SA flagged as key driver of new HIV infections in Matebeleland

Matebeleland South has emerged as the Zimbabwean province with the highest HIV prevalence, a situation closely linked to the migration of young women to South Africa and Botswana. According to the 2022 National Housing and Population Census, the province has an estimated population of 760,000, with approximately 93,000 people living with HIV. The HIV prevalence stands at 15%, significantly above the national average of 9%.

Mgcini Sibanda, Matebeleland South Provincial Manager for the National AIDS Council (NAC), highlighted that the migration of adolescent girls and young women (AGYW) via the Beitbridge and Plumtree border posts has intensified the spread of new infections. "The young girls go to South Africa and Botswana without proper papers. As a result, they end up depending on male people for their upkeep, who expose them to new HIV infections. At worst, they resort to sex work," Sibanda said. He explained that limited access to HIV services abroad increases risks, with returning migrants contributing significantly to new infections at home.

Female HIV incidence rates now exceed those of males across all seven districts, with Bulilima recording the highest rate at 0.38%. Other districts, including Mangwe at 16.8% and Umzingwane, also report prevalence far above the national average. Local advocates and affected women have called for targeted economic support to reduce migration. Memory Chere, a sex worker in Gwanda, said that empowering young people with small income-generating projects could curb risky cross-border movements. Nomathemba Madlambuzi from Umzingwane and Beulah Baloyi echoed these sentiments, emphasizing the role of financial support through government programs in reducing HIV exposure.

While antiretroviral therapy (ART) coverage is high at 98.4% across all ages, young women remain disproportionately affected. The surge in new infections is concentrated among key populations, including female sex workers and adolescent girls aged 15 to 24. Girls between 15 and 19 years face particularly high incidence rates, followed closely by those aged 20 to 24. Experts cite social and economic factors, including cultural practices such as early and forced marriages, societal norms undermining sexual autonomy, and economic dependence on male partners, as key drivers of vulnerability. Transactional sex, often linked to migration or artisanal mining work, further increases exposure to HIV.

Progress toward Zimbabwe's UNAIDS 95-95-95 targets has been uneven. While adult ART coverage in Matebeleland South reaches 98.8%, children lag at 89.9%, highlighting a gap in access and viral suppression among minors. Gender-transformative education initiatives, such as Not In My Village, are engaging traditional leaders to challenge harmful practices and promote safer behaviours, while social support programs target high-risk adolescent girls.

Despite these efforts, viral suppression remains a challenge among adolescents, due in part to stigma, caregiver dependency, and difficulties accessing consistent treatment. Boarding school students and those lacking supervision often struggle to adhere to ART regimens. Experts emphasize that addressing these structural, social, and economic barriers is essential to curb new infections and ensure sustained HIV control in the province.

The situation in Matebeleland South underscores the complex interplay between migration, economic vulnerability, and public health, highlighting the urgent need for multi-sectoral interventions that combine prevention, treatment, and economic empowerment for young women.