Civil Society Calls for Inclusive Lenacapavir Rollout

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Civil society organisations are calling for people who use and inject drugs to be included in Zimbabwe's rollout of long-acting HIV prevention drug lenacapavir, arguing that vulnerable populations should not be left behind as the country expands access to new prevention technologies.

Zimbabwe began rolling out lenacapavir earlier this year as part of efforts to broaden HIV prevention options, initially focusing on populations considered to face substantial HIV risk, including adolescent girls and young women, sex workers and pregnant women. Zimbabwe Civil Liberties and Drugs Network (ZCLDN) executive director Wilson Box said the expansion of the programme should be guided by equity and deliberately include communities that face barriers to accessing healthcare.

Box was speaking during a media advocacy dialogue on equitable access, domestic financing and the inclusive rollout of lenacapavir among key and vulnerable populations. He said people who use and inject drugs should be considered as the programme expands, particularly amid Zimbabwe's growing drug and substance abuse challenge. “Scientific innovation only becomes a public health success when the people who need it most can actually access it,” Box said.

“For key and vulnerable populations, including people who use and inject drugs, sex workers, men who have sex with men, transgender people and other communities that experience barriers to health services, the challenge has never simply been the absence of effective interventions. The challenge too often is whether services are accessible, affordable, acceptable and delivered without discrimination.”

Drug Use and HIV Prevention

Zimbabwe has been grappling with drug and substance abuse, which the Government has identified as both a public health and national security concern. The country's Multisectoral Drug and Substance Abuse Plan 2024–2030 includes demand and supply reduction, harm reduction, treatment and rehabilitation, community reintegration, communication, legal enforcement and resource mobilisation among its areas of focus.

The Government has also established the Zimbabwe National Committee on Drug and Substance Abuse to coordinate responses involving ministries, law enforcement agencies and other sectors. Box said these interventions should be complemented by ensuring that people who use and inject drugs are not excluded from advances in HIV prevention.

Lenacapavir is considered an important development in HIV prevention because its long-acting formulation could help address some of the adherence challenges associated with daily oral prevention. For civil society, however, introducing the technology is only the first step. Box said policymakers must also consider whether people at heightened risk can access the drug without stigma, discrimination or other barriers.

“Equity must be at the centre of the rollout. No person should be excluded because of their identity, occupation, behaviour, social status or circumstances,” he said.

Concerns Over HIV Financing

The advocacy groups are also raising questions about the sustainability of the programme as donor funding for HIV responses comes under increasing pressure. Box questioned whether Zimbabwe would have sufficient domestic resources to maintain access to lenacapavir and other HIV prevention interventions beyond donor-supported programmes. “Will domestic financing be sufficient to sustain access beyond donor-supported programmes?” he asked.

He urged affected communities to be meaningfully involved in decisions concerning the rollout, arguing that programmes should not simply be designed for vulnerable populations without their participation. Box also called on the media to scrutinise Government financing commitments, implementation plans and the extent to which communities are being included in national HIV programmes.

For civil society, the success of lenacapavir should therefore not be measured solely by its introduction into Zimbabwe's HIV prevention programme.

“Our success should be measured by whether those who need it most can access it safely, equitably, affordably, and without stigma or discrimination,” Box said.

lenacapavir rollout Zimbabwe

Civil society groups want people who use and inject drugs included in Zimbabwe's lenacapavir HIV prevention rollout.