In Harare, young women, mothers with their babies, and a few men lined up to receive an injection of a new HIV prevention drug, administered only twice a year. Zimbabwe is among the first countries to roll out lenacapavir, a long-acting treatment that could transform strategies for combating new infections.
Developed by the American pharmaceutical company Gilead Sciences, lenacapavir has demonstrated near-total protection against HIV in clinical trials. Its introduction in ten African countries is supported by the American PEPFAR (President's Emergency Plan for AIDS Relief) program, in partnership with the Global Fund. In Zimbabwe, it is offered free of charge to those most at risk: sex workers, adolescent girls and young women, men who have sex with men, and pregnant or breastfeeding women.
For many beneficiaries, the main advantage lies in the discretion and simplicity of the treatment. Unlike daily pre-exposure prophylaxis (PrEP) in tablet form, the six-monthly injection reduces the risk of forgetting and limits stigmatization.
Some sex workers explain that the presence of pills could arouse suspicion among clients, who confused HIV prevention with treatment. Others mention difficulties in adhering to a daily regimen due to irregular schedules or alcohol consumption. Lenacapavir, administered every six months, thus offers a solution better suited to these complex life realities.
Zimbabwean Health Minister Douglas Mombeshora stressed that "prevention must adapt to real life" and that solutions that are too visible or restrictive are often abandoned.
Zimbabwe, like Zambia and Eswatini, has made significant progress in recent years in controlling the epidemic, achieving the World Health Organization's targets for testing, treatment, and viral suppression. However, new infections remain a concern, particularly among adolescent girls and young women.
In sub-Saharan Africa, women and girls accounted for 63% of new HIV infections in 2024, according to UNAIDS. Among 10- to 24-year-olds, HIV prevalence is approximately three times higher in girls than in boys, due in particular to gender inequalities and unequal access to health services.
In Zimbabwe, approximately 46,000 people spread across 24 sites are expected to benefit from the first phase of the deployment, a limited number considering the needs of a country of 15 million inhabitants.
Cost remains a major obstacle to large-scale deployment. In Kenya, the negotiated price is approximately $54 per person per year, a significant amount for already fragile healthcare systems. Gilead claims to sell the drug at cost to low- and middle-income countries heavily affected by HIV.
But experts point out that lower prices are not enough if infrastructure, personnel, and equipment are lacking. Many African countries were dependent on US funding for up to 80 or 90 percent of their needs, but this is now declining following reductions in foreign aid.
Health professionals also stress that lenacapavir should complement (and not replace) other prevention tools, including condoms, which also protect against other sexually transmitted infections.
For the first beneficiaries, however, the impact is already tangible. Being able to feel protected for six months without daily constraints represents, for some, a profound change in their relationship to health and their work.
