Since its rollout on July 1, lenacapavir, a long‑acting HIV prevention injection that offers up to six months of protection, has already reached 2 000 people across Malawi.
The demand to access the jab is steadily rising, especially among the youths between the age of 25 and 35, according to Ministry of Health and Sanitation.
For one Lilongwe resident from Area 25 who opted for anonymity, the jab brought peace of mind after reuniting with a long‑distance partner.
Unsure how to persuade him to take an HIV test, she initially relied on daily oral PrEP pills, each a reminder of the risk she faced.
“At first I was not sure about the safety of the injection. But a month later, I never felt or experienced any side effects. I now feel safe and have peace of mind,” she said.
The resident said she needed the relationship after months of being apart from her partner, but was unsure how to persuade him to take an HIV test.
While she turned to post-exposure prophylaxis (Prep), each pill reminded her of the risk she was taking.
The introduction of lenacapavir came as a relief; hence, a few days after its rollout, she went to Lilongwe Area 25 Health Centre for the jab.
But she said the drug is not a licence for her to be reckless.
According to the Ministry of Health and Sanitation HIV prevention officer Martin Kapito, alongside the 2 000 people who have opted for injectable PrEP, about 100 000 Malawians are already on oral PrEP nationwide.
Officials say the uptake shows growing acceptance of HIV prevention measures, with healthcare workers being trained to deliver services free from stigma and discrimination.
He said: “More people are appreciating Prep. The good thing about it is that it is a drug which you can take without other people noticing. It will be up to you to disclose yourself.
“In terms of the response by our healthcare workers, they are being trained so that they can actually deliver Prep services without stigma and discrimination.”
Kapito said the country has about one million people living with HIV, with approximately 960 000 on antiretroviral treatment.
Professor of epidemiology and public at Kamuzu University of Health Sciences Adamson Muula said the figures are encouraging and give hope that the country might meet its target of ending HIV.
Muula said the number would increase as more awareness is raised, calling on all stakeholders to join hands in the fight against HIV.
“At the launch, there was more hype, and that should have continued. Prep is another line of defence. Prep should go along with other forms of protection, such as condoms,” said Muula.
In a separate interview, another public health expert, Jane Malewa, said research has shown that Prep is safe, further appealing to Malawians to embrace it.
“Injectable Prep is safe. It does reduce the risk of acquiring HIV, but also having unprotected sex is the right of an individual with mental capacity and autonomy,” she said. “We, as medical professionals, give advice about safety, but we cannot dictate an individual’s choice.”
Health and Rights Programme executive director Maziko Matemba said the rollout of Prep is reshaping how HIV prevention is discussed, shifting the emphasis from adherence challenges to personal choice.
Matemba said injectable Prep is reducing the burden of having to make frequent visits to health facilities, but warned that it should not be considered a gateway to unprotected sex.
He said in the wake of drug-resistant sexually transmitted infections, Prep should be used alongside condoms, calling on health authorities to analyse related data.
“Move the administration of injections out of heavily congested central hospitals and into community drop-in centres, youth clubs and local pharmacies to lower the barrier to entry,” he said.
“If a specific district shows a spike in drug-resistant gonorrhoea, public health campaigns can immediately pivot to targeted condom distribution blitzes in that exact locality.”
Malawi currently offers daily oral Prep and has recently added cabotegravir, another injectable Prep administered every two months, although it is currently limited to Lilongwe and Blantyre.
The six-month injectable Prep is anticipated to widen the country’s HIV prevention efforts as Malawi works towards ending HIV as a public health threat by 2030.
