HARARE, Zimbabwe – A new, long-acting injectable HIV prevention drug is being rolled out in Zimbabwe, offering a potential turning point in the fight against the virus. The drug, lenacapavir, requires administration only twice a year, a significant improvement over daily oral preventative medications.
Zimbabwe has been significantly impacted by HIV, experiencing tens of thousands of deaths over the past two decades. The introduction of lenacapavir is hoped to slow the spread of new infections, particularly among populations at highest risk. The rollout places Zimbabwe among the first countries to offer this novel preventative measure.
Clinical studies have demonstrated near-total protection with lenacapavir, leading some health officials to describe it as a game-changer. However, experts caution that realizing the drug’s full potential will require addressing challenges related to funding, infrastructure and patient adherence.
Constance Mukoloka, a 27-year-old sex worker in Harare, was among the first to receive the injection on . She expressed relief, noting the difficulties and social stigma associated with daily oral PrEP (pre-exposure prophylaxis) pills. “I am safe, I can work with confidence now,” she said, explaining that the daily pill regimen often created tension with clients and was sometimes forgotten due to unpredictable work schedules.
The drug’s rollout is occurring across ten African countries, supported by the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund. In Zimbabwe, the injection is being offered free of charge to individuals at high risk, including sex workers, adolescent girls and young women, gay men, and pregnant and breastfeeding women.
Mukoloka highlighted the stigma associated with daily PrEP pills, explaining that clients sometimes avoided her when they saw the medication. “They couldn’t tell the difference between PrEP and treatment drugs. With the work we do, that stigma costs you money,” she explained. She also described instances where she would forget to take the pills due to demanding work hours or alcohol consumption, and encounters with clients who refused to use protection despite being paid for sexual services.
Health authorities emphasize the discreetness and extended duration of lenacapavir as key advantages, particularly for key populations like sex workers. Zimbabwe’s Health Minister, Douglas Mombeshora, stated at the launch, “Prevention must fit into real life. If a health solution is too complicated, too demanding, or too visible, people simply won’t use it. Lenacapavir represents a new way of doing things.”
Lenacapavir has also been rolled out in Zambia and Eswatini. Zimbabwe, Eswatini, and Zambia have emerged as successful models in controlling the HIV epidemic, achieving World Health Organization targets for testing, treatment, and viral suppression.
Despite these gains, new infections remain a concern, particularly among adolescent girls and young women. According to the United Nations children’s agency, HIV prevalence among this demographic in sub-Saharan Africa is persistently three times higher than that of their male counterparts, driven by gender inequality, poverty, and limited access to health services. In 2024, women and girls of all ages accounted for 63% of all new HIV infections in sub-Saharan Africa.
Approximately 46,000 people across 24 sites in Zimbabwe are expected to benefit from the initial phase of the lenacapavir rollout, representing a fraction of the potential demand in a country of roughly 15 million people. Details regarding the next phase of the rollout are currently unclear, with the government expressing hope for increased access as more donor-funded doses become available and as they seek to secure their own supply for a broader rollout.
The high cost of mass rollouts presents a significant challenge. In Kenya, the injectable is being offered at a negotiated price of approximately $54 per person per year. Gilead Sciences, the drug’s developer, has stated it will sell the drug at no profit to low- and middle-income countries heavily affected by HIV. However, health advocates caution that reduced pricing alone is insufficient, particularly given diminishing external funding and existing infrastructure limitations.
Bellinda Thibela, who works on health justice and access at Health GAP, described Gilead’s pricing move as “a bit comforting,” but emphasized the need for sustained funding and adequate staffing and equipment in clinics. She noted that many countries are heavily reliant on U.S. Funding, and cuts to that funding could severely impact access.
Clinicians emphasize that lenacapavir should complement, not replace, existing prevention tools, such as condoms, which remain a cost-effective and versatile method of preventing both HIV and other sexually transmitted infections. Enerst Chikwati, Zimbabwe program director at AIDS Healthcare Foundation, stated, “Condoms remain key. They are cheap and they also prevent other sexually transmitted infections.”
For early recipients like Mukoloka, the impact of the drug is already being felt. “I am elated. I can go for a whole six months feeling safe,” she said.
