Takhalani Ngulube (16) sits on a mat selling wares at a health outreach programme at Samlodi business centre in Gwanda South.
Ngulube is among hordes of people that have come to the outreach, which has been convened by the National Aids Council (NAC) and the Health and Child Care ministry.
“I came here with my mother, she is the one selling these wares,” she said.
“My mother is among those in the queues seeking health services.
“I am just supporting her, but I can't read and write.”
Ngulube said she has never been to school.
“I have never attended school, even Grade 1,” she said.
Across the province, in Ngwana village, Machinge in Bulilima district, 17-year-old Princess Gumbo’s hopes of pursuing her education were shattered after she completed her Grade 7 with her parents citing lack of fees.
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Gumbo said she was keen to further her education, but her parents told her to stay at home.
Her predicament symbolises the challenges faced by many girls of her age in Bulilima, Mangwe and other districts in Matabeleland who have been denied the opportunity to learn.
Most of these girls are now compelled to work as domestic workers and do other informal jobs in towns with many illegally crossing into neighbouring countries.
“I went to school up to Grade 7, but I could not proceed because my parents said there was no money,” Gumbo said.
“At the moment I am looking around for capital to start in-come generating projects.”
Ngulube and Gumbo are among a myriad of girls in Matabeleland South province, who have not been given the opportunities to go to school.
According to Unicef, as of the most recent estimates, there are about 119 million girls worldwide who are out of school (primary through secondary).
Education is one of the strongest protective factors against HIV.
When girls or young people miss out on schooling — whether due to poverty, disability, early marriage, caregiving roles, cultural norms, or lack of resources — their vulnerability to HIV increases through multiple pathways.
Girls who are out of school are more likely to have their first sexual encounter at a younger age, often with older partners.
Early sexual debut increases exposure to HIV due to biological vulnerability, lack of negotiation power, and limited access to sexual health information.
Studies in Sub-Saharan Africa show that staying in school longer reduces HIV risk by up to 60% for girls because school delays early marriage and early sexual activity.
“I am not yet married, but most of my age mates are married or have children,” Ngulube said.
“My dream husband should be someone working in South Africa.”
Most families in Matabeleland South province are split by migration and survival often depends on long journeys across borders.
However, it is women who bear the heaviest weight.
New 2024 HIV data painted a stark picture: this is the province with the highest HIV burden in Zimbabwe, and women are at the centre of the epidemic.
Behind every statistic is a story of struggle, resilience, and communities grappling with deep-rooted social and economic vulnerabilities.
Matabeleland South’s HIV prevalence stands at 15%, alarmingly higher than the national average of 9,8%.
With a population of 760 342, the province has 92 882 people living with HIV.
Nearly all — 89 280 people — are on antiretroviral therapy, a testament to strong treatment uptake.
Every district in the province records an HIV prevalence above the national average, with the hardest-hit being Bulilima at 17,5%, Mangwe (16,8%) and Gwanda (15,8%).
These border districts tell a story of mobility, truck routes, informal trade, economic desperation — and the vulnerabilities that come with them.
Perhaps the most sobering finding is the gender disparity in new HIV infections.
Across all seven districts, female HIV incidence — the rate of new infections — is consistently higher than male incidence.
In some areas, the gap is alarmingly wide; Bulilima: 0,38% female vs 0,17% male, Mangwe: 0,27% female vs 0,17% male and Beitbridge: 0,26% female vs 0,15% male.
Limited power to negotiate safe sex, economic dependency, cultural expectations, and gender-based violence are some of the HIV drivers.
“I used to sell vegetables in Gwanda town because my husband had gone to South Africa,” said Sakhile Dube*, one of the women who was collecting ARVs at the Samlodi outreach programme.
“My husband would not come home and at some point, he spent the year without sending money home.
“I was faithful at first, but I ended up giving in to other men’s demands. I had no choice.”
Dube said most women trying to support their families were exposed to risky environments shaped by mobility, truck drivers, and transactional relationships born out of economic pressure.
“Women remain the face of the HIV epidemic here in Gwanda,” she said.
NAC provincial manager for Matabeleland South, Mcqini Sibanda, said the statistics pointed to a crisis that needs urgent, targeted action.
“The fact that female incidence is higher in every district tells us that women in Matabeleland South continue to shoulder the greatest burden of HIV,” Sibanda said.
“We must scale up targeted interventions for women and girls, especially in districts like Bulilima and Mangwe where new infections remain worryingly high.”
Sibanda attributed the elevated risks to deeply ingrained social and structural factors.
“Our province is highly mobile. People cross the border daily, and women are often the most exposed in these economic and social dynamics,” he said.
“We cannot treat this as just a health issue — it is a community and livelihood issue.”
This publication established that most girls enter relationships with older, mobile partners to secure basic necessities — groceries, airtime as well as transport money.
“I met this man, the age of my khulu (grandfather) through a friend, a malayitsha,” said Sibongile* from Machinge.
“He promised to buy me a smartphone and take me to South Africa, but before I knew it, I had fallen pregnant and the boyfriend disappeared.
“I am now looking after my son, he is three years old and the boyfriend is nowhere to be found.
“I am told he is from Tsholotsho, and I never received any support from him, even the promised smartphone and goodies never came.”
Across many communities in Matabeleland South, women bear the brunt of HIV’s impact — not only in terms of infection rates, but also as the primary caregivers for sick partners, children and relatives.
“I am HIV positive and on antiretroviral treatment, but I also take care of my grandchildren orphaned by Aids, while still supporting sick relatives,” said Gogo Monitor Dube of Empandeni.
“I have been on treatment since 2007, but I have committed to also help others living with HIV.”
Sibanda as part of interventions NAC and the Health ministry are working with partners, calling for localised, gender-sensitive solutions.
He said the province was implementing interventions that recognise the realities women face including gender-sensitive prevention and sexual and reproductive health rights programmes; economic empowerment and livelihood support; stronger cross-border HIV programming, mobile clinics for hard-to-reach communities as well as community dialogues on gender norms and violence.
NAC adopted models such as peer led approaches model for sex workers and other vulnerable groups such as fishermen, artisanal miners and tertiary students.
The thrust of this model is to address the HIV and Aids and sexual reproductive health needs for these vulnerable groups by giving them opportunities to learn from their peers.
The Sista2sista model, which aims to empower adolescent girls and young women with sexual reproductive health services, is one approach that is being implemented across all seven districts.
Experts warn that unless the gendered nature of the epidemic is addressed head-on, the province will continue to experience the highest rates in the country.
“Addressing the gendered nature of HIV head-on calls for gender-responsive policies, resources targeted at women and girls, and a deliberate effort to dismantle the social and economic inequalities that continue to fuel new infections,” said public health expert Johannes Marisa.
“If we protect and empower the women of Matabeleland South, we will change the course of the HIV epidemic in the entire province.”
- Not real name
