A long-acting HIV drug arrives in Zimbabwe for some at highest risk

HARARE, Zimbabwe — 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 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 out lenacapavir, a long-acting drug that authorities hope will slow new infections.

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 Zimbabwe launch, Constance Mukoloka stepped out of a mobile clinic, beaming with relief after receiving one of the first doses.

''I am safe, I can work with confidence now,'' said the 27-year-old sex worker, describing how daily preventive preexposure prophylaxis, or PrEP, pills often created tension with clients and proved difficult to take consistently — putting her and others at risk.

Could reshape HIV prevention strategies

Mukoloka is among the first beneficiaries of a donor-supported rollout of lenacapavir across 10 African countries. Health officials and advocates say the drug could reshape HIV prevention strategies if governments can navigate barriers of cost and fragile health systems.

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

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 and treatment drugs. With the work we do, that stigma costs you money.''

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,'' Mukoloka said. ''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?'''

Health authorities see lenacapavir's discreetness and extended duration as a critical advantage for key populations such as sex workers and therefore a boost in fighting the spread of HIV.

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

The drug has been rolled out in other southern African nations like Zambia and Eswatini.

Zimbabwe, Eswatini and Zambia, once global HIV epicenters, have emerged in recent years as among the world's most successful models in controlling the epidemic, achieving World Health Organization testing, treatment and viral suppression targets.

Yet despite these gains, new infections remain a concern, particularly among adolescent girls and young women.

In sub-Saharan Africa, women and girls of all ages accounted for 63% of all new HIV infections in 2024, according to UNAIDS. In all other geographical regions, about 73% of new infections in 2024 occurred among men and boys.

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

High cost of mass rollouts

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 rollout but, like many other African governments, lacks enough money.

Health officials, experts and activists warn that practical realities could tamper the drug's early promise in Africa, a continent of over 1.5 billion people, not least due to the high cost of mass rollouts for governments.

Gilead Sciences has said it would sell its drug at no profit to low and middle-income countries heavily affected by HIV.

Bellinda Thibela, who works on health justice and access at Health GAP, an international advocacy organization, described the move as ''a bit comforting'' but hardly enough on its own on a continent where health systems have heavily relied on external funding that is diminishing, particularly after U.S. President Donald Trump's foreign aid cuts.

Challenges will remain in countries that were "80% to 90% dependent on U.S. funding,'' Thibela said. ''What's the point of having a reduced price if there is no staff and equipment in clinics?''

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

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

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

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Associated Press writer Evelyne Musambi contributed to this report from Nairobi, Kenya.

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