Harare, Zimbabwe — Sex workers are the first to feel the effects, as mobile health clinics that offered condoms and preventative treatments disappear.
Rumbidzai, a sex worker from the bustling settlement of Epworth in Harare, has been taking antiretroviral drugs since 2017. For over two years, the mother of three has relied on mobile clinics that regularly visit her community to offer vital services such as ARVs, as well as condoms and HIV testing.
For years, the familiar sight of mobile health clinics rolling through the densely populated streets of the settlement meant survival for Rumbidzai and thousands like her. These clinics were lifelines, bringing essential HIV medication, testing and protection directly to those who needed it most.
Since Jan. 20, the clinics have all vanished — casualties of a sweeping United States foreign aid suspension that has left Zimbabwe’s most vulnerable populations in crisis.
“I don’t want to die — my children are still young. Who will take care of them?” says Rumbidzai, requesting only her middle name be used due to concerns about stigma.
A recent directive from US President Donald Trump ordering the United States Agency for International Development to cease operations has led to the shutdown of numerous crucial programs in Zimbabwe, directly impacting organizations such as Population Solutions for Health and CeSHHAR , which have long been a lifeline to sex workers.
“The sex workers are crying; they are afraid of dying,” says Chipo, an outreach worker who has served these communities since 2015. She asked only to use her middle name for fear of retribution. In Harare alone, she says, mobile clinics are serving nearly 6,000 sex workers — all now left scrambling for basic health care.
Zimbabwe has about 1.3 million people living with HIV/AIDS and close to 95% are on ARV treatment, a significant part of which is funded by the US, primarily through the President’s Emergency Plan for AIDS Relief program, known as PEPFAR.
In 2023, the allocated resources for HIV in eastern and southern African countries totalled 9.3 billion US dollars. Domestic funding covered about 40% of that amount, while the rest was provided by external sources, primarily PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria.
Community-based mobile health clinics have proven to be an effective model for delivering health care to vulnerable populations, especially in countries with lower gross national incomes. These clinics are especially valuable for people who may not typically visit public health centers, such as people engaged in transactional sex.
Beauty Magora, who began sex work in 2015 and now serves as a community mobilizer, is worried about her upcoming HIV prevention treatment. She typically receives preexposure prophylaxis treatment every two months through mobile clinics, which provided the service free of charge. PReP is an injectable antiretroviral treatment that diminishes the chance of contracting HIV.
With the clinics suspended, she’s uncertain about switching to tablet medication. “I don’t know if there will be any effects if I switch to tablets,” she says.
Magora’s uncertainty reflects a broader crisis affecting the estimated 45,000 female sex workers in Zimbabwe, more than half of whom are HIV-positive.
The impact reaches beyond medication. Condoms, once freely distributed, have become precious commodities. “Local clinics only give us three to four strips per week,” Rumbidzai says. “In our trade, that’s not enough. People will take risks when supplies run out — something we desperately want to avoid.”
A shortage of condoms will lead to the creation of a breeding ground for infections and reinfections, affecting not just sex workers but their clients as well, says Muchanyara Cynthia Mukamuri, chairperson of the Women’s Coalition of Zimbabwe. At the same time, a huge portion of funding for antiretroviral therapy came from the US, she adds. “If that is withdrawn, will Zimbabwe be able to cope with the rise of need for HIV prevention, treatment and all these things?”
Mukamuri emphasizes that with all the natural resources Zimbabwe possesses, the country should now strive for self-sufficiency. “We need to revisit our strategies, refocus our efforts, and redirect our resources to ensure that people living with HIV are not left at the mercy of whoever decides to provide — or withhold — resources,” she says.
Meanwhile, Rumbidzai is clinging to hope for a change in policy. “If anything, Trump should lighten his heart, because our lives are hanging by a thread,” she says.
