By Michael Gwarisa in Gweru
The Ministry of Health and Child Care (MoHCC) has warned of a decline in the coverage of Voluntary Medical Male Circumcision (VMMC) in the Midlands province owing to major disruptions in donor funding earlier this year.
For more than a decade, Zimbabwe’s VMMC program has relied heavily on external financing, particularly from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Centers for Disease Control and Prevention (CDC), as well as grants from the Bill & Melinda Gates Foundation. However, following the freeze on foreign aid by the new U.S. administration, funding for circumcision activities has been significantly reduced, leaving provinces like Midlands vulnerable.
Provincial Medical Director, Dr. Mary Muchekeza, said the effects of the cuts were already visible on the ground.
With regard to the VMMC uptake, off the cuff, I will not be able to give the figure, but we made significant strides when we used to have donor funding. I must speak at this point to say that we are seeing a decline in the number of people who are coming to VMMC,” she said.
VMMC is among the most widely adopted HIV prevention methods in Zimbabwe, having been scientifically proven to reduce a man’s risk of acquiring HIV through heterosexual sex by about 60%. However, experts caution that circumcision does not provide complete protection and must be used alongside other preventive measures, such as condom use, HIV testing, and Pre-Exposure Prophylaxis (PrEP).
WATCH: Dr. Muchekeza speaks on the impact of donor funding towards the VMMC program
Dr. Muchekeza said despite the setbacks, efforts were underway to revive demand for circumcision through local strategies.
“After the cut of funding, we saw a decline, but we are confident that with the interventions we are doing in terms of continuous education promotion, as well as sensitisation, we will get to see that picking up again. We continuously engage our local structures. As you know, we are a devolved country with structures that run all the way from the national to the provincial, down to the district level.”
In 2024, MoHCC reported that more than 150,000 men and boys had undergone circumcision under the INTEGRATE-Catalyzing Integrated Sustainable Subnational HIV Biomedical Prevention Program, an initiative aimed at strengthening decentralized HIV prevention services.
HIV Burden in Midlands
Speaking on the provincial HIV situation, Mr. Mambewu Shumba, the National AIDS Council (NAC) Provincial Manager, said VMMC remained an important pillar of the province’s HIV prevention response, alongside condom programming.
“We are there to bring together all those constituencies together, and we lead the response. And we are aiming to have an AIDS-free Zimbabwe by the year 2030, where we will be talking of less HIV infections, less stigma and less deaths within the country by then,” said Mr. Shumba.
He said Midlands has 8 administrative districts and 10 NAC districts, including Kwekwe Urban, Kwekwe Rural, Gweru Urban, and Gweru Rural — all with a high disease burden because of industries, tertiary institutions, and high population movement.
[pullquote]The province has more than 275 health facilities serving a population of about 1.8 million, of which an estimated 165,000 are living with HIV.[/pullquote]
According to NAC estimates, HIV prevalence in Midlands stands at 7.5% across all age groups, but rises to 10.9% among sexually active adults (15–49 years). Districts such as Zvishavane (16.3%), Shurugwi (14.6%), and Mberengwa (13%) have some of the highest prevalence rates, while Gokwe North (5.8%) has the lowest.
“Condom use and VMMC are critical in reducing the new infections we continue to record, especially in mining towns and high-mobility areas such as Kwekwe and Gweru. These are hotspots because of artisanal mining, industries, and tertiary institutions,” said Shumba.
He noted that while progress has been made in the fight against HIV, challenges remain, particularly around adolescent girls and young women, drug and substance abuse among youth, low condom use, and gaps in HIV testing and treatment coverage for children.
“Some of the problems we face are limited access to information and services, especially in resettlement areas where health facilities are scarce. There is also low comprehensive knowledge about HIV among young people, coupled with risky behaviours like unprotected sex and substance abuse. These are factors that continue to drive new infections in the province,” Shumba added.
Pushing Towards 2030 Goals
Mr. Shumba emphasized that the NAC was committed to achieving the 95-95-95 targets and ending AIDS as a public health threat by 2030. This means ensuring that 95% of people living with HIV know their status, 95% of those diagnosed are on treatment, and 95% of those on treatment achieve viral suppression.
Currently, ART coverage in Midlands is about 90% overall, but still lags behind in children at 61%, compared to 91% among adults.
To address these challenges, NAC is implementing combination HIV prevention strategies. This includes expanding condom distribution and education, scaling up VMMC services, strengthening community HIV testing and linkage to treatment, providing PrEP, addressing gender-based violence and stigma, and increasing youth-focused HIV and sexual health programs in schools, tertiary institutions, and workplaces.
As donor support dwindles, the Midlands province finds itself at a crossroads. Stakeholders like NAC and MoHCC are working to sustain momentum through community engagement and local resources, but the gap left by major external funders remains significant.
For Dr. Muchekeza, the way forward lies in innovation and resilience.
