Zimbabwe Launches Twice-Yearly HIV Prevention Drug for High-Risk Groups

Zimbabwe has become one of the first nations to distribute lenacapavir, a groundbreaking HIV prevention injection that only requires administration twice per year. The drug is being offered free to high-risk populations including sex workers, young women, and pregnant mothers through donor funding. Health officials hope the discreet, long-acting treatment will significantly reduce new HIV infections where daily pills have proven challenging to maintain.

HARARE, Zimbabwe — In a dusty area outside Zimbabwe’s capital city, dozens of young women, mothers carrying infants, and men gathered in lines Thursday to receive doses of a revolutionary HIV prevention medication that requires just two injections annually.

The southern African nation, which has experienced tens of thousands of HIV-related fatalities over the last twenty years, has become among the initial countries to distribute lenacapavir, an extended-release medication that officials believe will reduce new infection rates.

Clinical trials have shown the treatment provides nearly complete protection, leading some medical experts to call it a game-changer for vulnerable populations. However, others caution that transforming this scientific breakthrough into widespread success will depend on addressing funding limitations, healthcare system weaknesses, and maintaining patient participation.

Following her injection at the Zimbabwe launch event, Constance Mukoloka emerged from a mobile healthcare unit with a bright smile of relief after becoming one of the initial recipients.

“I am safe, I can work with confidence now,” the 27-year-old sex worker explained, discussing how taking daily preventive pills for preexposure prophylaxis, known as PrEP, frequently caused problems with clients and was hard to maintain regularly — endangering herself and others.

Mukoloka represents one of the earliest recipients of a donor-funded lenacapavir distribution program spanning 10 African nations. Medical authorities and advocates believe this medication could transform HIV prevention approaches if governments can overcome obstacles related to expenses and vulnerable healthcare infrastructure.

Created by Gilead Sciences in California, the introduction of lenacapavir in targeted high-risk nations receives backing from the United States President’s Emergency Plan for AIDS Relief, known as PEPFAR, working alongside the Global Fund.

Zimbabwe provides the injection at no cost to vulnerable groups including sex workers, teenage girls and young women, gay men, and expectant or nursing mothers.

For Mukoloka, this treatment means far more than simple convenience.

“When I took tablets, customers would see a container of pills and leave. They would never return due to fear,” she explained. “They couldn’t tell the difference between PrEP and treatment drugs. With the work we do, that stigma costs you money.”

Zimbabwe has offered daily oral PrEP for years along with condoms, vaginal rings, and shorter-duration injections. Still, consistent use has remained problematic, especially for individuals experiencing stigma or irregular routines.

“I work in beer halls looking for clients. Sometimes I would get drunk and forget to take my drugs,” Mukoloka noted. “Sometimes I would work all night and not have time. Some clients refuse protection. They say … ‘Why should I use protection when I have paid?'”

Medical officials view lenacapavir’s subtle nature and lengthy effectiveness as crucial benefits for key groups like sex workers, making it valuable in combating HIV transmission.

“Prevention must fit into real life. If a health solution is too complicated, too demanding, or too visible, people simply won’t use it,” stated Douglas Mombeshora, Zimbabwe’s health minister, during Thursday’s launch ceremony. “Lenacapavir represents a new way of doing things.”

Other southern African countries including Zambia and Eswatini have also introduced the medication.

Zimbabwe, Eswatini, and Zambia, formerly major HIV hotspots worldwide, have become leading examples of epidemic management in recent years, meeting World Health Organization goals for testing, treatment, and viral suppression.

Despite these achievements, new infections continue causing concern, especially among teenage girls and young women.

The United Nations children’s agency reports that HIV rates among adolescent girls and young women aged 10-24 remain “persistently” three times higher than their male peers in sub-Saharan Africa, caused by gender inequality, poverty, and unequal healthcare access.

Throughout sub-Saharan Africa, females of all ages represented 63% of new HIV infections in 2024, according to UNAIDS. In other global regions, approximately 73% of new 2024 infections affected males.

Zimbabwean authorities expect roughly 46,000 individuals across 24 locations to receive treatment during lenacapavir’s initial rollout phase, representing a small portion of potential need in this country of approximately 15 million residents.

Plans for subsequent phases remain unclear. Government officials express hope that beneficiary numbers will grow as additional donor-funded supplies become available. They also aim to purchase their own doses for broader distribution but, like many African governments, face insufficient funding.

Medical professionals, experts, and activists caution that real-world challenges could limit the drug’s early potential across Africa, a continent exceeding 1.5 billion people, particularly due to expensive mass distribution costs for governments.

Kenya, which received its initial 21,000 lenacapavir doses this week, announced the injection would cost approximately $54 per person annually at negotiated rates, still representing a substantial expense for many.

Gilead Sciences has committed to selling its medication without profit to low and middle-income countries significantly affected by HIV.

Bellinda Thibela, who focuses on health justice and access at Health GAP, an international advocacy group, called this move “a bit comforting” but insufficient alone on a continent where healthcare systems depend heavily on declining external funding, particularly following President Donald Trump’s foreign aid reductions.

Difficulties will persist in nations that were “80% to 90% dependent on U.S. funding,” Thibela observed. “What’s the point of having a reduced price if there is no staff and equipment in clinics?”

While numerous medical professionals consider lenacapavir a major advancement, they emphasize it should supplement, not substitute, existing prevention methods.

“Condoms remain key. They are cheap and they also prevent other sexually transmitted infections,” explained Enerst Chikwati, Zimbabwe program director at AIDS Healthcare Foundation.

However, for early users like Mukoloka, the medication’s effects already seem transformative.

“I am elated. I can go for a whole six months feeling safe,” she said.