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TRANSCRIPT
On the outskirts of Zimbabwe's capital Harare are a group of young women, some of them mothers holding babies.
Zimbabwe was once ravaged by the HIV epidemic, with tens of thousands of deaths over the past two decades.
It remains a problem - especially for women - with UNAIDS figures suggesting women and girls of all ages accounted for 63 percent of all new HIV infections in 2024.
Accordingly, these women have come to a clinic to take advantage of a donor-supported rollout of a new HIV prevention drug called lenacapavir, among them sex worker Constance Mukoloka.
"I work in beer halls looking for clients. Sometimes I would get drunk and forget to take my drugs. Sometimes I would work all night and not have time to take tablets but with this vaccine even if I get drunk, I know I'm safe."
The introduction of lenacapavir is happening in 10 African countries.
Developed by California-based Gilead Sciences, lenacapavir’s introduction in selected high-risk countries is being supported through the United States President’s Emergency Plan for AIDS Relief, or PEPFAR, in partnership with the Global Fund.
Zimbabwe is one of the first countries to implement the roll out.
Authorities say about 46,000 people across 24 sites are expected to benefit in the early phase of the rollout, a fraction of potential demand in a country of roughly 15 million.
Dr Ernest Chikwati is the program director at Aids Healthcare Foundation, and says the drug only needs to be taken twice a year.
"When someone's taking medicines every day, they tend to forget. But when someone is injected 6 months, it's very unlikely that they'll forget to take their medicine. So Lenacapvir is coming as an addition to all the pre-exposure prophylaxis methods."
The doctor says clinical studies have demonstrated near-total protection, and accordingly the drug has been described by some health officials as a turning point for high-risk groups that could slow the rate of new infections.
But he is also advising caution.
Daily oral PrEP has long been available in Zimbabwe alongside condoms, vaginal rings and shorter-acting injectables, yet adherence has remained a challenge, particularly for people facing stigma or unpredictable schedules.
He says that this suggests turning scientific promise into broad impact will require overcoming funding constraints, infrastructure gaps and the challenge of keeping patients engaged.
"Let's not say this is the silver bullet for HIV prevention. There are other methods. Condoms remain key for us as an organization, we've got two condom brands we give freely in the public sector. We also feel funding should be given to condoms as well. Condoms, why? Because they are very cheap."
Zimbabwe, Eswatini and Zambia, once global HIV epicentres, have emerged in recent years as among the world’s most successful models in controlling the epidemic, achieving World Health Organisation testing, treatment and viral suppression targets.
The injection of the new drug is offered for free to high-risk people such as sex workers, adolescent girls and young women, gay men and pregnant and breastfeeding women.
Yet despite these gains, new infections remain a concern.
Cesar Nunez is the director of the UNAIDS New York Office.
"The HIV epidemic is not over, and our previous progress is at risk."
Just how tenuous the position remains is laid bare by the numbers in sub-Saharan Africa.
HIV prevalence among adolescent girls and young women aged 10-24 is persistently triple that of their male counterparts in sub-Saharan Africa, driven by gender inequality, poverty and uneven access to health services.
Cesar Nunez has outlined how a lack of funding is contributing to these numbers.
"Most of the community response has depended on foreign assistance and that has currently been impacted. Some national AIDS commissions in African countries have had to invite or provide office space to organisations that have been left without that kind of funding. And UNAIDs anticipates that the impact of these fundings will represent 1.4 million annual new infections by 2030."
Details for the next phase of the rollout in Zimbabwe remains unclear.
The government says it hopes the number of beneficiaries will increase as more donor-funded doses arrive, and it also hopes to acquire its own doses for a mass rollout but, like many other African governments, lacks enough money.
Overall, health officials and advocates in Zimbabwe hope the drug will reshape HIV prevention strategies if governments can navigate barriers of cost and fragile health systems.
Meanwhile for Ms Mukoloka, the drug represents more than convenience.
"I am safe, I can work with confidence now. When we took tablets, customers would see a container of pills and leave, they would never return due to fear. They couldn’t tell the difference between PrEP and treatment drugs. With the work we do, that stigma costs you money."
