Zimbabwe: New HIV Prevention Drug Offers Hope, Faces Funding Challenges

On the outskirts of Harare, Zimbabwe, a group of women – some with infants – are accessing a latest HIV prevention option. The rollout of lenacapavir, a novel drug offering a different approach to protection, arrives at a critical moment for the country, which once faced a devastating HIV epidemic and continues to grapple with new infections, particularly among women.

A Shift in Prevention: Twice-Yearly Protection

Zimbabwe is among the first ten African nations to introduce lenacapavir, developed by Gilead Sciences and supported through the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund. The drug offers a significant change from daily oral PrEP (pre-exposure prophylaxis), requiring administration only twice a year. Dr. Ernest Chikwati, program director at Aids Healthcare Foundation, explains the potential benefit: “When someone’s taking medicines every day, they tend to forget. But when someone is injected 6 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.”

Clinical studies have demonstrated near-total protection against HIV infection with lenacapavir, leading some health officials to describe it as a potential turning point for high-risk groups. The initial phase of the rollout in Zimbabwe aims to reach approximately 46,000 people across 24 sites, a fraction of the potential need within the country’s population of roughly 15 million. The drug is being offered free of charge to those considered at higher risk, including sex workers, adolescent girls and young women, gay men, and pregnant and breastfeeding women.

Uneven Progress and Persistent Vulnerabilities

While Zimbabwe, along with Eswatini and Zambia, has made remarkable progress in controlling the HIV epidemic – achieving World Health Organization testing, treatment, and viral suppression targets – new infections remain a concern. UNAIDS data from 2024 reveals that women and girls of all ages accounted for 63 percent of all new HIV infections in Zimbabwe. This disparity is driven by factors like gender inequality and limited access to health services, a pattern mirrored across sub-Saharan Africa, where HIV prevalence among adolescent girls and young women aged 10-24 is persistently three times higher than that of their male counterparts.

Constance Mukoloka, a sex worker participating in the rollout, highlights the practical benefits of the new drug: “I operate 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 but with this vaccine even if I get drunk, I know I’m safe.” She also points to the reduction in stigma associated with the less frequent administration, noting that customers previously avoided her when they saw her taking daily medication.

Funding Constraints Threaten Gains

Despite these advancements, the gains made in controlling the HIV epidemic are increasingly fragile. Cesar Nunez, director of the UNAIDS New York Office, warns, “The HIV epidemic is not over, and our previous progress is at risk.” A significant factor contributing to this vulnerability is a decline in funding. Nunez explains that many community-led HIV programs rely on foreign assistance, which has recently been impacted, forcing some organizations to seek alternative office space. UNAIDS anticipates that these funding cuts could lead to 1.4 million additional new infections by 2030. UNAIDS provides further information on the situation in Zimbabwe.

Beyond the Drug: A Multifaceted Approach

Dr. Chikwati emphasizes that lenacapavir is not a “silver bullet.” He stresses the continued importance of other prevention methods, particularly condoms, citing their affordability and accessibility. “Condoms remain key for us as an organization,” he states, “we’ve got two condom brands we give freely in the public sector. We also feel funding should be given to condoms as well.” This underscores the need for a comprehensive prevention strategy that combines biomedical interventions with behavioral approaches and addresses the social determinants of HIV risk.

The successful implementation of lenacapavir also hinges on addressing existing challenges with adherence to prevention methods. While daily oral PrEP, vaginal rings, and shorter-acting injectables are available in Zimbabwe, maintaining consistent use remains a hurdle, particularly for individuals facing stigma or unpredictable schedules. The UNAIDS Results and Transparency Portal details ongoing efforts to improve the quality of HIV services, including the implementation of digital patient charts and integrated HIV, nutrition, and immunization services.

Navigating Systemic Challenges and Future Steps

The Zimbabwean government hopes to expand access to lenacapavir as more donor-funded doses become available and is exploring options for procuring its own supply for a broader rollout. However, like many African governments, Zimbabwe faces significant financial constraints. The long-term success of the program will depend on securing sustainable funding and strengthening the country’s health systems. Research published in PMC highlights the sociodemographic constraints and geospatial heterogeneity impacting progress towards UNAIDS’s 95-95-95 targets in Zimbabwe, emphasizing the need for targeted interventions.

For Ms. Mukoloka, the new drug offers a sense of security and empowerment. “I am safe, I can work with confidence now. When we took tablets, customers would see a container of pills and leave, they would never return due to fear. They couldn’t notify the difference between PrEP and treatment drugs. With the work we do, that stigma costs you money.” Her experience underscores the potential of lenacapavir to reshape HIV prevention strategies, but only if governments can effectively address the systemic barriers to access and care.

Looking ahead, ongoing monitoring and evaluation will be crucial to assess the impact of lenacapavir on new HIV infections and identify any challenges to implementation. Further research is needed to understand the long-term effectiveness of the drug and its potential role in achieving HIV epidemic control in Zimbabwe and beyond. Public health officials will continue to monitor trends in new infections, assess the effectiveness of prevention programs, and adapt strategies as needed to ensure that progress towards ending the HIV epidemic is not reversed.