A Twice-Yearly Shield: Zambia’s New Hope in the Fight Against HIV

By Alain Kabinda

For a woman visiting the University Teaching Hospital (UTH) Women and Newborn Hospital in Lusaka, HIV prevention may soon become less about remembering a pill every day and more about making two decisions a year.

That possibility is emerging with the introduction of injectable lenacapavir, a new HIV prevention option that is administered twice a year.

More than 200 women at the UTH Women and Newborn Hospital have already been initiated on the injection, marking an important step in Zambia’s efforts to prevent new HIV infections.

And for many women, particularly those who are pregnant or breastfeeding, staying HIV-negative is not only about protecting their own health. It can also mean protecting their children from the consequences of an infection acquired during pregnancy or breastfeeding.

The arrival of lenacapavir therefore represents more than the introduction of another medicine. It offers women another choice in how they protect themselves from HIV.

Daily oral pre-exposure prophylaxis, commonly known as PrEP, has given people at risk of HIV an effective tool for preventing infection. But taking a tablet every day can be difficult for some people.

Instead of requiring daily tablets, the injectable prevention option is administered twice a year, potentially reducing the burden associated with daily medication.

For women who struggle with taking a pill every day, the twice-yearly injection could provide greater convenience and privacy.

Speaking during the handover ceremony and marking the arrival of the shipment. in Lusaka U.S. Assistant Secretary of State for African Affairs Frank Garcia said the medicine could help save lives by giving women another way to protect themselves from HIV.

                                                            Mr. Frank Garcia

“This is a Zambian achievement, led by Zambians for Zambians,” Mr Garcia said.

He highlighted a significant aspect of the development: while the medicine is supported by the United States, its implementation is being led by Zambian health workers and institutions.

Mr Garcia said U.S. support was intended to strengthen Zambia’s health institutions and leadership rather than replace the work of local authorities.

At the centre of the initial rollout is the UTH Women and Newborn Hospital, where health workers are gaining practical experience in administering the injection and supporting women receiving it.

And Senior Medical Superintendent Dr Mukatimui Kalima Munalula said more than 200 women had already been initiated on injectable lenacapavir, including some male partners.

“What we are doing here will help us to generate information that can be used to roll out the service to the rest of the country,” she said.

Dr Munalula says the lessons emerging from UTH will be critical to future expansion.

The experience being accumulated at UTH could become important as Zambia considers expanding access to the new HIV prevention option beyond the capital.

Health workers are learning how women respond to the intervention, how services can best be delivered and what may be required to make the programme accessible on a larger scale.

Behind every new HIV prevention intervention lies a history of lives lost and families changed by the epidemic.

Meanwhile Ministry of Health Permanent Secretary for Donor Coordination George Sinyangwe offered a deeply personal reminder of that history.

                                                  Dr. George Sinyangwe 

Mr Sinyangwe said he had lost four brothers to HIV, despite all of them being educated, with some reaching PhD level.

“I am the only one remaining,” he said.

It has taken parents from children, breadwinners from families, professionals from workplaces and loved ones from communities.

Mr Sinyangwe said HIV had once contributed to a dramatic decline in Zambia’s life expectancy, but increased access to treatment and other interventions had helped reverse some of the damage.

He said life expectancy had recovered to around 64 years, while HIV-related deaths had fallen sharply.

Every new prevention tool represents another opportunity to ensure that fewer families experience the loss that his family endured.

The introduction of lenacapavir also highlights the long-standing health partnership between Zambia and the United States.

Mr Sinyangwe described the United States as the single largest external supporter of Zambia’s HIV response, with assistance spanning prevention and treatment.

The medicine, manufactured by U.S. pharmaceutical company Gilead Sciences, is being made available free of charge at Zambian health facilities.

For women and families who may otherwise worry about the cost of HIV prevention, removing the price of the medicine could make the intervention more accessible.

The partnership also reflects a broader shift in HIV prevention: from simply making medicines available to ensuring that people have prevention options that fit their lives.

For a woman who is HIV-negative, preventing infection during pregnancy and breastfeeding is important not only for her own health but also because acquiring HIV during these periods can create risks for her child.

The introduction of injectable PrEP at the Women and Newborn Hospital creates an opportunity to integrate HIV prevention more closely into services that women already use.

Rather than treating HIV prevention as a separate intervention, health workers can make it part of a broader conversation about maternal health, family wellbeing and protecting children.

The more than 200 women already initiated on lenacapavir represent an important beginning, but Zambia’s HIV prevention needs extend far beyond one hospital.

The success of the programme will depend not only on the availability of the medicine but also on health workers, supply systems, community awareness, counselling and the ability of women to make informed choices about HIV prevention.

The challenge will be ensuring that a promising innovation does not remain concentrated in a few facilities or become accessible only to women living near major urban centres. For Lenacapavir does not end Zambia’s HIV challenge.

Rather, it adds another tool to an arsenal that includes condoms, HIV testing, oral PrEP, treatment and other prevention strategies.

Not every person at risk of HIV will want the same prevention method. Some may prefer daily tablets, while others may find a twice-yearly injection easier to maintain.

For a country that has witnessed the devastating human cost of HIV, the promise is straightforward: fewer new infections, healthier mothers, protected children and more families spared the grief of losing loved ones.

And for the women receiving the injection, the meaning may be even simpler—a little more freedom, a little less daily burden, and another opportunity to remain HIV-negative.

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