Zimbabwe has begun a phased rollout of lenacapavir, a long-acting HIV prevention injection administered twice a year. Nyasha Sayi, a 31-year-old sex worker from Epworth on the outskirts of Harare, recently received her first dose as part of the phase one programme. Officials said at a 31 January meeting in Harare that an estimated 2,000 people have already received injections. The programme covers 11 sites nationwide and aims to reach about 46,000 people at high risk, targeting groups such as sex workers, men who have sex with men and other key populations.
In February the US Ambassador to Zimbabwe announced a wind down of major US-supported health interventions after Harare halted negotiations over a proposed US$300 million deal. The government said the agreement looked extractive and imbalanced and alleged the US sought access to sensitive pathogenic data and critical mineral resources. The US Embassy denied those claims and said any data requests were within standard programmes such as PEPFAR. That diplomatic dispute has put future doses of lenacapavir at risk.
Scientists and programme staff warn of a clear clinical risk: residual drug concentrations can remain for up to 12 months or longer at declining levels, a factor noted in Gilead's prescribing information. If people are exposed to HIV when drug levels are sub-protective, there is a risk of resistance to this class of drugs. Emily Gwavava, a consultant in Zimbabwe's lenacapavir programme, said remaining drug levels after 12 months could be sub-protective and raise resistance concerns. Trial data presented at the 2026 Conference on Retroviruses and Opportunistic Infections showed a Phase 3 PURPOSE 1 participant who missed a dose contracted HIV 16 months after their last injection. Zimbabwean health authorities say current supplies are not immediately threatened: Owen Mugurungi of the Ministry of Health and Child Care said existing doses were obtained through a special arrangement with the Global Fund, UNITAID and other partners and have already been paid for. Africa CDC’s Yap Boum said the agency is monitoring shifting global health financing and supporting member states. Sayi said she is unsure whether she will get her next dose and warned that discontinuation would put her at personal risk.
Difficult words
- lenacapavir — long-acting injectable medicine to prevent HIV
- rollout — planned introduction of a programme or product
- residual — remaining in the body after treatment finishes
- sub-protective — drug level too low to fully prevent infection
- resistance — when a drug becomes less effective against disease
- extractive — taking resources in a way that feels unfair
- wind down — gradual reduction or ending of an activity
Tip: hover, focus or tap highlighted words in the article to see quick definitions while you read or listen.
Discussion questions
- What concerns might people have about starting a long-acting HIV prevention injection if future doses could be disrupted?
- How could diplomatic disputes between governments affect public health programmes in a country? Give examples from the article.
- What measures could health authorities use to reduce the risk of drug resistance if some people miss their next injection?
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