THE LENACAPAVIR HIV DRUG: Who Will Really Get This Twice-Yearly HIV ‘Miracle’ Injection?

HARARE – A palpable sense of anticipation hangs in the air as Zimbabwe prepares to roll out Lenacapavir, a groundbreaking HIV prevention injection, on the 18th of February 2026. Hailed by many as a “miracle” drug, this twice-yearly injection promises to revolutionise the fight against HIV, offering a powerful new weapon in a country that has long battled the epidemic. Yet, beneath the surface of this seemingly triumphant public health moment, a complex and troubling reality is taking shape.

With an initial target of just 46,000 people in a nation where over 1.3 million live with HIV, the rollout is shaping up to be less of a universal solution and more of a high-stakes lottery. This investigative piece delves into the science, the politics, and the hidden costs of this new technology, asking the crucial question: who will truly benefit from this breakthrough, and who will be left behind?

The initial phase of the programme is set to launch in Epworth, a high-density, peri-urban settlement on the outskirts of Harare. It is a community that has been disproportionately affected by the HIV epidemic, making it a logical starting point for such an initiative. Dr. Aspect Maunganidze, the Permanent Secretary at the Ministry of Health and Child Care, has stated that the programme will prioritise “vulnerable groups, including adolescent girls, pregnant women, and high-risk populations.”

This targeted approach, while seemingly sensible, raises concerns about the potential for exclusion and the creation of a two-tiered system of healthcare.

The science behind Lenacapavir is indeed revolutionary. Unlike traditional oral pre-exposure prophylaxis (PrEP), which requires daily pill adherence, Lenacapavir is administered via injection only twice a year. This extended protection offers a lifeline to those who struggle with the stigma, logistical challenges, or simply the daily burden of remembering to take a pill. For many, particularly young women and marginalised communities, this could be a game-changer. However, the very innovation that makes Lenacapavir so promising – its long-acting nature – also presents a significant hurdle: the cold chain.

To remain viable, Lenacapavir, like many advanced medications, requires a stable and controlled temperature environment throughout its journey from manufacturer to patient. This “cold chain” infrastructure, while standard in developed nations, is a significant challenge in many parts of Zimbabwe, particularly in rural areas where electricity is unreliable and resources are scarce. The initial focus on urban centres like Epworth, while practical, risks exacerbating the existing urban-rural health divide. Will this “miracle” injection become a “boutique” health solution, accessible only to those in well-connected urban areas, while those in remote, high-prevalence regions are left to rely on older, less effective prevention methods?

The question of access is further complicated by the murky world of global pharmaceutical politics. Gilead Sciences, the company that developed Lenacapavir, has been lauded for its voluntary licensing agreements with several generic manufacturers, a move that has drastically reduced the cost of the drug. While the US list price for a year’s supply of Lenacapavir is a staggering $42,250, the generic versions are expected to be available for as little as $40 per person per year.

This seemingly benevolent gesture, however, is not without its critics. Médecins Sans Frontières (MSF), among other health advocacy groups, has pointed out that Gilead’s licensing agreements exclude several middle-income countries with significant HIV burdens, such as Brazil and Mexico.

These countries are left in a precarious position, forced to either pay exorbitant prices or engage in lengthy and often contentious battles for compulsory licenses. This selective approach to access raises uncomfortable questions about the role of profit in public health and the power of pharmaceutical companies to dictate who lives and who dies.

The Zimbabwean government, for its part, has been working tirelessly to prepare for the rollout. The programme’s first phase includes 24 operational sites and nearly 400 trained health workers, with rollout beginning in urban areas before expanding to other high-incidence regions across the country. Dr. Maunganidze has emphasised the importance of community engagement and education, stating that “the launch of Lenacapavir is a significant step forward, but it is only the beginning. We must ensure that everyone who needs this drug has access to it, regardless of their location or socio-economic status.”

