As thousands of Zimbabweans return home from South Africa in a wave of deportations and anti-immigrant sentiment, health experts warn that disruptions to HIV treatment could leave many at risk unless returnees are quickly reconnected to care, reports SciDev.Net
According to Statistics South Africa, Zimbabweans constituted one of the country’s largest migrant communities, with an estimated 1m living here.
Research in Gauteng has found HIV prevalence among international migrants to be around 10%, and for many migrants who are infected, sudden displacement presents immediate risks: medication may be left behind, treatment records lost, and patients may struggle to navigate health systems on their return.
“The disruption is not just about the medicines,” Efison Dhodho, research co-ordinator at Zimbabwe’s Biomedical Research and Training Institute, told SciDev.Net.
“Many returnees may have lost their treatment records, some fear accidental disclosure of their HIV status when they return to their communities, while others are dealing with the psychological stress of suddenly losing their livelihoods.”
Health authorities in Zimbabwe, which has one of Southern Africa’s largest HIV treatment programmes, say they are responding through a combination of digital health and patient-centred care models designed to prevent treatment interruptions among mobile populations.
Owen Mugurungi, director of the Aids and TB unit in Zimbabwe’s Ministry of Health and Child Care, said the Ministry was working with the Zimbabwe National Network of People Living with HIV (ZNNP+) and others to make sure everyone who needs antiretroviral drugs can access them.
The Zimbabwe National Aids Council (NAC) urged returning migrants with HIV to enrol immediately into Zimbabwe’s HIV treatment programme upon arrival.
“We have a very robust HIV treatment programme in Zimbabwe,” said NAC chief executive officer Bernard Madzima. “We have capable health workers at every facility in the country, from clinic level up to the highest referral hospitals, so there should be no problem in terms of them being integrated into this system.”
‘Omalayitsha’ network
Madzima said many Zimbabweans working in South Africa had been accessing six-month supplies of antiretroviral medicines from Zimbabwe through an informal cross-border transporter network known as “omalayitsha”, allowing them to remain on treatment while living elsewhere.
However, he said, more people are now returning permanently and need to be fully integrated into local HIV services.
Mental health challenges, stigma and the practical realities of displacement can all affect adherence to treatment, said Dhodho, who has worked on Zimbabwe’s HIV care strategies for migrant populations.
“If your life is suddenly disrupted and you’re forced to leave, your medicines may be left behind. Even a short disruption in routine can affect adherence. HIV treatment works best when people maintain viral suppression, which protects both their own health and helps prevent onward transmission.”
Dhodho said the country had already developed approaches, including the omalayitsha model, which could help returning migrants reintegrate into care more effectively.
However, he added that omalayitsha depends on predictable travel patterns and stable living arrangements, both of which have been disrupted by deportations.
Telehealth solutions
To bridge that gap, ZNNP+ has expanded the use of Kutabila, a virtual health platform that links returning migrants with HIV treatment and care services.
“The increase in Zimbabweans returning home has raised huge concerns about their continuity of HIV treatment,” said Tatenda Makoni, executive director of ZNNP+.
Through telephone-based counselling and referral services, trained counsellors assess callers’ treatment needs, direct them to the nearest health facility and provide adherence counselling and psychosocial support, he said.
Between 1 June and 8 July, the platform received more than 300 calls from returning migrants, Makoni added, with most seeking help on restarting treatment, replacing lost medical records, transferring HIV care from South Africa or accessing medicines after treatment interruptions.
Since its launch, Kutabila has handled more than 10 500 client interactions and successfully linked more than 7 300 people to treatment and care services.
Empathy approach
Zimbabwe is also applying lessons from Uzwelo, meaning empathy, a person-centred approach developed after the Covid-19 pandemic to re-engage people who had interrupted HIV treatment.
Rather than focusing only on tracing people who miss clinic appointments, Uzwelo encourages healthcare workers to understand the individual circumstances that caused treatment interruption and to develop care plans tailored to each patient’s situation.
According to Dhodho, who helped develop the approach, Uzwelo helped recover nearly a quarter of patients who had fallen out of care within just three months after being introduced in pilot districts.
“The health worker meets the client with empathy instead of judgment,” he said. “The question becomes, ‘How do we make treatment work for your circumstances?’ rather than ‘Why did you default?’”
Makoni believes such innovations offer lessons that extend beyond Zimbabwe. “Migration is a regional issue, and ensuring continuity of HIV treatment requires regional solutions,” he said. “Continuity of HIV treatment should not stop at national borders.”
SciDev.Net article – Digital tools help Zimbabwe’s HIV migrants stay in care (Open access)
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No evidence migrants causing hospital overcrowding – SAHRC
Call for inquiry into ‘systemic healthcare xenophobia’ against migrants in SA
Zimbabwe’s voluntary foot-soldiers against TB and HIV