By Michael Gwarisa, recently in Masvingo
For the past 12 months, Wellington*, a 41-year-old Masvingo man who has sex with men (MSM) and a male sex worker, has relied on oral Pre-Exposure Prophylaxis (PrEP) to reduce his risk of HIV infection. He has also used condoms and occasionally Post-Exposure Prophylaxis (PEP).
At the start of 2025, Wellington hoped he would be initiated on the injectable form of PrEP, Cabotegravir Long-Acting (CAB-LA), to further protect himself. But like many other HIV prevention services, the injectable program had been suspended following the halt in U.S. government funding for HIV programs in Zimbabwe. Now, clinics in Masvingo have announced the return of CAB-LA and the Dapivirine Vaginal Ring, reigniting hope among key populations.
I am hopeful that this time I will get my shot,” said Wellington. “I was on the pill all along and it helped me a lot, but the problem is sometimes I would skip doses or forget to take the pill, and this put my life in harm’s way.”
Wellington noted that when CAB-LA was first introduced in Masvingo, it was largely targeted toward female sex workers (FSWs). He is among a growing number of MSM receiving services at Runyararo Clinic, one of the key facilities implementing Key Population (KP) friendly programs in the city.
Sarudzai (35), a female sex worker who also preferred to be identified only by her first name, welcomed the return of the Vaginal Ring and injectable PrEP. She has been in the trade for 5 years
“Even though the injection was suspended, I never stopped taking the oral PrEP. I also used the female condom and made sure I carried male condoms for my clients,” she said. “Now that the injectable is returning, I am very glad. I can’t wait to get it.”
Sarudzai began oral PrEP in 2021 at CESHAR Clinics along Simon Mazorodze but now collects her medication at Runyararo Clinic. She said the clinic has improved service delivery by increasing medication allocations from one to three months. The resumption of injectable PrEP, she says, adds another layer of protection.
Masvingo began implementing KP programs in 2018 through facilities like Mucheke, Rujeko, and Northwest clinics, with the aim of boosting uptake of HIV services and reducing new infections among vulnerable groups.
The City Health Director for Masvingo, Suzanne Madamombe, confirmed that the city has resumed the provision of HIV prevention services, including CAB-LA and the Vaginal Ring.
“We resumed these programs on the 9th of June,” Madamombe said. “It’s also important to note that clients who were already on the program before the stop-work order have maintained their HIV-negative status. They successfully migrated to oral PrEP without major issues.”
The city’s efforts have been significantly strengthened by a Community-Led Monitoring (CLM) initiative that puts KP members at the center of service delivery and evaluation. The CLM approach ensures healthcare services are more responsive to the needs of key and vulnerable populations.
Sister Chauke, the Acting Sister-in-Charge at Runyararo Clinic, explained how the program evolved.
“At the beginning, the clinic was only seeing MSM and three female sex workers. We had a committee to track the progress of the KP program, which included representatives from NAC, the Ministry of Health, and the Provincial Authority,” said Sr. Chauke.
In 2019, the introduction of the CLM initiative allowed KPs to lead and manage aspects of service delivery. KP representatives were selected to monitor the clinic’s performance, identify barriers, and propose solutions.
“The CLM acts as a bridge between the community and the facility,” Chauke added. “It ensures that challenges in service delivery are addressed, allowing KPs to access services without stigma or discrimination.”
The approach has proven effective. Since the implementation of CLM, client numbers have increased, and community members now refer peers to the clinic. Follow-ups on defaulting clients have also improved.
“Currently, we have 79 female sex workers, 32 MSM, and one transgender person on antiretroviral therapy (ART),” said Sr. Chauke. “On PrEP, we serve 20 female sex workers, 14 MSM, and two transgender individuals.”
The clinic, which serves a catchment population of over 28,000 people, offers a range of services including STI management, PrEP, PEP, condom and lubricant distribution, and maternal care. It also conducts TB screening, mental health support, and health education.
Madamombe noted that while donor support had been critical, the city had made deliberate efforts to sustain KP services using internal resources.
“As a local authority, we’ve maintained some level of independence. Even during the funding freeze, we had budgeted for expansions to improve privacy in our clinics, especially for KP clients,” she said. “That work is ongoing.”
The city also benefited from prior training of nurses and community health workers, who are now implementing community models and conducting patient follow-ups.
“We’re fortunate to have retained most of our trained staff. Those staff are now training others, though we still need more capacity building to strengthen KP services,” she added. “We’ve also trained nurses to support adolescent KPs, particularly those living with HIV, by establishing adolescent support groups.”
Munorwei Munyikwa, the National AIDS Council (NAC) Masvingo Provincial Monitoring and Evaluation Officer, highlighted the role of training in building KP-friendly services.
“Runyararo Clinic is an illustrative health facility where we’ve trained a number of healthcare workers to provide KP-friendly services,” said Munyikwa. “With sufficient funding, our goal is to ensure every healthcare worker receives training to serve key and vulnerable populations.”