However, the reality on the ground is often more complex. Qualitative studies in Zimbabwe show that stigma and gender dynamics often undermine PrEP efforts. Healthcare workers may exhibit “gatekeeping” attitudes, especially toward adolescent girls and young women (AGYW), judging their sexual activity and potentially denying them access to the drug. This “political gatekeeping,” combined with the limited supply of the drug, could lead to a situation where access is determined by who you know rather than what you need.

The cost of the rollout is another major concern. While the drug itself may be affordable, the infrastructure required to deliver it is not. The cold chain, the training of health workers, and the establishment of operational sites all require significant investment. Zimbabwe, which already has a unique 3% income tax levy to fund its HIV response, still relies heavily on international donors like PEPFAR and the Global Fund for new technologies like Lenacapavir. The long-term sustainability of the programme is therefore a major question mark.

As Zimbabwe grapples with the complexities of the Lenacapavir rollout, a different kind of HIV breakthrough is making headlines in neighbouring South Africa. In a historic moment for African-led research, the first human trials of a locally developed HIV vaccine have begun in Cape Town. The BRILLIANT 011 clinical trial, a partnership between the South African Medical Research Council (SAMRC), the Desmond Tutu HIV Foundation (DTHF), and the Wits Health Consortium, represents a major milestone in the quest for an effective HIV vaccine.

Led by a team of predominantly African women scientists, the BRILLIANT Consortium is a testament to the growing scientific capacity on the continent. The trial, which was almost derailed by US funding cuts, was saved by the swift action of its leaders and the mobilisation of new investment, a powerful symbol of African resilience and determination. The first participant was enrolled in late January 2026 at the Desmond Tutu HIV Foundation site at Groote Schuur Hospital.

Professor Glenda Gray, the President of the SAMRC, has stated that the BRILLIANT 011 trial is “a historic step toward contributing to the development of an HIV vaccine, aimed at HIV vaccine strains circulating in Southern Africa.”

The trial is part of a broader effort to test multiple vaccine candidates, with the hope of finding one that provides long-term protection against the virus. While the road to a widely available HIV vaccine is still long and uncertain, the BRILLIANT 011 trial offers a glimmer of hope for a future where HIV is no longer a threat.

The juxtaposition of these two stories – the promise and peril of Lenacapavir in Zimbabwe and the nascent hope of a vaccine in South Africa – highlights the complex and often contradictory nature of the global fight against HIV. While technological breakthroughs offer new hope, they also expose the deep-seated inequalities that continue to plague our world. The Lenacapavir lottery in Zimbabwe is a stark reminder that a miracle drug is only a miracle if it reaches those who need it most.

As the first injections are administered in Epworth, the world will be watching to see if this new chapter in the HIV story will be one of equitable access or of broken promises. The success of the Lenacapavir rollout will depend not only on the science but also on the political will to ensure that the most vulnerable are not left behind. It will require a concerted effort from governments, pharmaceutical companies, and international donors to overcome the logistical and political hurdles that stand in the way of universal access.

In the end, the story of Lenacapavir is not just about a drug; it is about the fundamental right to health. It is about whether we, as a global community, are willing to ensure that the benefits of scientific progress are shared by all, or whether we are content to let the lottery of birth and geography determine who lives and who dies. The choice is ours, and the stakes could not be higher.

The table above illustrates the trade-offs between the new injectable technology and the existing oral treatment. While Lenacapavir offers superior adherence and long-term protection, its reliance on a robust medical infrastructure makes it more difficult to scale in resource-limited settings. This is the heart of the “lottery” – the drug exists, it is affordable in generic form, but the system to deliver it remains the bottleneck.

For the young women of Epworth, the 18th of February represents a chance at a different future. But for the millions in the rural hinterlands of Matabeleland or the remote villages of Manicaland, the “miracle” remains a distant promise, locked away behind the barriers of geography and the cold chain.

Follow @MyZimbabweNews