Zimbabwe’s HIV Strategy Reboots with Reusable Kits After Donor Exits
Zimbabwe’s HIV prevention programme is on the brink and to save it, the country is turning to reusable circumcision kits.
With donor funding gone, this bold move could redefine how lifesaving care is delivered in struggling health systems.
Since its launch in 2009, the Voluntary Medical Male Circumcision (VMMC) programme has been a cornerstone of Zimbabwe’s HIV strategy.
By 2012, over 1.1 million circumcisions had been performed, pushing the country close to its target of 80% coverage among adult males and newborns.
To maintain momentum, the Ministry of Health and Child Care (MoHCC) had aimed for at least 150,000 circumcisions annually.
But that progress is now in jeopardy.
In 2024, major donors — including PEPFAR, the Global Fund, and the Bill & Melinda Gates Foundation, withdrew support for circumcision and condom programming, citing shifts in global health priorities.
Although PEPFAR introduced a US$65 million Bridge Plan to temporarily support Zimbabwe’s HIV response, VMMC and condom distribution were excluded.
With donor funding gone, the MoHCC has taken full control of the programme, signaling a shift toward domestic ownership and cost-saving strategies.
Dr. Tsitsi Apollo, deputy director in the MoHCC’s AIDS and TB Unit, confirmed that VMMC is among the programmes most affected by the cuts.
With zero external funding, the ministry is now relying on reusable kits and efficiency-based delivery.
She outlined a tiered approach: at 25% funding, the ministry can combine reusable and limited disposable kits with targeted campaigns, at 50%, operations could expand with more flexibility.
Condom programming has also been severely impacted.
The shift to reusable kits has sparked concern among public health experts, particularly around safety and sterilization.
Improper cleaning could lead to infections or cross-contamination if strict protocols are not followed.
According to World Health Organization (WHO) guidelines, reusable instruments must be cleaned with soapy water and brushes, avoiding corrosive disinfectants like chlorine, and regularly inspected for damage.
Dr. Apollo assured the public that safety remains a top priority.
She emphasized that Zimbabwe’s infection control policies are designed to minimize risk and that the practice aligns with WHO recommendations.
Several countries — including Kenya, Tanzania, Eswatini, and South Africa have successfully implemented mixed models using both disposable and reusable kits.
WHO recognizes both approaches as safe when sterilization protocols are strictly followed.
Despite VMMC’s proven effectiveness — reducing female-to-male HIV transmission risk by up to 60%, uptake in Zimbabwe has dropped sharply.
Between January and March 2024, only 41,160 circumcisions were performed out of a target of 235,366.
By December 2023, no province had reached the 80% coverage goal.
Lupane and Tsholotsho led with 61%, while Kariba and Binga recorded just 17% and 19%, respectively.
Behind these numbers are communities still vulnerable to HIV, waiting for solutions that feel safe and accessible.
The low uptake has prompted calls to reallocate resources to other HIV prevention tools.
Munyaradzi Chimwara, Country Director for COMPASS Zimbabwe, said VMMC uptake has been very low when measured in U.S. dollar terms compared to condoms and PrEP.
He argued that VMMC, like condoms, is a male-controlled prevention measure, which limits women’s protection.
PrEP, he noted, provides an opportunity for both genders to take control of their s€xual health.
As Zimbabwe transitions to locally funded HIV prevention, health analysts say the country must balance cost efficiency, clinical safety, and public trust.
Reusable kits, if implemented under WHO-compliant protocols — could offer a practical solution.
But Zimbabwe’s next chapter in HIV prevention will depend not just on tools, but on trust.
-Health Times
