Lenacapavir and the Sustainability Question in Zimbabwe’s HIV Fight
A few days ago, my country, Zimbabwe, officially launched lenacapavir as part of its HIV prevention programme. This marks a significant milestone in our national response to HIV and could prove to be a true game changer in the fight against the epidemic.
Lenacapavir is a long-acting injectable medicine administered twice a year for HIV prevention. Unlike traditional pre-exposure prophylaxis (PrEP) tablets, which must be taken orally every day, lenacapavir offers protection through a single injection given every six months. This difference in dosing schedule represents a major shift in convenience and adherence. Daily oral PrEP has been highly effective when taken consistently, but many people struggle with adherence due to stigma, forgetfulness, mobility, or unstable living conditions. A twice-yearly injection significantly reduces these barriers and improves the likelihood of sustained protection.
Clinical trials have shown that long-acting lenacapavir for HIV prevention is highly effective in reducing the risk of HIV acquisition among people at substantial risk (Gilead Sciences, 2023; Bekker et al., 2024). For key populations in Zimbabwe—including sex workers, adolescent girls and young women, men who have sex with men, and serodiscordant couples (where one partner is HIV-positive and the other is HIV-negative)—this innovation could dramatically reduce new infections.
Does lenacapavir prevent sexually transmitted infections (STIs)?
While lenacapavir is scientifically proven to prevent HIV infection, it does not protect against other sexually transmitted infections (STIs). Individuals who wish to protect themselves from STIs are still strongly encouraged to use male or female condoms and to undergo regular STI screening.
Common STIs such as chlamydia, human papillomavirus (HPV), syphilis, and gonorrhoea can have serious sexual and reproductive health consequences if left untreated. These include infertility in both men and women, pelvic inflammatory disease, increased risk of ectopic pregnancy, heightened vulnerability to HIV infection, and certain cancers, particularly cervical cancer associated with persistent HPV infection (World Health Organization [WHO], 2023). Therefore, lenacapavir should be viewed as part of a comprehensive prevention package—not a replacement for safer sex practices.
The cost and sustainability question
Although lenacapavir brings hope, it does not come entirely free of cost. An insider working at a non-governmental organisation-run medical facility indicated that the drug may be administered to individuals who can afford an annual payment of approximately USD 40.00 to access the yearly doses. While this fee may appear modest in some contexts, it could still present a barrier for many Zimbabweans, particularly those already economically vulnerable.
The introduction of lenacapavir into Zimbabwe’s healthcare system was made possible largely through the support of international agencies, including programmes funded by the United States government. For over two decades, Zimbabwe’s HIV response has relied heavily on support from initiatives such as the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the United States Agency for International Development (USAID). These programmes have played a pivotal role in expanding access to antiretroviral therapy (ART), prevention services, laboratory systems, and health workforce capacity.
However, recent developments have raised serious concerns. Reports circulating online suggest that the United States government may be withdrawing its healthcare support to Zimbabwe following disagreements over certain terms of engagement. According to these reports, the dispute involved issues related to access to national health data and biological resources. At the time of writing, these claims require careful verification, but even the possibility of reduced funding is deeply troubling given Zimbabwe’s dependence on external assistance.
What lies ahead?
Zimbabwe carries one of the highest HIV burdens in sub-Saharan Africa. According to UNAIDS, approximately 1.3 million Zimbabweans are living with HIV, and over one million people are currently receiving antiretroviral therapy (UNAIDS, 2023). The country has made commendable progress in scaling up treatment and prevention services, largely due to international partnerships.
Yet the sustainability of our HIV response remains fragile. For decades, Zimbabwe’s health sector has depended significantly on donor funding. If the government had sufficient fiscal capacity and political will to fully finance its health programmes, it would have gradually reduced its reliance on external support. The reality, however, is that many public health facilities continue to experience shortages of essential medicines, diagnostic supplies, and basic equipment. Healthcare workers often operate under strained conditions, with limited resources and delayed remuneration.
If major donors withdraw or significantly reduce funding, the consequences could be severe: interruptions in ART supply, reduced prevention programming, weakened laboratory systems, and stalled progress toward epidemic control. This would not only reverse gains made over the years but could also lead to increased HIV transmission and mortality.
Zimbabwe has committed to achieving the UNAIDS 95-95-95 targets—ensuring that 95% of people living with HIV know their status, 95% of those diagnosed are on treatment, and 95% of those on treatment achieve viral suppression. Meeting these targets requires sustained investment, strong governance, and transparent partnerships. In the current economic climate, there is limited evidence that domestic resources alone can fill the potential funding gap.
A call for balanced engagement
As a Zimbabwean, I believe that the way forward lies in principled negotiation rather than abrupt disengagement. The era of unconditional aid is long past. African countries are increasingly demanding accountability, transparency, and respect for sovereignty in international partnerships. At the same time, governments must demonstrate responsible stewardship, fiscal commitment, and prioritisation of public health.
Renegotiating terms to ensure both national sovereignty and continued healthcare support could provide a balanced solution. HIV is not merely a political issue; it is a public health imperative affecting millions of families. The introduction of lenacapavir offers hope and technological progress, but without sustainable financing and strong health systems, its impact may be limited.
Zimbabwe stands at a crossroads. The promise of biomedical innovation must be matched by political maturity, economic planning, and renewed commitment to health equity. Our people deserve not only new medicines, but also a resilient and self-sustaining healthcare system capable of protecting future generations.
Reference List
Bekker, L.-G., Das, M., Abdool Karim, Q., et al. (2024). Lenacapavir for HIV prevention in cisgender women. New England Journal of Medicine.
Gilead Sciences. (2023). Press release: Phase 3 data on lenacapavir for HIV prevention.
UNAIDS. (2023). Zimbabwe HIV and AIDS estimates. Joint United Nations Programme on HIV/AIDS.
World Health Organization (WHO). (2023). Sexually transmitted infections (STIs) fact sheets. WHO.
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