PrEP not shield against STI

Health experts in Bulawayo have cautioned that while the introduction of Lenacapavir marks a major breakthrough in HIV prevention, the long-acting injectable pre-exposure prophylaxis (PrEP) does not protect against sexually transmitted infections (STIs), amid growing concern over drug-resistant gonorrhoea and other opportunistic infections.

The warning follows last week's provincial rollout of the twice-yearly HIV prevention injection, with senior clinicians urging communities not to develop a false sense of security.

Director of Health Services for the City of Bulawayo, Dr Edwin Sibanda-Mzingwane, said opportunistic infections and STIs remain a significant public health concern, particularly among sexually active populations.

"Pre-exposure prophylaxis protects against HIV, but it does not prevent other sexually transmitted infections such as gonorrhoea, syphilis or chlamydia," he said.

"We are increasingly seeing cases of drug-resistant gonorrhoea globally, and that is worrying. If people abandon condom use because they feel protected from HIV, we may face another public health challenge.

"We, therefore, celebrate Lenacapavir as an addition to our combination prevention strategy, but abstinence, faithfulness and condom use still work. Condoms have not gone out of fashion and are still proven to be highly effective against HIV, pregnancy and STIs," said Dr Sibanda-Mzingwane.

According to the World Health Organization, antimicrobial resistance in gonorrhoea is an emerging global threat, limiting treatment options and increasing the risk of serious complications if infections are left untreated.

Dr Byron Chingombe, technical director at CeSHHAR Zimbabwe, echoed the warning, saying enthusiasm around Lenacapavir must be balanced with strong public health messaging.

"Lenacapavir is a powerful tool in preventing HIV, but it is not a replacement for condoms or regular STI screening," he said.

"We are encouraging clients to continue testing, seek early treatment for symptoms and understand that prevention must be layered."

Dr Chingombe added that untreated STIs can increase vulnerability to HIV infection and may lead to long-term reproductive health complications if not addressed promptly.

The clinicians also reminded communities that Zimbabwe has signed up for global validation processes aimed at eliminating mother-to-child transmission of HIV, syphilis and hepatitis B — a key public health milestone under the WHO framework for eliminating vertical transmission of the three infections.

Dr Sibanda-Mzingwane said maintaining high prevention standards across the board is critical if the country is to achieve that goal.

"Eliminating paediatric HIV, congenital syphilis and hepatitis B transmission requires sustained effort from antenatal screening to treatment adherence and broader STI control," he said.

"This is why we cannot relax. HIV prevention innovations must go hand in hand with strong maternal and child health systems."

Health authorities note that while Zimbabwe has made significant progress in reducing new HIV infections and expanding antiretroviral therapy coverage, sustained vigilance is essential to safeguard those gains.

Dr Chingombe stressed that combination prevention remains the gold standard.

"We must continue promoting condoms, regular HIV testing, STI screening, treatment adherence and behavioural interventions. Biomedical innovation alone is not enough," he said.

As Bulawayo continues rolling out Lenacapavir to key populations, health officials say public education will remain central to ensuring that progress in HIV prevention does not inadvertently fuel complacency in other aspects of sexual health.

The message from clinicians is clear: protection must be comprehensive, consistent and informed.