HARARE, Zimbabwe — In a significant step toward combating HIV, Zimbabwe has launched a new long-acting injectable prevention drug, lenacapavir, offering a potential turning point in the country’s fight against the virus. The rollout, which began on , initially focuses on high-risk individuals in Epworth, Harare, making Zimbabwe one of the first nations globally to offer this next-generation prevention tool.
Lenacapavir, administered via injection just twice a year, is a capsid inhibitor designed to provide long-lasting protection against HIV. This innovative approach aims to improve adherence to preventative measures and reduce the incidence of new infections, particularly among populations where daily oral PrEP (pre-exposure prophylaxis) has faced challenges with consistent use.
The initiative targets key populations including adolescent girls, young women, sex workers, and men who have sex with men. Approximately 46,000 high-risk individuals are expected to benefit from the initial phase of the rollout, which is being implemented across 24 sites in urban centers like Harare, Bulawayo, and Gweru. Nearly 400 health workers have already been trained to administer the injection.
Addressing Adherence Challenges with a New Approach
For individuals like Constance Mukoloka, a 27-year-old sex worker, the new injectable offers a welcome alternative to daily PrEP pills. Mukoloka described how the need to take daily medication often created difficulties with clients, who sometimes avoided her when they saw her pills, fearing they were HIV treatment drugs. “They couldn’t tell the difference between PrEP and treatment drugs. With the work we do, that stigma costs you money,” she explained.
Adherence to daily oral PrEP has been a persistent challenge in Zimbabwe, particularly for those facing stigma or unpredictable schedules. Mukoloka also shared the difficulty of remembering to take the pills consistently, especially when working long hours or consuming alcohol. “Sometimes I would get drunk and forget to take my drugs,” she said. “Sometimes I would work all night and not have time.”
The discreet nature and extended duration of lenacapavir are seen as critical advantages for these key populations. As 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.” He described lenacapavir as “a new way of doing things.”
A Global Effort and Zimbabwe’s Role
The introduction of lenacapavir in Zimbabwe is supported through the United States President’s Emergency Plan for AIDS Relief (PEPFAR), in partnership with the Global Fund. The drug is being offered free of charge to high-risk individuals. Zimbabwe was selected in as one of 10 countries for a global early access program, highlighting international confidence in the nation’s HIV response capabilities.
Developed by Gilead Sciences, the rollout in Zimbabwe follows similar initiatives in other southern African nations, including Zambia and Eswatini. These countries have emerged as successful models in controlling the HIV epidemic, achieving key World Health Organization targets for testing, treatment, and viral suppression.
Persistent Challenges and Future Outlook
Despite these gains, new HIV infections remain a concern, particularly among adolescent girls and young women, who experience disproportionately higher rates of infection compared to their male counterparts. According to the United Nations children’s agency, HIV prevalence among adolescent girls and young women aged 10-24 in sub-Saharan Africa is consistently three times higher than that of their male peers, driven by factors such as gender inequality, poverty, and limited access to health services.
While the initial phase of the lenacapavir rollout is expected to benefit 46,000 people, this represents a fraction of the potential demand in a country of roughly 15 million. Details regarding the next phase of the rollout are still being determined, with the government expressing hope that increased access will be possible as more donor-funded doses become available. The government also aims to secure its own doses for a broader rollout, but faces financial constraints common to many African nations.
Health officials and advocates acknowledge that practical realities, including cost and the capacity of health systems, could impact the drug’s long-term success. In Kenya, lenacapavir is being offered at a negotiated price of approximately $54 per person per year, a cost that remains substantial for many. Gilead Sciences has committed to selling the drug at no profit to low and middle-income countries heavily affected by HIV.
Bellinda Thibela, of Health GAP, described Gilead’s commitment as “a bit comforting,” but emphasized the need for sustained external funding and robust health infrastructure. She cautioned that diminished funding, particularly following cuts to U.S. Foreign aid, could undermine the impact of reduced drug prices. “What’s the point of having a reduced price if there is no staff and equipment in clinics?” she asked.
Experts stress that lenacapavir should complement, not replace, existing prevention tools, such as condoms, which remain a crucial component of comprehensive HIV prevention strategies. Enerst Chikwati, Zimbabwe program director at AIDS Healthcare Foundation, emphasized the importance of condoms in preventing both HIV and other sexually transmitted infections.
For early recipients like Constance Mukoloka, however, the impact of lenacapavir is already being felt. “I am elated. I can go for a whole six months feeling safe,” she said.
