On 1 December 2025, Zambia introduced lenacapavir as a long-acting pre-exposure prophylaxis (PrEP) for HIV, marking the first rollout of the injectable on the African continent.
First Recipients Share Their Reasoning
Ruth Manga, 29, said she had long recognized her high risk of infection after seeing friends struggle with condom negotiation. “I have known that I am at substantial risk of contracting HIV,” she said, adding that she chose the new prevention method for herself.
Ruth was among the initial cohort to receive the drug at the University Teaching Hospital (UTH) in Lusaka, where the first batch of 500 doses was split between the hospital and a clinic in Chawama.
Within weeks, health workers reported that the allocated stock was exhausted, prompting concerns about how to sustain demand when the supply line remains uncertain.
Community-Led Outreach Focuses on Young Women
Adaptive Leadership Zambia (ALZ), a non-profit partnered with the Ministry of Health, organized community meetings weeks before the launch to explain the new option.
“We let the communities come up with their own sustainable interventions,” said Veronique Malupande, the programme’s national coordinator. “What Lusaka is doing might not be what Chikankata is doing because the terrain is different.”
Communications lead Alex Shumba noted that conversations take place in familiar settings such as family gatherings and church groups, avoiding the need for new structures.
Data gathered by peer advisor Jacob Zulu show a stark gender gap: roughly one HIV-positive result for every five girls tested, compared with one in twenty boys.
Because of this disparity, the group set specific targets for girls aged 15 to 24. “We have targets that we need to reach to get more girls on PrEP,” Zulu explained, adding that mobilising this group requires programmes that attract them and pinpoint hotspots where they live.
Many young clients value the privacy of an injection. Mazza Batyanza, head nurse at the Youth Friendly Space in Chilenje Level 1 Clinic, reports a steady flow of adolescents seeking the discreet option each week.
Funding Cuts and Supply Shortfalls
Recent funding reductions have limited the NGO’s reach from nearly half of Zambia’s 72 districts to just four. Malupande said the cuts disrupted staff, partners, and the rented spaces where youth previously gathered.
To preserve activities, it is embedding programmes in churches, schools and market associations, relying on volunteers and radio broadcasts to reach remote areas with limited smartphone access.
Supply of the medication has also dwindled since the initial rollout. Nurse Batyanza described anxiety over managing a two-dose regimen amid uncertain stock, saying, “We still don’t have enough supply because this is just when we started, and we don’t actually want to lose clients by defaulting.”
According to Dr Mundia, the rollout is expanding beyond the original sites through a “hub-and-spoke” model that will place the drug in private pharmacies and hospitals, offering it free or at low cost rather than over the counter.
Implications for Young People
Ruth remains hopeful. “I would love everyone to be on prevention,” she said, “because prevention starts with us.” Whether lenacapavir can meet that hope will depend on more than demand. People must be able to choose it freely, receive it on schedule and return for follow-up.
