already making decisions about sex and relationships.

In Harare, 23-year-old peer educator Angela Gutu is taking that message beyond the clinic. Working with the Harare municipality, the health ministry, nongovernmental organisations and churches, she helps organise pop-up health services at markets, transport hubs, university campuses and sporting events — places young people already visit. At the pop-up clinics, young people can access HIV self-testing kits and condoms, while mobile health workers provide referrals for PrEP and other services. 'It's about speaking young people's lingo, taking away the HIV stigma,' Gutu said.

Zimbabwe's health authorities say they are also working to bring prevention and treatment closer to communities. Dr Innocent Hove, Provincial Medical Officer for Harare Metropolitan Province, told reporters at an August meeting that tackling HIV among young Zimbabweans was an urgent priority. The government is decentralising services including PrEP, PEP, HIV testing and treatment, as well as screening and treatment for sexually transmitted infections and tuberculosis. Hove also pointed to mobile healthcare trucks being used to reach people in areas where conventional health facilities are difficult to access, including informal mining communities and remote artisanal gold-mining sites.

Bongani, who plans to volunteer as a peer educator through the health ministry's programme in January, wants to help make prevention information more accessible to his generation. 'My generation was born with the best array of HIV prevention tools. It'll be a tragedy if AIDS deaths make a dramatic comeback due to our reckless behaviours,' he said.