US Aid Cuts Cripple HIV Services for Zimbabwe’s Sex Workers

U.S. funding cuts have disrupted HIV prevention and treatment services for Zimbabwe’s sex workers (image source)

Zimbabwe’s sex workers are facing a public health emergency after major cuts to U.S. funding disrupted HIV prevention and treatment services nationwide. Mobile clinics and outreach programmes once supported by USAID and CDC have scaled back or shut down entirely, leaving thousands of women vulnerable to infection and interruptions in life-saving treatment.

In informal settlements such as Epworth, key mobile clinics providing antiretrovirals (ARVs), HIV testing, and condoms have ceased regular visits. Sex workers like “Rumbidzai” now walk several kilometres to access the nearest facilities, only to find long queues and limited supplies. Doctors Without Borders reports clinics in Harare suburbs, including Epworth and Mbare, are overstretched, with dwindling resources leaving patients uncertain where to seek services. Project lead Charlotte Pignon warns that treatment gaps could fuel drug resistance and viral rebounds.

UNAIDS data show widespread interruptions in ARV distribution, viral load monitoring, and condom supply. Previously, facilities supported by USAID and PEPFAR provided roughly $90 million annually to HIV programmes. The sudden withdrawal left gaps in logistics, storage, and outreach, disproportionately affecting sex workers. Reports indicate women are now receiving as little as a 10-day ARV supply, and condoms have become scarce, forcing sex workers into unsafe practices to protect themselves and clients.

Zimbabwe’s adult HIV prevalence stood at 12.6 percent in 2024, with key populations, including sex workers, disproportionately affected. Centre for Humanitarian Analytics estimates over 40,500 women engage in sex work nationwide. Funding cuts have eroded their ability to negotiate safe sex, with some charging as little as 50 US cents per client—well below the cost of a single condom.

From 2005 to 2024, U.S. support contributed over $500 million to Zimbabwe, underwriting ARV procurement, testing, community outreach, and stigma reduction. When these funds were curtailed in January 2025, organizations scrambled to cover the shortfalls. The Global Fund continues financing in 21 of 64 districts, but no single donor matches PEPFAR’s scale. Government efforts to reallocate resources and partner with new donors—including China and the Gates Foundation—remain insufficient to fill the immediate gap.

In response, the Ministry of Health and Child Care is mobilizing public facilities to absorb demand, while civil society groups train peer educators and traditional healers to maintain outreach. Organizations such as All Women Advocacy and Springs of Life coordinate door-to-door sensitization, condom distribution, and ART refill drives in high-risk areas like Chitungwiza and Bulawayo.

Cecilia Ruzvidzo, a 47-year-old HIV-positive sex worker in Epworth, described the period after U.S. funding cuts as “very difficult. I literally lost my mind when they gave me just 10 days of ARVs.” Young mother Sharon Mukakanhanga resorted to using baby socks as improvised condoms, highlighting the life-threatening choices forced on women when prevention tools vanish.

“Any gap in ARVs or prevention tools for sex workers is a public health risk for them and for the general population,” a UNAIDS source said. Without rapid mobilization of alternative funding and the reinstatement of outreach services, Zimbabwe risks an HIV resurgence among sex workers and the wider community. Key questions remain: how many U.S.-funded clinics have closed permanently? What proportion of sex workers are now off stable ART regimens? Will international donors or domestic health budgets fill the gap in 2026 and beyond?

Monitoring organizations will be critical in tracking treatment retention, viral suppression rates, and new infection clusters in the coming months. By reinforcing community-led interventions, securing diverse funding streams, and restoring mobile clinic operations, Zimbabwe can protect one of its most vulnerable populations and prevent a reversal of hard-won HIV prevention achievements.