Chiedza Makura only learned she had been dismissed from her nursing job when a WhatsApp message came through on the evening of 28 January. The 37-year-old single mother of three worked as an HIV nurse at Zim-TTech, a private voluntary organisation established out of the University of Washington’s International Training and Education Center for Health in 2003, to provide HIV and Aids-related services.
“I felt shuttered,” Makura told the Guardian, after finding herself out of a job and struggling to feed her family and keep them in school. For the past three years she had been earning $500 (£400) a month. “My job was my only source of income. I still do not know what to do,” she says.
Her dismissal came shortly after Donald Trump’s executive order pausing foreign assistance, pending a 90-day review period, to developing nations. She is one of those who worked for organisations that relied on the US president’s emergency plan for Aids relief (Pepfar) and USAid.
In Zimbabwe, USAid provided funding of up to $360m to support health and agriculture programmes. Makura is one of thousands of Zimbabwean healthcare workers who worked for non-governmental organisations and civil society groups supporting HIV and Aids-related services, who received those funds.
She was responsible for collecting blood samples, measuring viral load, tuberculosis (TB) screening, TB prophylactic treatment advocacy, viral load collection and antiretroviral therapy (ART) resupplying. About 1.2 million people taking ART were supported by USAid along with services such as counselling and testing.
Clinics such as the Population Solutions for Health (PSH) and New Start centres providing counselling, free testing, voluntary male circumcision, ART and pre-exposure prophylaxis, known as PrEP, across the country were closed down on 28 January.
In a press release dated 29 January, the US embassy in Harare encouraged the Zimbabwean government to “take seriously its responsibility for the health of its people”.
Trump’s administration gave a reprieve to some of the services on HIV and Aids after a public outcry, but in Zimbabwe, healthcare workers say they are yet to receive any communication on what is exempted from the executive order.
Gumisayi Bonzo, a director at Trans Smart Trust, an organisation offering HIV and Aids services to transgender and intersex people, says they have been forced to stop implementing programmes.
“All nine transgender staff who were referring transgender people for clinical services at PSH clinics lost their jobs,” Bonzo says, adding that they are also struggling with paying the rent on their offices in Harare.
Hazel Zemura, director of All Women Advocacy, an organisation representing sex workers in Zimbabwe, says it is a blow to her community that clinics offering HIV and Aids services have been forced to close.
“These are safe spaces where HIV key-affected populations go for ART refill, STI screening and treatment, viral load testing, cervical cancer screening, PrEP and post-exposure prophylaxis (PEP),” she says, adding that they had also stopped providing services to sex workers under USAid funded programmes.
Calvin Fambirai, executive director at the Zimbabwe Association of Doctors for Human Rights, said because the health sector in Zimbabwe is donor-dependent, any gains made over the years in areas such as HIV and Aids are likely to be eroded.
“There is a need to strengthen domestic financing for health to ensure that shocks such as the withdrawal of US support are mitigated,” he says.
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In 2023, Zimbabwe reached 95-95-95, the UN Aids target where 95% of people living with HIV know their status, 95% of those are on ART, and 95% of those on ART have achieved viral suppression.
Activists attribute this milestone to donor-funded interventions, while Zimbabwe’s health sector is under-resourced. Annual funding falls short of the 2001 Abuja declaration, which calls for at least 15% of the budget to be allocated to the health sector.
Martha Tholanah, an Aids activist, says it is a wake-up call for Zimbabwe to put more domestic resources towards health.
“The way it has been done in such an abrupt manner is disruptive, unfair and cruel,” she says, adding that the most vulnerable people are exposed to even greater risks.
“Our government needs to act. We need to see action, as words alone will not be enough to reassure citizens.”
While Trump’s administration is reviewing foreign assistance during the 90 days, Makura’s future is uncertain.
“My days are dark with uncertainty. I will transfer my children to cheaper schools. Should I now give notice of vacation to my landlord and maybe find a little room where I can squeeze in with my three children?” she says.
“I am confused because of poor communication. Perhaps starting a job hunt is the only sensible action while I wait in vain,” she says.
