Thirty years on with an HIV epidemic in Zimbabwe (1985–2015)

Zimbabwe, like many of her neighbours, is going through an HIV epidemic since 1985. It is imperative to assess progress with epidemic over the past three decades. We conducted a systematic review of reports in Pubmed/ScienceDirect, and a number of sentinel surveillance reports published by local and international organisations that have dealt with HIV/AIDS in the country, including the National AIDS Council of Zimbabwe, Ministry of Health and Child Welfare of Zimbabwe, UNAIDS and World Health Organisation. Thirty-five original research articles and 16 review articles, 4 surveillance reports and 2 conference reports met our inclusion criteria. The first 5 years of the epidemic were characterised by an exponential increase in prevalence (65-fold) and incidence (up to 13-fold) which were fuelled by high risk sexual behaviour. Comprehensive AIDS programmes that were launched between mid-1990s and 2015 and high mortality over the same period are thought to have played a role in slowing down the epidemic since the mid-2000s. Increased uptake of antiretroviral therapy (ART) and prevention-of-mother-to-child-transmission (PMTCT) (95%) prophylaxis accounted for a 70% drop in HIV-related mortality between 2003 and 2013. However, the epidemic has been characterised by a low paediatric ART coverage (35% in 2011 to 46.12% in 2013) and a recent increase in adolescent HIV prevalence. The epidemic has been driven by a number of social factors that include the local traditional beliefs and customs. A more holistic approach which deals with the epidemic in its socio-political context is required to effectively lower the country's HIV burden.