By Michael Gwarisa
For 21 years, Martha Tholanah (60) has lived with HIV. She has experienced it all, from the days when an HIV diagnosis was a death sentence to today, when people living with HIV can lead healthy, fulfilling lives.
Testing positive on January 3, 2003, Martha recalls her heartbreak when health workers informed her that her CD4 count was below 200.
I had fallen sick and had to get tested. I had also just been accepted for a new job, so I needed to know where I stood. When I got my CD4 count, it was 31. At the time, the World Health Organization (WHO) classified a CD4 count below 200 as stage four. Usually, hospitals would send you home for Home-Based Care, which meant there was nothing more that could be done—you were sent home to die,” she said.
Despite this grim prognosis, Martha had secured a new job at GALZ and was set to start on January, 6 the same year. A positive HIV diagnosis shook her, and she feared losing her job. However, her employer assured her she would not be dismissed. Compounding her fears, Martha also discovered she was pregnant.
“This was a surprise because two years earlier, I had been told I was in early menopause. I hadn’t menstruated for two years. I only took a pregnancy test because I felt something moving in my tummy, which was very strange.”
Her daughter was born, and at that time, an infant could only be tested for HIV at eighteen months. After testing negative at eighteen months and again at two years old, her daughter remained HIV-free.
Fast forward 21 years, and Martha’s viral load is now undetectable. Like many others living with HIV, she leads a life as healthy as someone without the virus, thanks to treatment literacy campaigns, anti-stigma initiatives, and the availability of antiretroviral therapy (ART).
Despite her success story, Martha now faces underlying health challenges that she believes impact her quality of life.
“People see us happy because we have undetectable viral loads and are on treatment, but the reality is we are not okay. We go about our work because we have to feed our families. No one seems to listen. If you visit a health center and mention body aches and pains, they just note it down—if at all—and no intervention follows. This is why people collapse and die unexpectedly, as they silently battle untreated underlying conditions,” she explained.
Chronic pain has forced Martha to avoid public gatherings and family functions.
“Family events are a time to connect, but I avoid them now because the pain makes it impossible to enjoy myself. If I do attend, I often leave early.”
Martha expressed concern about the focus on younger populations in HIV programming, which has overshadowed the needs of older adults who have lived with HIV for decades.
“Sadly, HIV focus has shifted, likely due to funding issues. The spotlight is on young people or the zero-to-49 age group, ignoring the reality that people are aging with HIV,” she said.
She emphasized that there is no proper care system for those aged 50 and above, and no significant investment has been made to support this demographic in HIV care.
“I get my treatment from the public health sector and see many older people living with HIV. They are often left to manage on their own without adequate care and support. HIV facilities used to include strong psychosocial support systems, but these are now lacking, especially for people over 49.”
Why Vital Monitoring Is Essential
Although Zimbabwe has made strides in combating AIDS, the country still has an HIV prevalence rate of 11.58%, amounting to 1.3 million people living with HIV as of 2021. Of these, 72,100 are children aged 0–14, and 77,300 are adolescents aged 10–19.
However, the country’s public health system lacks comprehensive diagnostics for people living with HIV, aside from viral load testing, which is effectively implemented annually.
“It’s good that viral load testing is done once a year, but other vital monitoring is missing. In private healthcare, you have to request these tests. The lack of proper monitoring means we are losing people with HIV to sudden deaths or illnesses that could have been managed,” Martha said.
She highlighted that while ARV packaging clearly outlines potential side effects, the lack of regular organ monitoring undermines progress made in HIV treatment.
“Packaging warns that ARVs can affect your liver, kidneys, and other organs. These need regular monitoring. Previously, external funding supported such monitoring, but since funders left, it’s no longer available.”
Young people living with HIV in Zimbabwe have also raised concerns about health complications linked to long-term antiretroviral use.
“When people discuss HIV and aging, they forget about young individuals born with HIV or diagnosed as toddlers. Many have been on treatment for 20 or more years. While they are healthy now, I worry about who is looking after their long-term health,” she said.
Weight Gain and Hypertension
A longitudinal study led by Zimbabwean clinical scientist Tinei Shamu explored the relationship between body weight, blood pressure, and antiretroviral therapy (ART). It linked significant weight gain and a high incidence of hypertension in Zimbabweans to Dolutegravir (DTG)-, Efavirenz (EFV)-, and Atazanavir (ATV/r)-based ART regimens.
The study found that high blood pressure in people living with HIV who switched to DTG was closely associated with weight gain, particularly among those with larger weight increases.
