Migrant Workers Trapped: HIV Treatment Cut Off as South Africa Closes Clinics to Foreigner

Renious Gumbi spent two decades in South Africa as a bricklayer, building homes and quietly collecting his antiretroviral medication from a local clinic under the country’s constitutional guarantee of healthcare access. When anti-migrant groups blockaded clinics and hospitals across the country, barring non-citizens from entering, he could not reach his ARVs for months. He died shortly after his wife arranged for him to return to Zimbabwe using cross-border transporters.

His widow, Senzeni, grieved not only her husband’s death but what she saw as abandonment by both governments. “It was cruel for South African leaders to leave anti-migrant activists blocking my husband from getting his ARV treatment drugs,” she told Health Policy Watch. “It is also heartless for the Zimbabwean government not to have a plan for its people living with HIV in South Africa when the same regime benefits from the money many Zimbabweans based in South Africa formally send to help their loved ones back home.”

Gumbi’s death is not an isolated tragedy. It reflects a crisis unfolding across the region as xenophobic violence in South Africa has forced thousands of Zimbabweans to flee. Between two and three million Zimbabweans are estimated to live there, many having migrated following the near-collapse of Zimbabwe’s economy from the early 2000s. Over recent months, anti-immigrant groups such as Operation Dubula and March and March have blamed non-citizens for service delivery problems, though systemic government corruption bears primary responsibility. These groups blockaded health facilities, preventing undocumented migrants from accessing care. The South African High Court ruled in 2025 that Operation Dubula could not bar people without identity documents from health facilities, but March and March gave undocumented migrants until 30 June to leave the country and resorted to threats, violence, and ongoing blockages. On that date, thousands were forced from their homes, seeking refuge in parks, churches, and consulates.

Gilbert Muzokomba, 58, had lived in South Africa since 1999 and married a South African woman five years into his stay. Both tested positive for HIV in 2009 and began treatment together. After his wife died in 2020, Muzokomba faced mounting pressure from neighbours to leave. When anti-migrant groups barred him from his clinic in Gauteng province’s East Rand, he made the decision to return to Zimbabwe. “I left South Africa voluntarily after seeing that I might end up dying without access to my HIV treatment drugs, having been repeatedly barred from accessing the treatment by anti-immigrant groups. I had already defaulted, and my health is deteriorating fast,” he said. Back home, he was placed on a waiting list for local HIV patients accessing free ARVs. The process stretched longer than expected, costing him his health.

Nelisiwe Mugodhi, 23, was born with HIV in South Africa and had remained healthy on treatment her entire life. When xenophobic violence erupted this year, she was barred from a clinic in Khayelitsha, a large settlement in Cape Town, and defaulted on her medication. Her parents had died of AIDS years earlier, and she had relied on Good Samaritans in South Africa to survive. Fleeing to a country she barely knew, Mugodhi eventually received ARV treatment back home, but the interruption left her suffering from diarrhoea, headaches, swollen feet, and persistent coughing. “To be honest, I don’t know if I will ever recover. I was healthy and have never fallen sick when I had access to treatment while in South Africa before the latest xenophobic tensions,” she said.

Meanwhile, Zimbabwe’s health system is absorbing the pressure. Health Minister Douglas Mombeshora told Parliament that health workers had been deployed at the country’s borders to screen returnees and identify those with chronic conditions including HIV, diabetes, and hypertension. “We have screened over 99,000 Zimbabweans,” he said. He acknowledged, though, that baseline tests such as viral load measurements cannot be conducted at ports of entry, delaying comprehensive treatment initiation. By early July 2026, 21,000 Zimbabweans had been repatriated with government assistance, while 57,000 returned at their own expense. Media reports indicate that 34,000 people have returned to Malawi and 100,000 to Zimbabwe, illustrating the regional scale of displacement.

Médecins Sans Frontières has established a clinic at the Musina repatriation centre on the Zimbabwe-South Africa border, assisting people who have defaulted on ARVs and chronic medications. Caroline Masunda of MSF put the numbers in stark terms. “More than 100,000 people fleeing or being displaced are the kind of numbers MSF see in hot conflict areas, not relatively stable democracies like South Africa,” she said. “With so many displaced people, we call on governments in the region to step up collaborative efforts to ensure continuity of care for patients.”

The returnees arrive into a system already under strain. An estimated 1.3 million people are living with HIV in Zimbabwe according to UNAIDS, and the influx will increase that number. Kensington Marufu, an HIV/AIDS activist and lawyer aged 36 who was born with HIV, warned of what comes next. “Most of these returnees are definitely secretive about their health status, especially HIV, which will cause problems here. They don’t know where to get help with their condition after being away from home for many years. I think these returning migrants will have a problem with adherence to treatment, which will negatively impact on their health,” he said.

Pastor Reki Jimu, who has lived with HIV for decades and leads HIV prevention work in Zimbabwe, has documented returnees who defaulted on treatment after fleeing xenophobia. “I know several returnees from South Africa who have defaulted on ARV treatment after getting disturbed by xenophobic tensions there. Many of these people are now hospitalised here because of missing out on opportunities to acquire their medication here,” he said.

The crisis deepens as Zimbabwe itself faces pressure on its HIV response. Access to ARV treatment has grown more difficult since talks between the United States and Zimbabwe on future US aid for HIV and other health services broke down in February, jeopardising treatment for some 1.2 million people reliant on US assistance. A recent study projects that approximately 75,000 Zimbabweans will contract HIV within a year if there is a complete withdrawal of the US President’s Emergency Plan for AIDS Relief.

For those caught between countries, the uncertainty is acute.