HARARE – For the 1.3 million Zimbabweans living with HIV, the arrival of February 2026 marked the beginning of a medical revolution.
It was the month the country began rolling out Lenacapavir—a breakthrough, twice-yearly injectable PrEP with a staggering 99% effectiveness rate. For many, it promised a life free from the “pill fatigue” of daily medication and the stigma that often accompanies it.
But as the initial rollout targets 46,000 high-risk individuals across 24 sites, a vital segment of the population is raising its voice, fearing they have been left in the shadows.
The Zimbabwe Civil Liberties and Drug Network (ZCLDN) has issued a pointed challenge to the government’s implementation strategy. Their concern? That people who use and inject drugs (PWUID) are being systematically overlooked in the deployment of this life-saving technology.
A Missed Connection
Speaking at a media advocacy dialogue in Harare this Tuesday, ZCLDN Executive Director Wilson Box stood before a room of journalists with a clear message: science is only as effective as its reach.
“We can see that 1.3 million people are living with HIV in Zimbabwe, and adult prevalence is at 10.5%,” Box noted, highlighting the persistent gap in the country’s response. “Lenacapavir presents a massive opportunity… but there is an inclusion challenge.”
The dialogue, held under theme “Power of Prevention (PoP) Project,” highlighted a glaring contradiction. While Zimbabwe’s National HIV Strategic Plan identifies people who use and inject drugs as a key target population, they have been noticeably absent from the priority lists in public communications regarding the Lenacapavir rollout. Currently, the spotlight remains on sex workers, adolescent girls, young women, and men who have sex with men.
The Burden of the Daily Pill
The stakes for the drug-using community are uniquely high. For those managing substance use, the “adherence burden” of a daily oral pill can be an insurmountable barrier. The discretion offered by a twice-yearly injection isn’t just a matter of convenience; for many, it is the difference between protection and infection.
“The injection offers greater privacy and discretion,” the PoP concept note explains, but those benefits only matter if the needles and the vials reach the hands of those most marginalized.
The Funding Tightrope
The challenge isn’t just about who gets the shot, but who pays for it. Zimbabwe’s HIV response is currently navigating a precarious financial landscape. While the Global Fund currently cushions the cost of Lenacapavir, donor support is on a downward trend.
Box warned that the “Power of Prevention” response must be more than just medical—it must be political. The PoP project is currently mobilizing key population-led organizations to advocate for domestic financing and a more “enabling policy environment.”
“A very important question is: why this dialogue at this moment in time?” Box asked. The answer lies in the urgency of self-sufficiency. As external funding becomes less certain, the ZCLDN argues that Zimbabwe must own its prevention strategy, ensuring it is informed by evidence rather than exclusion.
The Role of the Messenger
The ZCLDN is now leaning on the Fourth Estate to bridge the gap. Box challenged journalists to look beyond the clinical success of the drug and investigate the equity of its distribution.
The goal of the PoP project is to foster a “small grants initiative” that empowers local organizations to push for evidence-informed HIV prevention planning. By bringing the struggle of people who use drugs to the forefront, advocates hope to ensure that the “Power of Prevention” isn’t reserved for those easiest to reach, but extended to those most in need.
As the rollout continues across Zimbabwe’s 24 pilot sites, the message from Harare is clear: A breakthrough that leaves the most vulnerable behind is a breakthrough only half-achieved. For Wilson Box and the ZCLDN, the fight for Lenacapavir is not just about a needle in an arm—it’s about a seat at the table.
