A community-driven revolution in HIV prevention is taking root across Matabeleland, as sex worker-led initiatives prove to be the “missing link” in reaching the region’s most vulnerable populations.
Speaking at a National Aids Council (NAC) engagement in Esigodini last Friday, Molinah Phiri, a regional technical officer for the Centre for Sexual Health and HIV/Aids Research (CeSHHAR) Zimbabwe, revealed that shifting leadership to the communities themselves has drastically improved trust and service uptake.
The programme, which operates 165 service points across 42 districts, puts female, male, and transgender sex workers at the forefront of design and implementation.
By using a strategy called “microplanning,” teams can now identify and support both visible and “hidden” sex workers who might otherwise avoid conventional clinics due to fear of judgment.
“Many struggle to access services in conventional health facilities due to stigma,” Phiri said.
“Our model brings services closer to them in safe, non-judgmental environments”.
A critical component of this outreach is the targeting of “highway sites.” Mobile teams are now delivering HIV testing, STI screening, and mental health support directly to high-traffic areas including Hwange, Lupane, Gwanda, and Bulilima.
Phiri said protecting sex workers ultimately protects the broader community.
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“The partners of sex workers are our cousins, our fathers, our brothers, and our husbands,” she said. “We want sex workers to access services so that we are also protected.”
The region is also at the forefront of a major medical shift with the move from daily pills to long-acting injectable pre-exposure prophylaxis (PrEP).
In Bulawayo, where the rollout of injectables like Lenacapavir (LEN) began in February 2026, the response has been swift.
All initial doses were administered within weeks, with a balanced uptake between new clients and those switching from oral medication.
These long-acting options offer “discreet protection,” which Phiri noted is vital for those in difficult social situations who may not want to keep pill bottles in their homes.
Despite the success in Bulawayo, challenges remain. There is lingering “hesitancy” regarding new medications like LEN, alongside issues with injection site pain and occasional stock-outs of supplies.
While uptake is high among women, engagement with men and other key populations remains a hurdle.
As Zimbabwe aims to end Aids as a public health threat by 2030, the message from the Esigodini meeting was clear: local, community-led models are no longer optional—they are the strategy.
“If we are to end HIV, we must prioritise key populations,” Phiri said. “No one should be left behind.”
