Zimbabwe roll-out of long-acting HIV prevention drug gets underway

Young women, mothers holding babies and some men lined up in a dusty field on the outskirts of Zimbabwe’s capital, Harare.

They came for injections of a new lenacapavir HIV prevention drug launched in the country on Thursday, one that only needs to be administered twice a year.

Zimbabwe, where HIV has led to tens of thousands of deaths over the past two decades, is one of the first countries to roll it out.

With clinical studies demonstrating near-total protection, the drug has been described by some health officials as a turning point for high-risk groups.

Others warn that turning scientific promise into broad impact will require overcoming funding constraints, infrastructure gaps, and the challenge of keeping patients engaged.

At the launch, Constance Mukoloka stepped out of the mobile clinic, beaming with relief after receiving one of the first doses of the donor-supported rollout of lenacapavir across 10 African countries.

“I am safe, I can work with confidence now,” said the 27-year-old sex worker.

For Mukoloka, the drug represents more than convenience.

“When I took tablets, customers would see a container of pills and leave. They would never return due to fear,” she said.

“They couldn’t tell the difference between PrEP [preventative] and treatment drugs. With the work we do, that stigma costs you money.”

Health officials and advocates say lenacapavir could reshape HIV prevention strategies if governments can navigate barriers of cost and fragile health systems.

Developed by California-based Gilead Sciences, its introduction in selected countries is supported by the United States President’s Emergency Plan for AIDS Relief (PEPFAR) in partnership with the Global Fund.

The injection is offered for free to high-risk people such as sex workers, adolescent girls and young women, gay men, and pregnant and breastfeeding women.

Daily oral PrEP has long been available in Zimbabwe alongside condoms, vaginal rings, and shorter-acting injectables.

Yet adherence has remained a challenge, particularly for people facing stigma or unpredictable schedules.

“I work in beer halls looking for clients. Sometimes I would get drunk and forget to take my drugs. Sometimes I would work all night and not have time to take tablets,” Mukoloka said.

Despite gains in dealing with the epidemic, new HIV infections remain a concern in Zimbabwe, particularly among adolescent girls and  young women.

UNAIDS says women and girls of all ages accounted for 63 per cent of all new infections in sub-Saharan Africa in 2024, driven by gender inequality, poverty, and uneven access to health services.

Zimbabwean health officials hope lenacapavir will change this.

The authorities say about 46,000 people across 24 sites are expected to benefit in the early phase of the lenacapavir roll-out, a fraction of potential demand in a country of roughly 15 million.

Details for the next phase are not clear. The government says it hopes the number of beneficiaries will increase as more donor-funded doses arrive.

It also hopes to acquire its own doses for a mass roll-out but, like many other African governments, lacks enough money.

While many clinicians describe lenacapavir as a significant advance, they stress it must complement, not replace, prevention tools.

Lenacapavir is a “game-changer” for HIV prevention, said Dr Ernest Chikwati, Zimbabwe programme director at AIDS Healthcare Foundation, though warning that “it’s not a silver bullet.”

He emphasized the continued importance of cheaper options such as condoms. But for early recipients like Mukoloka, the drug’s impact already feels profound.