Zimbabwe approves injectable PrEP

Zimbabwe has made history after becoming the first African country to approve injectable PrEP.

What is this news about?

An injectable PrEP called cabotegravir (CAB-LA). This is an injection that people can have to protect themselves from getting HIV. It is called ‘long-acting’ because people only have to get the injection every two months (after getting the first two injections one month apart), instead of taking a PrEP pill every day.

The US approved CAB-LA as injectable PrEP in December 2021. In July 2022, the World Health Organization officially recommended injectable PrEP. Australia then approved its use in August 2022.

In October 2022, Zimbabwe became the first non-high-income country to approve injectable PrEP for people at high risk of HIV. This includes adolescent girls and young women, sex workers, transgender people, gay and bisexual men and other men who have sex with men.

Why is it important?

A number of African and Asian countries provide PrEP in pill form. In Africa, uptake is highest in Kenya and South Africa. But demand has not been as high as was hoped, particularly among adolescent girls and young women.

The challenge of taking a PrEP pill every day stops some people from using PrEP, even if they are at high risk of getting HIV.

Another issue is stigma. Despite PrEP being a way for people to protect their health, it is seen by some as a sign of being sexually promiscuous and therefore bad. Another issue is that some people mistake PrEP pills for HIV treatment. This can make people reluctant to use PrEP, as they are worried they will be seen as having HIV.

Making PrEP available as an injection could make it more appealing. It is more discreet to use and people would only have to go to a clinic every two months to get it.

What does this mean for HIV services?

PrEP could soon become available in a number of low- and middle-income countries. Botswana, Kenya, Malawi, South Africa and Uganda have already made licensing applications.

But to roll out injectable PrEP successfully, communities most at risk of HIV must be involved in designing, delivering and evaluating CAB-LA programmes. Unless community-based and community-led organisations are involved, people at high risk of HIV may be reluctant to use injectable PrEP due to the stigma, discrimination and criminalisation these communities face.

Injectables are a growing area of the HIV response. As well as injectable PrEP, a number of countries are working to approve long acting injectable HIV treatment.