By Michael Gwarisa
The global landscape of humanitarian aid has been increasingly uncertain, particularly in the wake of political changes in key donor countries. A recent example is the shift in U.S. foreign aid policy under President Donald Trump, who signed multiple executive orders that limited funding to international health programs, including HIV/AIDS. These moves have left many countries, especially those in sub-Saharan Africa, scrambling to find alternatives to ensure the continuation of vital healthcare services. Zimbabwe, like many of its neighbors, has found itself in a precarious position, dependent on external resources to meet the needs of its HIV-positive population. The aid freeze has sparked panic within the healthcare sectors of these countries, as they face the harsh reality of losing a crucial funding stream at a time when the HIV epidemic is far from over.
In Zimbabwe, the National AIDS Council (NAC) has been at the forefront of managing HIV and AIDS programs, providing antiretroviral (ARV) therapy to over a million people living with HIV (PLHIV). Recently, the NAC’s Chief Executive Officer, Bernard Madzima, reassured Zimbabweans that despite global shifts and concerns surrounding funding, there are adequate supplies of ARVs to meet the country’s needs. While such statements aim to alleviate public concern, the reality is more complex. Although the NAC has played a pivotal role in ensuring a steady supply of medications, the continuous reliance on foreign aid to fund these efforts presents a growing national security risk. To understand why, we need to examine the scale of HIV in Zimbabwe, the potential dangers of ARV interruptions, and the broader implications of HIV-related drug resistance.
HIV prevalence in Zimbabwe remains a significant public health issue. According to the Zimbabwe National Statistics Agency (ZIMSTAT), an estimated 1.3 million people are living with HIV in the country, with nearly 1 million receiving antiretroviral treatment (ART) as of 2020. This makes Zimbabwe one of the countries with the highest number of PLHIV in the region. The availability of ARVs, which has been made possible largely through foreign aid, has dramatically reduced the mortality rates associated with HIV/AIDS. These medications not only prevent the progression to AIDS but also help people living with HIV to lead longer, healthier lives. However, the interruption of ARV supply could have devastating consequences, both for the individuals directly affected and for the country as a whole.
A disruption in the supply of ARVs would significantly impact national security, as it would increase the number of individuals with untreated HIV, leading to a rise in new infections and preventable deaths. More importantly, the interruption could fuel the spread of HIV drug resistance, a growing global concern. When individuals miss doses or stop treatment altogether due to supply shortages, the virus can mutate and develop resistance to the drugs being used. This has already become an issue in several countries and poses a serious challenge for managing HIV in the future. According to the World Health Organization (WHO), drug resistance could reverse the significant progress made in the fight against HIV/AIDS. In Zimbabwe, a country already struggling with a high HIV burden, the development of ARV-resistant strains would compound the health crisis, making it more difficult and expensive to treat the disease.
The phenomenon of drug resistance is not merely a theoretical concern—it has real-world implications. Studies have shown that in sub-Saharan Africa, where the majority of the global HIV-positive population resides, resistance to first-line ARVs is already emerging. A study published in The Lancet HIV in 2019 found that nearly 8% of adults on ART in Africa developed resistance to the commonly used first-line ARV drugs. This resistance makes the virus harder to treat, and necessitates the use of second- or third-line treatments, which are more expensive and less readily available. If disruptions in ARV supply lead to more widespread resistance, Zimbabwe could face a situation where the current treatment regimens no longer work effectively, driving up healthcare costs and putting an even greater strain on an already overstretched system.
In addition to drug resistance, the mutation of the HIV virus itself presents a unique challenge. HIV is a rapidly mutating virus, and over time, the virus can evolve in response to the selective pressure exerted by antiretroviral drugs. This means that even in the best-case scenario, where patients adhere strictly to their treatment regimens, the virus continues to mutate, making it difficult to develop a single vaccine or a perfect treatment. The ongoing evolution of HIV means that strategies that are effective today may not work in the future. The need for a consistent, uninterrupted supply of ARVs, and ongoing research into better treatments, is critical if we are to stay ahead of the virus’s natural ability to evolve.
Given these concerns, Zimbabwe and other countries in the region must consider alternative strategies to safeguard their healthcare systems and mitigate the risks associated with over-reliance on foreign aid for HIV funding. One potential solution lies in leveraging existing natural resources to create a more sustainable funding model. Zimbabwe is rich in mineral resources, including gold, platinum, and diamonds, which could be harnessed to create a national HIV fund. By developing these resources in a responsible and transparent manner, Zimbabwe could generate revenue to invest in its healthcare infrastructure, reducing the country’s dependence on external aid.
Countries such as Botswana have already taken steps in this direction. In 2017, the government of Botswana announced a partnership with the mining sector to create a national fund aimed at combating HIV/AIDS. This model could serve as an inspiration for Zimbabwe, where the private sector, especially in the mining industry, plays a significant role in the economy. A well-managed fund could not only ensure the continuous supply of ARVs but also support research and development into new treatment options, helping to future-proof the country’s HIV response.
It is essential, however, that any such fund be carefully managed to avoid the corruption and mismanagement that has plagued other national programs. Transparent governance, accountability, and community involvement are key to ensuring that such resources are used effectively and for the benefit of all Zimbabweans, particularly the most vulnerable.
In conclusion, while the recent reassurances from the NAC regarding ARV supplies in Zimbabwe are reassuring, they mask the deeper issue of dependency on foreign aid for HIV treatment. The interruption of ARV supply not only threatens the health of millions but also poses a significant risk to national security. The emergence of drug-resistant strains of HIV, combined with the virus’s ability to mutate, makes it all the more urgent that Zimbabwe and other countries explore sustainable funding solutions for HIV and other health emergencies. Leveraging the nation’s natural resources to create a national HIV fund could help mitigate this risk and ensure that Zimbabwe is better prepared to face the evolving challenges of the HIV epidemic.
Michael Gwarisa is the Editor for HealthTimes. For feedback he can be reached on +263 776 280 754, michaelmjgwarisa@gmail.com, editorial@heamthtimes.co.zw
