What the new Lenacapavir announcement means for Zimbabwe

PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria have announced a partnership with the pharmaceutical giant Gilead to supply Lenacapavir to Zimbabwe and other countries. Is this the gamechanger the HIV response has been waiting for? 

What is Lenacapavir and why does it matter for HIV prevention?

Lenacapavir is a type of PrEP, a drug that stops people getting HIV through sex. It normally comes in daily pill form, but many people struggle with adherence.  

Over the past few years, new injectable forms of PrEP have been approved in several countries. One of these is Lenacapavir, which provides six months of protection. Another is long-acting Cabotegravir (CAB-LA), which gives two-months of protection. 

Having to think about HIV prevention just twice a year could make a big difference in people’s lives. It is no wonder that Peter Sands, head of the Global Fund, has described Lenacapavir as “a turning point”. Countries have expressed interest in providing twice-yearly PrEP at scale. But how big an impact this initial rollout will have remains to be seen. 

What will the Lenacapavir partnership bring?

The US government through PEPFAR is partnering with the Global Fund to co-fund Lenacapavir for up to 2 million people in low- and lower-middle-income countries between now and 2028.  

Under the agreement, PEPFAR will help 8 to 12 countries introduce Lenacapavir. This is through their national HIV prevention programmes by 2026. Zimbabwe is among the countries included.  

Reports say Zimbabwe will likely focus on adolescent girls, young women, and pregnant or breastfeeding women for twice-yearly PrEP. This aligns with PEPFAR’s goals. In the coming months, each country will create its own rollout plan. These plans will confirm who gets priority and where Lenacapavir will be available.

Why is Zimbabwe one of the first countries chosen for the rollout?

In 2022, Zimbabwe became the first country in Africa and the third country in the world to approve bi-monthly CAB-LA injections. In 2024, it began providing CAB-LA in selected heath facilities for people at high risk of HIV. This means Zimbabwe has the existing infrastructure to distribute and deliver Lenacapavir. And it will have learnt lessons from the CAB-LA rollout which it can use to improve Lenacapavir delivery. 

Zimbabwe has also shown commitment and leadership towards ending AIDS. It is one of only a handful of African countries to reach the UNAIDS 95-95-95 targets.  

What are the barriers to rollout?  

Cost

Lenacapavir’s current cost means a large-scale rollout will not yet be feasible in Zimbabwe. This means certain groups will be prioritised over others. 

However, the agreement will enable generic manufacturers to seek regulatory approval for Lenacapavir. Once this happens, they will be able to make cheaper versions that will drive down costs. 

Regulatory

Currently, Lenacapavir is only approved for use in the USA and the EU. Gilead intends to use this to gain regulatory approval in 18 countries by the end of 2025. Zimbabwe has not yet granted approval for Lenacapavir, although the process is now underway. Until this happens, the rollout cannot go ahead.  

The Global Fund says the first batch of Lenacapavir could arrive in Africa before the end of the year. South Africa is expected to receive it first, as Gilead has already filed for regulatory approval there. 

Stigma

Some people have stigmatising views about PrEP. One of the most damaging is the misconception that anyone who uses PrEP is promiscuous. This might stop people using Lenacapavir, especially unmarried women, even if they can access it. 

On top of this, criminalised groups such as LGBTQI+ people and sex workers are highly stigmatised. This might stop people from these groups trying to get Lenacapavir, despite being at high risk of HIV. The lack of clear targeting for these groups also shows how institutional discrimination still exists.  

Delivery systems

The CAB-LA rollout in Zimbabwe faced several challenges. Supply chain disruptions and funding cuts slowed down progress. This forced some people using CAB-LA to switch to PrEP pills. The same challenges could affect the Lenacapavir rollout. They may even worsen as the impact of recent funding cuts continues.  

Lenacapavir will also be available only at select health facilities. These are likely to be in major towns and cities. This means people in rural places may struggle for access. 

What has the response to the announcement been in Zimbabwe?

Speaking to The Herald, Raymond Yekeye, Zimbabwe’s National AIDS Council Operations Director, said Lenacapavir will “revolutionise our HIV prevention space”. However, he added: “… at the current cost we are not able to roll it out at a public health scale, where we give everyone who requires it. So, we need to sit down and say which priority populations are we going to give. “These discussions will be guided by our data,” he said. “We want to focus on areas with the highest number of new HIV infections.” 

In an interview with Cite, Tjedu Moyo-Maphosa, head of the Lunia Centre for Youths in Bulawayo, said: “This is a good start but let us make sure that no one is left behind, especially adolescent girls and young people. We need to address issues of access, availability and demand creation. “The government must ensure that PrEP is easy to access for everyone who needs it,” she said. “Public health institutions should take the lead.” 

In the DW AfricaLink podcast, Dr. Ponesai Nyika, a public health expert in Zimbabwe, shared optimism about Lenacapavir. However, he noted that many people still doubt its effectiveness. He said public scepticism could affect how well it supports the HIV response.

If you work in sexual health, it’s important to stay up to date on HIV prevention options. Some methods are already available, while others, like Lenacapavir, are on the way. Knowing what’s new helps you guide and support the people you work with. Keep following Be in the Know for clear, accurate updates on the latest HIV prevention tools.