Bulawayo rolls out twice yearly HIV injection

Bulawayo has marked a significant milestone in Zimbabwe’s fight against HIV with the launch yesterday of Lenacapavir, a long-acting injectable pre-exposure prophylaxis (PrEP) that is administered just twice a year.

Scores of key vulnerable groups, including sex workers, thronged the “Sisters Clinic at Centre for Sexual Health and HIV/Aids Research” housed at the Khami Clinic in the city to access the new life-changing, long-lasting injectable HIV prevention drug.

The introduction of Lenacapavir, recently recommended by the World Health Organisation as an additional HIV prevention option, is being hailed as a potential game-changer in Zimbabwe, a country that continues to battle one of the highest HIV burdens in southern Africa.

Unlike daily oral PrEP pills, Lenacapavir offers six months of protection per injection, easing the burden of adherence for individuals who struggle with taking medication every day. Health authorities say this innovation strengthens Zimbabwe’s combination HIV prevention strategy, complementing condom use, regular testing, treatment and behavioural interventions.

Zimbabwe has made notable progress over the past decade in expanding antiretroviral therapy and reducing HIV-related deaths.

However, new infections persist, particularly among adolescent girls and young women, sex workers and other key populations.

The initial rollout will prioritise groups at higher risk of acquiring HIV, including adolescent girls and young women, sex workers and their clients, men who have sex with men, and pregnant and breastfeeding women in high-incidence settings.

Bulawayo, as one of the country’s key urban centres with significant HIV incidence, is part of the phased introduction.

Sex workers, who spoke to The Chronicle during the launch at the Khami Clinic in Bulawayo said the twice-yearly injection addresses real challenges they face.

“We sometimes travel for our work, and it becomes difficult to take a pill every day at the same time. With an injection that lasts six months, I feel more protected and less stressed,” said Carol Banda.

Others highlighted stigma as a major barrier to daily PrEP use, saying the injectable option is empowering and will help them manage their health with fewer hassles.

“When clients see pills, they start asking questions. Some assume you are HIV positive, or have other health conditions,” said another sex worker who declined to be named.

“This injection is private. No one has to know, and I feel empowered and can take better charge of my health,” she said.

“It is much more empowering for me as I can render maximum services to my clients and ensure maximum pleasure and satisfaction without having to worry about taking oral prep on a daily basis. It helps me manage my work and the risks that come with it better.”

A local hairdresser, Gertrude Khanye, who attended the event and also took the Lenacapavir injection, said greater awareness is needed to normalise HIV prevention.

“People still whisper about PrEP as if it is something shameful. If we talk about it openly, like family planning, more people will protect themselves,” she said.

“I encourage other women, even those with one stable partner, to take PrEP because they cannot account for the actions of their partners,” said Khanye.

“I also encourage women with spouses in the diaspora to take PrEP and protect themselves because they can never know about the other lives that their partners are living. Prevention is best, and this new PrEP is so efficient and not stressful at all,” said Sehli Moyo, another sex worker.

An outreach officer from CeSHHAR Zimbabwe, Clementine Sithole, said offering choice is critical in prevention programming.

“For years, we have encouraged daily PrEP, but adherence has been a challenge, especially among mobile populations.

“A twice-yearly injection reduces that burden and gives clients more control over their health,” Sithole said.

CeSHHAR Technical Director Dr Byron Chingombe said Lenacapavir does not replace other prevention methods but adds another layer of protection.

“This is an additional tool in our HIV prevention toolkit. Scientific evidence shows very high effectiveness when administered correctly. Our priority now is ensuring equitable access, proper follow-up and sustained supply,” he said.

“We are happy as CeSHHAR about this significant milestone.”

The Medicines Control Authority of Zimbabwe approved the drug following an expedited review process, underscoring its public health importance.

Health workers are undergoing training to administer the injections and manage follow-up care.

The programme is being supported by partners, including Pepfar and The Global Fund, to help ensure sustainable supply and technical assistance.

Health experts have stressed that Lenacapavir must be used as part of comprehensive HIV prevention. Regular HIV testing, condom use and risk-reduction counselling remain essential components of protection. Side effects are reported to be generally mild, with minor injection-site reactions, among the most common.

As the rollout begins in Bulawayo, attention now turns to community uptake, awareness and sustained funding, factors that will determine how transformative the intervention becomes.

For many at the launch, however, the significance of the moment was already clear.

“This gives us hope,” one of the sex workers said. “It shows that prevention is evolving, and that we are not forgotten.”