In Zimbabwe, the burden of drug and substance abuse has grown significantly over the years. This crisis was further compounded by the COVID-19 pandemic, which, through global lockdowns, exposed many young people to negative coping mechanisms as they struggled with the idleness and isolation brought about by restrictions.
According to official data, over 75% of mental health hospitalizations in Zimbabwe are linked to drug and substance use. Psychiatric facilities across the country are often overwhelmed, operating at full capacity as they attempt to accommodate the rising number of drug-related admissions.
To explore interventions being implemented to address this growing problem, HealthTimes Editor, Michael Gwarisa (MG), spoke to Wilson Box (WB), the Director of the Zimbabwe Civil Liberties and Drug Network (ZCLDN). ZCLDN is one of the leading Key Population (KP) organizations working with People Who Use and Inject Drugs (PWUID) in Zimbabwe.
This Q&A story delves into how the AIDS and Rights Alliance for Southern Africa (ARASA), under the Love Alliance Programme, has supported ZCLDN in advancing advocacy efforts for policy reform and service improvement for PWUID in Zimbabwe. The Love Alliance Programme, a five-year initiative (2021–2025) funded by the Dutch Ministry of Foreign Affairs through Aidsfonds, brings together diverse allies across eleven African countries, including Zimbabwe, to address systemic barriers to sexual and reproductive health and rights (SRHR) for KPs. Managed by ARASA in Southern Africa, the programme empowers communities, including PWUID, sex workers, LGBTQI+ individuals, and people living with HIV, who are disproportionately affected by criminalisation and social exclusion.
Wilson Box sheds light on the organization’s journey, key achievements, and the transformative impact of ARASA’s capacity-strengthening and advocacy support.
MG: Thank you, Mr. Wilson Box, for taking the time to share your valuable insights with us today. To begin, could you please elaborate on the health challenges faced by people who use and inject drugs in Zimbabwe, specifically highlighting those exacerbated by the lack of a supportive policy environment?
WB: PWUID in Zimbabwe face numerous challenges due to stigma, discrimination, and criminalisation of drug possession and use. Societal stigma leads to violence, marginalisation, and homelessness. The negative and judgmental attitudes of healthcare providers make it extremely difficult for them to access essential services, including HIV prevention and treatment.
The derogatory term “Zvigunduru” (useless persons with no fixed abode) used in reference to PWUID perpetuates further stigma and discrimination. A 2022 situational analysis conducted by ZCLDN, UNAIDS, NAC, and the Ministry of Health and Child Care revealed a significant link between drug use and HIV transmission through transactional sex. Of 300 participants, 65% reported engaging in transactional sex with multiple partners without condoms.
Zimbabwe’s lack of harm reduction programmes and tailored prevention and treatment services exacerbates the situation. PWUID are 35 times more likely to acquire HIV due to the sharing of needles and syringes. Other health challenges include TB, STIs, and Hepatitis C. Addressing these issues requires decriminalisation, harm reduction services, and drug policy reform.
MG: Can you tell us about your organisation and its journey with the Love Alliance Programme under ARASA?
WB: ZCLDN partnered with ARASA in 2014, marking the beginning of a transformative journey. At that time, ZCLDN had only two staff members. Through ARASA’s support under the Love Alliance Programme, we have expanded to a team of 12, with seven staff members trained in capacity-strengthening programmes.
With ARASA’s assistance, we launched the “Bestie” peer-led outreach programme, which provides health awareness, drug use education, and self-care for PWUID. This programme has encouraged PWUID to seek treatment services and is operational in eight provinces, with a goal to reach one million people by 2030.
In 2020, ARASA supported us in developing Zimbabwe’s first-ever National Drug Master Plan, adopted in 2021. This has since evolved into the Zimbabwe Multisectoral Drug and Substance Abuse Plan (2024–2030), launched by the President in June 2024. Additionally, ARASA has facilitated training for parliamentarians and hosted Zimbabwe’s inaugural Summer School on Drug Policy and Harm Reduction in 2024.
MG: How has ARASA’s capacity-strengthening support in the past year or two impacted ZCLDN’s advocacy work?
WB: ARASA’s support has been pivotal in building our staff’s capacity through training programmes like the Annual Regional Training and Leadership Programme (TaLP) and sessions on SRHR, SOGIE, and HIV advocacy. These initiatives have enhanced the effectiveness of staff like Knowledge Mupembe and Tinashe Chiweshe in advocating for KPs in Zimbabwe.
We also established a National Drug and Substance Use Observatory, which analyses data on drug use patterns and interventions. This has significantly contributed to a shift in Zimbabwe’s drug policy landscape towards decriminalisation and harm reduction.
MG: What specific policy changes have you influenced?
WB: Our advocacy has led to several notable achievements. Key among them is the adoption of the Zimbabwe National Drug Master Plan in 2021, developed in collaboration with 14 ministries. This plan addresses drug-related challenges through five pillars: Supply Reduction, Demand Reduction, Harm Reduction, Treatment and Rehabilitation, and Community Reintegration.
ZCLDN also advocated for the creation of a National Drug Coordinator position, leading to the appointment of Dr. Agnes Mahomva. In collaboration with her, we developed the Zimbabwe Multisectoral Drug and Substance Abuse Plan (2024–2030) and national guidelines for drug and alcohol treatment and rehabilitation, including harm reduction strategies.
MG: How many people/PWUID have benefited from your advocacy work?
WB: Over the past five years, we have directly engaged with over 100,000 PWUID. Through media advocacy on platforms like radio, television, and print media, we have reached over three million Zimbabweans. We have also trained over 300 healthcare workers, law enforcement officers, and community leaders to reduce stigma and improve service delivery for PWUID.
MG: How has ARASA’s grantmaking support facilitated ZCLDN’s advocacy work?
WB: ARASA’s grants have enabled us to expand our reach and amplify our message. Through national media platforms, we have educated millions on the need for drug policy reform and harm reduction services. Collaborations with local artists and radio stations have further increased our visibility, reaching over 10 million Zimbabweans.
MG: What best practices can other organisations working with PWUID in East and Southern Africa learn from ZCLDN?
WB: Organisations can learn the importance of placing PWUID at the centre of interventions. Empowering them to design and lead programmes fosters ownership and effectiveness. Networking with civil society organisations and engaging policymakers is also crucial for driving meaningful change.
MG: What challenges remain, and what is your call to action for policymakers?
WB: Challenges include the lack of tailored services, harm reduction programmes, and decriminalisation. Our call to action is for policymakers to adopt a public health approach, including:
- Naloxone interventions for overdose prevention
- Opioid agonist therapy
- ART services for those living with HIV
- Needle syringe programmes
- Comprehensive counselling and employment initiatives for youth.
MG: How have ARASA’s interventions helped address the challenges faced by PWUID?
WB: ARASA played a critical role in developing the Zimbabwe National Drug Master Plan and the Multisectoral Drug and Substance Abuse Plan (2024–2030). These initiatives signify Zimbabwe’s strengthened political will to address drug use through a public health approach.
MG: Thank you, Mr. Wilson Box, for your thoughtful and informative responses. Do you have any additional information you deem relevant for this interview?
WB: Thank you, Michael, for the opportunity to share our work. I have no further additions.
