By Ben Musanje
Uganda’s introduction of a twice-yearly HIV prevention injection has been hailed as a potential game-changer in the fight against new infections, but leading scientists and advocates warn that its impact will depend less on science and more on how well it is delivered to the people who need it most.
At a Science Café organized by the Health Journalists Network in Uganda (HEJNU) in Kamwokya, researchers, policymakers, and community advocates unpacked the promise—and the pressure—surrounding Lenacapavir, a long-acting injectable pre-exposure prophylaxis (PrEP) now being rolled out in the country.
In February 2026, Uganda received its first consignment of 19,200 doses, supported by the Global Fund and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). The rollout places Uganda among the first high-burden countries to introduce the twice-yearly HIV prevention drug, which clinical trials show is more than 99% effective when properly used.
But experts emphasized a crucial distinction early in the discussion: this is not a vaccine.
As explained by Dr. Flavia Matovu Kiweewa, a senior scientist at the Makerere University-Johns Hopkins University research collaboration, Lenacapavir works only while present in the body.
“A vaccine trains the body to produce immunity,” she said. “This drug itself must be in your system to protect you. If it’s not there at protective levels, you are not protected.”
Demand rising—but access remains uneven
While enthusiasm for the injection is high, uptake patterns are already raising concern among researchers. Early observations suggest more men are accessing the drug than women, a gap experts attribute not to biological risk but to information and access disparities.
Dr. Kiweewa noted that men tend to access health information earlier due to greater economic and social empowerment, while many women—especially in rural and low-income settings—remain less informed or unable to reach facilities.
“The girl in the village may not even have transport to come to a health facility,” she said, pointing to structural barriers that continue to shape HIV prevention outcomes.
She warned that without targeted communication, the intervention risks missing those most vulnerable.
“We must ensure Lenacapavir reaches the people who need it most. That is how we create impact.”
Who is most at risk?
Public health experts at the event stressed that HIV risk is not evenly distributed. Dr. Micah Kulubya, Director of Programs at the Uganda Key Populations Consortium (UKPC), emphasized that certain groups face significantly higher exposure.
These include female sex workers, men who have sex with men, people who inject drugs, long-distance truck drivers, and fishing communities. Young women and girls particularly in transactional relationships were also highlighted as a priority group.
“Every time you have sex with someone whose HIV status you don’t know, your risk changes,” Dr. Kulubya said bluntly. “We are still at very high risk, despite knowing more than ever before.”
He warned that prevention efforts must focus on “priority populations” where transmission is most concentrated, rather than being diluted across low-risk groups.
How the injection works—and why timing matters
Dr. Kiweewa also explained the scientific complexity behind the drug’s use. Although the injection provides protection for six months, it requires careful dosing at the start.
Patients must take two oral tablets on the day of injection and another two the following day to rapidly achieve protective drug levels. Without this “loading dose,” it can take up to a month for the drug to reach effective concentrations.
“If someone comes in today because they are at risk, they cannot wait a month,” she said. “We accelerate protection using tablets.”
She added that adherence is critical. Missing follow-up doses could leave individuals with insufficient drug levels, creating a dangerous window where infection could occur.
Breakthrough infections and real-world challenges
While clinical trials showed over 99% effectiveness, experts acknowledged rare “breakthrough infections” in real-world settings. In isolated cases, infections occurred due to late follow-up visits or low drug levels in the body.
Dr. Kiweewa stressed that such cases do not mean the drug is ineffective.
“It is not failure of the drug—it is failure of timing or adherence,” she said.
Supply constraints and rollout strategy
Uganda’s Ministry of Health is currently distributing the injection through selected health facilities nationwide, with plans to scale up to about 300 sites. Facilities were chosen to ensure geographic coverage across all regions, rather than only high-risk zones.
However, limited supply means prioritization is necessary. Pregnant and breastfeeding women are being prioritized in some districts due to ongoing mother-to-child transmission risks.
At Mityana Hospital, for example, health workers reported allocating the majority of doses to pregnant women.
“If we prevent infection in the mother, we protect the child,” Dr Kiweewa explained.
Community concerns and the demand dilemma
Advocates say demand has surged following widespread awareness campaigns on radio, television, and social media. But this surge has created its own problem: supply pressure and inequitable access.
Moses Nsubuga, commonly known as Supercharger and a HIV advocate, said the excitement around the drug has led to overwhelming demand, sometimes from people at relatively low risk.
“The reality is everyone feels they are at risk now,” he said. “But we must prioritize those most vulnerable or we dilute impact.”
He emphasized that donor-supported distribution systems are still stabilizing, warning that stock-outs could undermine trust if not managed carefully.
A fragile but promising step forward
Uganda currently has an estimated 1.5 million people living with HIV, with around 70 new infections occurring weekly, according to the Uganda AIDS Commission. Health experts say long-acting prevention tools like Lenacapavir could significantly reduce these numbers—if adherence systems and delivery infrastructure keep pace.
Yet even as optimism grows, a central question remains unresolved: how to ensure people return for their next dose on time.
Dr Kulubya summed up the challenge starkly: “We know who is at risk. We know what works. The real question now is whether we can deliver it consistently to the people who need it most.”
For Uganda’s HIV response, Lenacapavir may be one of the most powerful tools ever introduced—but its success will depend not only on science, but on systems, equity, and sustained community engagement.
