HIV experiment rollout in Zimbabwe sparks debate

Zimbabwe has been chosen as one of 10 countries globally to roll out lenacapavir, the world's first twice-yearly injectable drug for HIV prevention, a move hailed as a "transformative step" in the fight against the virus.

The announcement was made by the US Embassy in Harare, highlighting Zimbabwe's selection for the initial rollout of the breakthrough medication. The country is home to 1.3 million people living with HIV, according to UNAids, and recently achieved the 95-95-95 fast-track targets, ensuring high levels of diagnosis, treatment, and viral suppression.

Public health expert Ponesai Nyika told DW that Zimbabwe has a "very solid HIV response infrastructure," supported by strong partnerships with Pepfar and local institutions, creating a robust foundation for lenacapavir's introduction.

The drug targets individuals at heightened risk of HIV infection, including adolescent girls, pregnant women, and breastfeeding mothers.

"While an HIV vaccine remains elusive, lenacapavir is the next best thing: a long-acting antiretroviral shown in trials to prevent almost all HIV infections among those at risk," said WHO Director-General Tedros Adhanom Ghebreyesus. UNAids deputy director Angeli Achrekar described it as a "potential miracle drug," with efficacy rates exceeding 99% in clinical trials conducted in sub-Saharan Africa and the United States.

A key advantage of lenacapavir is its twice-yearly administration, which reduces the risks associated with poor adherence to daily treatment. Patients begin with an initial oral dose over two days before proceeding to the biannual injections.

While the drug is being celebrated globally, some concerns remain regarding cost, accessibility, and safety. Initially projected to cost up to US$28,000 per person annually, the regimen's price has been reduced to around US$40 per year through support from international partners. Nyika stressed the importance of transparent communication on potential side effects and equitable access, suggesting that negotiations and possible local or regional production could further lower costs.

Zimbabwe will join countries including Kenya, Nigeria, Zambia, Uganda, Tanzania, South Africa, Eswatini, and Botswana in rolling out the drug by January 2026. The programme is expected to significantly reduce the 1.3 million new HIV infections occurring each year in low- and middle-income countries.

Lenacapavir is seen as a landmark advancement in HIV prevention, offering hope for millions and marking a major step toward controlling the epidemic in southern Africa.