Zimbabwe launches long-acting HIV drug targeting high-risk populations

Zimbabwe on Thursday became one of the first countries to roll out lenacapavir, a long-acting HIV prevention drug requiring only twice-yearly injections. Deployed in fields on Harare’s outskirts, the drug is being offered free to sex workers, adolescent girls and young women, gay men and pregnant and breastfeeding women, with clinical studies showing near-total protection.

The rollout, supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund, is part of a donor-funded introduction across 10 African countries.

Zimbabwe, along with neighboring Eswatini and Zambia, has emerged in recent years as one of the world’s most successful models for controlling the HIV epidemic. Yet new infections remain a concern, particularly among adolescent girls and young women.

Health officials and advocates say lenacapavir could reshape HIV prevention strategies if governments can overcome cost and capacity barriers. For sex workers and other key populations, the drug’s discreet nature and extended duration offer a significant advantage.

Constance Mukoloka, a 27-year-old sex worker, was among the first to receive a dose at a mobile clinic. “I am safe, I can work with confidence now,” she said, describing how daily preventive pills often created tension with clients and proved difficult to take consistently.

Mukoloka said the stigma surrounding visible pill containers had significant consequences. “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 and treatment drugs. With the work we do, that stigma costs you money.”

Zimbabwe’s Health Minister Douglas Mombeshora emphasized the drug’s practical fit with real-world circumstances. “Prevention must fit into real life,” he said at Thursday’s launch. “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.”

A Better Option for Sex Workers

Adherence to daily preventive medications has long posed a challenge in Zimbabwe and across sub-Saharan Africa. Shorter-acting injectables, vaginal rings, and condoms have been available alongside daily oral PrEP, but adherence barriers persist, particularly for people facing stigma or unpredictable schedules.

The drug has already been rolled out in other southern African nations like Zambia and Eswatini, countries that have achieved World Health Organization testing, treatment and viral suppression targets and emerged as among the world’s most successful HIV control models. Yet new infections remain a concern, particularly among adolescent girls and young women, who account for disproportionately high HIV prevalence rates across sub-Saharan Africa.

According to the United Nations children’s agency, HIV prevalence among adolescent girls and young women aged 10-24 is “persistently” triple that of their male counterparts in sub-Saharan Africa, driven by gender inequality, poverty and uneven access to health services. In sub-Saharan Africa, women and girls of all ages accounted for 63% of all new HIV infections in 2024, according to UNAIDS.

Persistent Gender Disparities

In the early phase of the rollout, about 46,000 people across 24 sites are expected to benefit in Zimbabwe, a fraction of potential demand in a country of roughly 15 million. The government says it hopes the number of beneficiaries will increase as more donor-funded doses arrive, though it also plans to acquire its own doses for a mass rollout.

Cost poses a significant barrier. In Kenya, which received its first 21,000 lenacapavir doses this week, the government negotiated a price of about $54 per person per year. Gilead Sciences, the California-based company that developed the drug, said it would sell at no profit to low and middle-income countries heavily affected by HIV.

Health officials, experts and advocates warn that practical barriers could limit the drug’s impact across Africa, a continent of over 1.5 billion people. Bellinda Thibela, who works on health justice and access at Health GAP, an international advocacy organization, said the promised price reduction provides limited benefit if broader support collapses. “What’s the point of having a reduced price if there is no staff and equipment in clinics?” she said, noting that some countries are “80% to 90% dependent on U.S. funding.”

The Barriers to Scale

While many clinicians describe lenacapavir as a significant advance, they stress it must complement, not replace, existing prevention tools. “Condoms remain key,” said Enerst Chikwati, Zimbabwe program director at AIDS Healthcare Foundation. “They are cheap and they also prevent other sexually transmitted infections.”

For early recipients such as Mukoloka, the drug’s impact is already profound. “I am elated. I can go for a whole six months feeling safe,” she said.