Harare, Zimbabwe – On the outskirts of Zimbabwe’s capital, a new sense of hope is taking root among women at high risk of HIV infection. A recently launched program is offering lenacapavir, a novel long-acting HIV prevention drug, offering a potential turning point in the country’s decades-long battle against the epidemic. But the rollout also highlights the precarious state of global health aid and the challenges of sustaining progress in the face of funding cuts.
Zimbabwe, once among the nations hardest hit by HIV, has made remarkable strides in recent years, achieving significant progress in testing, treatment, and viral suppression. However, the virus continues to disproportionately affect women, accounting for 63% of all new infections in 2024, according to UNAIDS. This disparity is driven by complex factors including gender inequality, poverty, and limited access to healthcare. The introduction of lenacapavir, developed by Gilead Sciences, offers a potentially game-changing option for those most vulnerable.
Constance Mukoloka, a sex worker, is among the first to benefit from the donor-supported program. “I operate in beer halls looking for clients,” she explained. “Sometimes I would secure drunk and forget to grab my drugs. Sometimes I would work all night and not have time to take tablets, but with this vaccine, even if I get drunk, I grasp I’m safe.” Lenacapavir requires administration only twice a year, a significant advantage over daily oral PrEP (pre-exposure prophylaxis) which often struggles with adherence.
A New Approach to HIV Prevention
Lenacapavir represents a significant advancement in HIV prevention. Unlike daily pills, the drug is administered as an injection, providing sustained protection over a six-month period. Clinical trials have demonstrated near-total protection against HIV acquisition, leading some health officials to describe it as a potential turning point for high-risk populations. The rollout is currently underway in 10 African countries, supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund. Zimbabwe is among the first nations to implement the program, initially targeting approximately 46,000 people across 24 sites.
Dr. Ernest Chikwati, program director at the Aids Healthcare Foundation, emphasized the convenience factor. “When someone’s taking medicines every day, they tend to forget. But when someone is injected every six months, it’s very unlikely that they’ll forget to take their medicine. So Lenacapvir is coming as an addition to all the pre-exposure prophylaxis methods.” He cautioned, however, that the drug is not a “silver bullet.” Daily oral PrEP, condoms, vaginal rings, and shorter-acting injectables remain crucial components of a comprehensive prevention strategy.
Funding Concerns Threaten Progress
Despite the promise of lenacapavir, the rollout is occurring against a backdrop of growing concern over declining global health funding. Cesar Nunez, director of the UNAIDS New York Office, warned that “the HIV epidemic is not over, and our previous progress is at risk.” He highlighted the impact of reduced foreign assistance on AIDS programs across Africa, noting that some national AIDS commissions have been forced to share office space with organizations that have lost funding. UNAIDS estimates that these funding cuts could lead to 1.4 million additional HIV infections by 2030.
The situation is particularly concerning given the existing inequalities that drive the epidemic. HIV prevalence among adolescent girls and young women aged 10-24 in sub-Saharan Africa remains persistently three times higher than that of their male counterparts, fueled by gender-based violence, poverty, and limited access to education and healthcare. Addressing these underlying social determinants is critical to achieving lasting progress.
Navigating Infrastructure and Cost Barriers
Zimbabwe, along with Eswatini and Zambia, has been lauded for its success in controlling the HIV epidemic, achieving World Health Organization targets for testing, treatment, and viral suppression. The new drug is being offered free of charge to high-risk groups, including sex workers, adolescent girls and young women, gay men, and pregnant and breastfeeding women. However, scaling up the program beyond the initial phase presents significant challenges.
The Zimbabwean government hopes to expand access to lenacapavir as more donor-funded doses become available, and ultimately to procure its own supplies for a mass rollout. However, like many African nations, Zimbabwe faces severe financial constraints. The long-term sustainability of the program hinges on securing adequate and consistent funding, both from international donors and domestic sources.
Mukoloka’s experience underscores the potential impact of the drug beyond its medical benefits. “I am safe, I can work with confidence now,” she said. “When we took tablets, customers would see a container of pills and depart, they would never return due to fear. They couldn’t tell the difference between PrEP and treatment drugs. With the work we do, that stigma costs you money.”
The successful implementation of lenacapavir in Zimbabwe, and across Africa, will require a concerted effort to overcome funding constraints, strengthen health systems, and address the social and economic factors that drive the HIV epidemic. The next phase of the rollout in Zimbabwe remains unclear, with officials awaiting further donor commitments and exploring options for domestic procurement. The coming months will be critical in determining whether this promising new tool can truly reshape the landscape of HIV prevention.
If you or someone you know is struggling with HIV/AIDS, resources are available. You can locate information and support from the Centers for Disease Control and Prevention and AIDS.gov.
Share your thoughts on this important development in global health. What steps do you think are most crucial to ensuring equitable access to HIV prevention tools?
