By Michael Gwarisa in Masvingo
She is nine months pregnant and could give birth any day now, yet Melody Mhlanga* still sells sex to survive. The 25-year-old from Gutu, Masvingo Province, found herself thrust into the world of sex work three months ago after her marriage collapsed. With no income, no support, and a baby on the way, she saw no other path.
“I joined sex work three months ago when my marriage crumbled,” she says, her voice trembling. “I didn’t have any source of income, and I needed to buy clothes and prepare for my baby. He could come any time now.”
Melody, like many others in similar circumstances, dropped out of school early and never had the chance to gain formal employment. In a country battling high unemployment and donor fatigue, women like her are increasingly turning to sex work not by choice, but out of necessity. The dangers, especially for pregnant women, are immense, ranging from physical violence to heightened vulnerability to HIV and other sexually transmitted infections (STIs) due to hormonal and physiological changes during pregnancy.
But in the midst of this adversity, Melody has found support and dignity through the Public Sector Key Populations (KP) Program, spearheaded by the National AIDS Council (NAC). Implemented across various districts in Masvingo Province, including Gutu and Zaka, the program has emerged as a lifeline for vulnerable groups, especially female sex workers, in the wake of donor funding cuts that shuttered many NGO-run clinics.
I feel safe here,” Melody says of her visits to Gutu District Hospital. “They don’t judge me. They give me PrEP, test me, monitor my baby, and treat me with respect.”
At the hospital, Melody receives antenatal care, HIV counselling and testing, Pre-Exposure Prophylaxis (PrEP), condoms, and Prevention of Mother-to-Child Transmission (PMTCT) services, all free of charge. What makes this access even more remarkable is the clinic’s sex worker-friendly approach, a result of deliberate training and sensitization of healthcare personnel under the KP program.
The NAC-led initiative was born out of urgent need. When the United States government withdrew financial support earlier this year, several NGO-run facilities serving key populations—sex workers, men who have sex with men, and others at high risk, were forced to shut their doors. This sudden void exposed just how fragile and donor-dependent Zimbabwe’s HIV response had become. In response, the NAC launched the Public Sector KP Program to institutionalize services within public health facilities and ensure continuity and sustainability.
“The goal is simple,” says Pasca Mukuwe, the District AIDS Coordinator (DAC) for Gutu. “Sex workers are among the most vulnerable. They struggle to access services. So, we are bringing services to their doorstep and creating a KP-friendly environment at our health facilities.”
This shift is not just logistical, it’s philosophical. The program embraces the UNAIDS vision of ending AIDS by 2030, ensuring no one and no place is left behind.
At Jerera Growth Point in Zaka, sex worker Sarudzai Kunodziya echoes Melody’s sentiments. The program, she says, has provided more than just healthcare, it has offered hope.
“Even when other programs closed, this one never stopped. They continued giving us male and female condoms,” she says. “The Community-Led Monitoring (CLM) initiative has also helped us. It allows us to speak openly about problems we face at clinics and work with health staff to fix them.”
The CLM mechanism, embedded within the broader KP program, enables sex workers to monitor services at health facilities, report discrimination, and help shape a more responsive healthcare system. It empowers communities that are often marginalized and voiceless.
Sister Farirai Dambwara, a midwife and KP nurse at Gutu Rural Hospital, says attitudes among staff have evolved since the program began.
“Most of our staff have been trained on how to welcome beneficiaries of the program,” she says. “There is no discrimination. When they arrive, we offer all services free of charge, just like we do for anyone else.”
Understanding that many sex workers operate at night, the program has also rolled out quarterly night clinics, held between 6 PM and 10 PM in high-risk communities. These clinics offer STI treatment, HIV testing, family planning, cervical cancer screening, and access to antiretroviral therapy.
“We take the services to where they are,” explains Sister Rejoice Makuzva of Jerera Satellite Clinic. “Our night clinics target those who can’t come during the day, especially sex workers and artisanal miners. They come, we treat them, we counsel them, and we provide everything they need.”
To mobilize clients, peer educators and community health workers are engaged, ensuring wide reach and building trust within the community. In Gutu, the clinics are hosted in known HIV hotspots such as Chomsy, Bhasera, Zoma, and Runyowa. In Zaka, services center around Jerera Growth Point, with outreach extended to other high-risk areas.
In Zaka, the KP Program began in 2022 and has steadily grown. Anastacia Zendakwaye, the DAC for Zaka, says the program has fundamentally reshaped their HIV response strategy.
“This program has really enhanced the way we do our work. In HIV, we say no one should be left behind,” she says. “Traditionally, most KP programs in Zimbabwe were run by NGOs. But we had to ask ourselves: how sustainable is that?”
By embedding KP services in public facilities, the NAC is future-proofing Zimbabwe’s response to HIV and ensuring that even in the absence of donor funding, sex workers and other key populations won’t be left out.
“At Jerera, we’ve trained our health personnel, and even conducted exchange visits with other facilities running these services,” says Zendakwaye.
The impact is evident. At Jerera Satellite Clinic alone, over 90 female sex workers are officially registered under the facility. But healthcare workers believe the actual number is far higher, possibly over 500, due to stigma and fear that prevent many from coming forward.
“But we’re reaching them,” says Sister Makuzva. “Our counsellors go into the community. We’ve also introduced door-to-door services. I remember one lady had an STI and was too afraid to come. So we went to her.”
The Public Sector KP Program is more than a healthcare initiative—it is a declaration of dignity for women like Melody and Sarudzai, whose lives are often defined by marginalization and invisibility. It fills a critical gap left by the exit of international donors, signaling a shift toward self-reliant, community-driven healthcare.
As Zimbabwe’s economy continues to wobble and traditional funding sources dry up, such innovations become not just helpful, but essential.
“Sex workers are human beings with the same rights to health and protection,” says Mukuwe. “And this program ensures they get exactly that.”
For Melody, the support she receives may not change her reality overnight, but it provides a measure of safety, health, and dignity as she prepares to bring new life into the world.
Name* changed to protect identity.
