A shortage of a long-acting HIV prevention injection is limiting access to a promising new tool in Uganda, particularly in high-prevalence communities where health workers say funding cuts and gaps in awareness are undermining prevention efforts.
The drug, lenacapavir, is administered twice a year and has raised hopes of reducing new HIV infections because it eliminates the need for daily preventive pills. However, limited supplies mean many people in Mbarara, western Uganda, are unable to access it.
Immaculate Nyamwija, founder of Action for Improved Health and Wealth, an organisation providing HIV support services to women facing discrimination, said the shortage was compounding existing challenges in the city, where HIV prevalence is estimated at 10 per cent, twice the national average.
She said funding cuts had forced the suspension of community outreach programmes that previously brought HIV testing, counselling and pre-exposure prophylaxis (PrEP) closer to vulnerable populations.
“We used to have outreaches whereby these outreaches were bringing services nearer to the communities,” Nyamwija said, explaining that community-based organisations and peer workers had collaborated with health facilities to provide testing and prevention services.
She added that reduced outreach activities and reluctance among some people to seek medical attention early had made prevention more difficult.
“Many people have poor health-seeking behaviours. If I am not sick, if I am not feeling headache, I cannot go to the facility, but HIV will just be in there as you are waiting to get the headache and the diarrhoea,” she said.
Uganda has approximately 1.5 million people living with HIV, while health authorities have identified Mbarara as a priority location for expanded prevention services because of its comparatively high infection rate.
The city’s HIV burden has been linked partly to sexual activity in urban hotspots, including commercial sex areas, where health workers say condom use remains inconsistent.
Tarsisio Biryeija, a nursing officer and counsellor at Mbarara Health Centre IV, said inadequate awareness of HIV risks continued to expose people to infection.
“People go and enjoy their money, we have gotten these institutions that are nearby us and when it comes to weekend, people go and enjoy without knowing that HIV is around the corner,” he said.
Lenacapavir was approved in the United States in 2025 as a twice-yearly HIV prevention option following clinical studies that demonstrated strong protection against infection among people at risk.
Uganda was among the countries selected for assistance in accessing the drug, but the limited number of doses available has necessitated distribution across several locations, including Mbarara and Lira in the north.
As a result, some people seeking long-acting protection are instead offered cabotegravir, another injectable PrEP option administered every two months.
Dorcus Twinabaitu, a clinician who identified herself as Mbarara’s HIV/AIDS focal person, described lenacapavir as a major development in HIV prevention.
She said the injection could offer a more convenient option for people who struggle to maintain regular prevention routines.
The six-month dosing schedule is particularly attractive to sex workers in Mbarara’s Kijungu district, where Nyamwija said demand for the drug was high.
“They want Len because you see it is long lasting. Six months at least can give someone a breathing space,” she said, adding that the injection could be easier to manage than carrying and taking pills every day.
Lisa Mutoni, a Rwandan sex worker living in Uganda, said she would prefer lenacapavir but had repeatedly been unable to obtain it.
Mutoni, who requested that her face not be shown because her family and friends do not know about her work, said she had taken daily preventive pills for a year before switching to cabotegravir.
“I go there, to check if it is there, they tell me that it is finished,” she said.
She explained that the longer-lasting injection would be particularly useful for sex workers who relocate for several months, potentially making it easier to maintain protection against HIV.
Mutoni also described difficulties negotiating condom use with some clients, including men who attempt to remove or damage condoms during sex. She receives counselling and other support, including condoms, through Nyamwija’s organisation.
The access challenge comes as international partners work to expand the availability of lenacapavir in countries with significant HIV burdens.
The United States and the Global Fund aim to procure enough of the drug to protect up to three million people by the end of 2028.
The 2026 target is to reach 600,000 people in 24 countries. By mid-September, 430,000 doses, comprising 327,000 initiation doses and 103,000 continuation doses, had been delivered, while national programmes reported that more than 118,000 people had received lenacapavir, according to the Global Fund.
Gilead Sciences, the drug’s manufacturer, said it shared the urgency of expanding access.
The company said it would provide lenacapavir at no profit through partnerships with the Global Fund and the United States President’s Emergency Plan for AIDS Relief (PEPFAR) while licensed generic manufacturers increase production.
Initial generic supplies were expected in late 2026, with wider availability anticipated in 2027, according to the company.
For health workers and vulnerable communities in Mbarara, however, the immediate challenge remains ensuring that the promising prevention option reaches those who need it, alongside sustained funding for testing, counselling, condoms and other essential HIV services.
